Covid-19 #17: Covid Is For Ever

[Ran]

@Tywin et al.

Sweden has successfully kept down the curve, but the start was bad as the structure of nursing home facilities and a lack of PPE early on led to a high death toll among the elderly there. Since that situation improved, though, deaths have been falling precipitously.

That said, Sweden never went for the "herd immunity" option the way that it seems to be spoken of. The entire time, the goal in Sweden was to find effective mitigation strategies that were sustainable in the long term. We have basically made no changes to the recommendations the authorities made since late March or early April. This seems to have succeeded, so far. Sweden got caught up in the "herd immunity" debate for a couple of reasons: because its mitigation strategies seemed facially similar to what the UK had proposed before it reversed itself (which was, explicitly, the same plan as what the US now seems to be talking about) people assumed it was for the same reason, and because FHM (the health authority) did rightfully note that as a contagion spreads through a society, the rate of spread will naturally decline, which when combined with mitigation efforts could lead to the R value falling below 1, thus leading to its eventual decline.

Again, this has worked for us so far. But Sweden has a very different healthcare system than the US, and Swedes seem to have much higher trust in authorities than the US does.

ETA: A recent paper gets into don't of the factors that contributed to the bad early start of the pandemic in Sweden vs its neighbors.

[Zorral]

Prepare! Prepare! Prepare!

The virus is both political and medical subject as well as economic and social:

"Experts project autumn surge in coronavirus cases, with a peak after Election Day"

Caused by schools, bars, restaurants and etc. plus this long Labor Day holiday weekend, during which people travel, gather and party.  Particularly because, ironically -- Labor Day, the reason for the holiday --  so many are without jobs?  And because, of course, people won't wear masks and won't distance.

https://www.washingtonpost.com/health/coronavirus-fall-projections-second-wave/2020/09/04/6edb3392-ed61-11ea-99a1-71343d03bc29_story.html?

Quote

[....]
A model produced by the University of Washington’s Institute for Health Metrics and Evaluation and published Friday forecasts a “most likely” daily death toll of 1,907 on Election Day, roughly double the current toll. Under the IHME forecast, the numbers would continue to rise until early December, peaking at more than 2,800 deaths daily.
[....]
By year’s end, 410,000 people in the United States will have died under the model’s most-likely scenario. That’s more than double current fatalities. The model also produced best-case and worst-case scenarios — ranging from 288,000 to 620,000 deaths by Jan. 1 — depending on the degree to which people wear masks, adhere to social distancing and take other precautions.
[....]
Klein, the Hopkins epidemiologist, warns the fall wave is likely to be more intense than the peak in the spring. Maryland had 2,000 covid-19 patients in hospitals at its peak in April, he said, and his midrange scenario envisions twice that many hospitalized patients at the next peak.
[....]

 

[Clueless Northman]

Contrary to what's argued by idiot deniers, Sweden still took some strict measures, and contrary to most of Europe, they're still active. Across most of Europe, the measures were far wider and harsher, they worked well to crush the curve, but they couldn't be kept for months and months, and since the idiots in charge of the governments thought everything was well, they went for a far wider opening of society than Sweden allowed (as Ran pointed out). The end result is that Sweden has few cases nowadays, but 2nd wave is rolling across most of the continent. Granted, with few casualties most of the time, because it's been mostly the young reckless ones who didn't give a crap about the virus and got infected, but eventually the virus spreads from 18-30 to 40+ and eventually to 70+.

One can argue Sweden screwed up in the first weeks, possibly was too lenient in the first couple of months, but most of the other countries screwed up by reopening too much, too often without putting into place serious counter-measures like mandatory masks and controlled quarantines.

Of course, one can expect some surge in Sweden as well in the next couple of months. How big of a surge is unknown - hopefully, a limited one. But if Sweden sticks to its April measures without going further, I wouldn't be surprised if the numbers and casualties come close to April's as well.

[Filippa Eilhart]

what are the measures in Sweden that are not in force in most of Europe? Because most of Europe still has masks, social distancing, ban on gatherings to a varying degree, varying measures regarding re-opening of schools (temperature checks, ban on parents entering premises, ubiquitous testing). So it’s interesting to see what Sweden is doing that’s different than all that.

[The Anti-Targ]

Interesting to now see the companies developing vaccines saying they will make a collective pledge not to apply for any vaccine approval until they are sure it is safe and effective. It's a sad day when multinational corporations appear to have a greater social conscience than the most powerful governments in the world.

[Mr. Chatywin et al.]

1 hour ago, The Anti-Targ said:

Interesting to now see the companies developing vaccines saying they will make a collective pledge not to apply for any vaccine approval until they are sure it is safe and effective. It's a sad day when multinational corporations appear to have a greater social conscience than the most powerful governments in the world.

Who do you think runs those governments? 

[Fragile Bird]

Both Pfizer and Modena are slowing down enrollment in their Phase 3 trials because they don’t have enough diversity in candidates. They are stepping up recruitment of PoC, not because the vaccine is expected to have different effectiveness on different races, but because it undermines confidence in the vaccine. One of the problems is that a candidate has to spend a couple of hours in the process on getting the vaccine and there are fewer PoC who have the ability to spend that time at a test center.

[BigFatCoward]

Huge and easily predictable surge in new cases in the uk. Far too many selfish arseholes. 

[rotting sea cow]

4 hours ago, Fragile Bird said:

Both Pfizer and Modena are slowing down enrollment in their Phase 3 trials because they don’t have enough diversity in candidates. They are stepping up recruitment of PoC, not because the vaccine is expected to have different effectiveness on different races, but because it undermines confidence in the vaccine. One of the problems is that a candidate has to spend a couple of hours in the process on getting the vaccine and there are fewer PoC who have the ability to spend that time at a test center.

The vaccine safety and effectivity definitively needs to be investigated in other ethnic groups. For example, I was reading that around 70% of the children with that multi-inflammatory syndrome are of Latino descend. So, there is an angle to take into account.

[Durckad]

8 hours ago, BigFatCoward said:

Huge and easily predictable surge in new cases in the uk. Far too many selfish arseholes. 

Come across the pond sometime and be amazed.

We'll put you to shame.

[BigFatCoward]

7 hours ago, Durckad said:

Come across the pond sometime and be amazed.

We'll put you to shame.

Obviously. We are dumb, but not 'that' dumb. 

[Zorral]

Covid-19 doesn't have to be forever at all, say the FDA people:

Which bookends very well with this story, which includes a university attempting to literally run-off campus housed students out of town (to keep numbers down, like Disney World isn't reporting to anyone, including the work force, how many of its work force are infected and sick with the virus):

https://www.thedailybeast.com/white-house-said-to-keep-sick-kids-on-campus-emails-reveal-the-messy-reality?

 

[Clueless Northman]

Good Twitter thread, indeed. And I have the same viewpoint about the Covid. In a way, despite the 1-2% deaths, despite the long-terme health issues, we're still quite lucky that it's not a bigger killer. This is definitely a test run, and that's what drives me mad with inept politicians and covidiots: you shouldn't act as if it was just a common cold, but you have to act as if it's the Black Plague Redux, because when the killer bug comes (and for decades, I've expected it to show up sooner or later during the 21st century), we won't have the luxury of failure.

I just disagreee with him when he implies that the path of infection of Covid is good news. Airborne spread with a/pre-symptomatic contagion is pretty much the worst we can conceive, at least for advanced societies (compared to HIV, cholera or plague for instance) - and I've always dreaded to see a bug with a high lethality and infectiousness being transmitted the way the flu is. Thankfully, coronavirus is milder than Ebola, rabies or smallpox. And hopefully, the incoming killer bug won't spread in such a way.

[Zorral]

14 minutes ago, Clueless Northman said:

I've always dreaded to see a bug with a high lethality and infectiousness being transmitted the way the flu is.

Indeed!  The second kind of the black death was pneumonic (which I know you know!) and was spread like that.

[Altherion]

On 9/6/2020 at 7:33 AM, The Anti-Targ said:

Interesting to now see the companies developing vaccines saying they will make a collective pledge not to apply for any vaccine approval until they are sure it is safe and effective. It's a sad day when multinational corporations appear to have a greater social conscience than the most powerful governments in the world.

They don't have a social conscience, they just have more to lose and are extremely cautious. Here's an article about the vaccines and why they're taking so long:

Quote

 

The intention is to enroll at least 30,000 volunteers per trial. Half will get an injection containing the vaccine candidate, and half will get an injection of an inert placebo. Neither the person giving the injection nor the person getting the shot knows which is being administered. This is so neither party has a predetermined idea of what the outcome might be. Studies like this are called double-blind, placebo-controlled trials, and they are generally considered the best design to get definitive answers.

Researchers chose enrolling 30,000 people as a target for pragmatic reasons. To test a vaccine, it needs to be given to enough people who will subsequently be exposed to the virus. But researchers didn't know for sure where the virus would be circulating when they were ready to test their vaccine.
...
These are what's called event-driven trials. "An event-driven trial means that the primary analysis of the trial happens when you get enough events," Janes says. "We don't know how long that's going to take."

By "events," Janes means laboratory-confirmed cases of COVID-19 disease. Janes says the trial now underway aims to get at least 150 events among the trial participants.

 

In other words, the reason they need so many people and are taking an insanely long time is that they dare not expose anyone (vaccinated or not) to this virus. It has nothing to do with the long term consequences or anything of this sort, they're just waiting for a tiny fraction of their test cases to become infected naturally. This is a perfect illustration of why Asimov's First Law of Robotics says that a robot may neither harm a human through its actions nor allow a human to come to harm through inaction. Here, they've gone to considerable lengths to do no harm to the test subjects through their actions, but through their inaction, thousands of people die every day.

[The Anti-Targ]

23 minutes ago, Altherion said:

They don't have a social conscience, they just have more to lose and are extremely cautious. Here's an article about the vaccines and why they're taking so long:

In other words, the reason they need so many people and are taking an insanely long time is that they dare not expose anyone (vaccinated or not) to this virus. It has nothing to do with the long term consequences or anything of this sort, they're just waiting for a tiny fraction of their test cases to become infected naturally. This is a perfect illustration of why Asimov's First Law of Robotics says that a robot may neither harm a human through its actions nor allow a human to come to harm through inaction. Here, they've gone to considerable lengths to do no harm to the test subjects through their actions, but through their inaction, thousands of people die every day.

Hence I said "appear to have a greater social conscience". Sometimes self-interest can appear to be a social conscience but it is not.

 

[Old Zog]

1 hour ago, Altherion said:

[...] Here, they've gone to considerable lengths to do no harm to the test subjects through their actions, but through their inaction, thousands of people die every day.

What do you suggest they should do instead?

[Mudguard]

2 hours ago, Altherion said:

They don't have a social conscience, they just have more to lose and are extremely cautious. Here's an article about the vaccines and why they're taking so long:

In other words, the reason they need so many people and are taking an insanely long time is that they dare not expose anyone (vaccinated or not) to this virus. It has nothing to do with the long term consequences or anything of this sort, they're just waiting for a tiny fraction of their test cases to become infected naturally. This is a perfect illustration of why Asimov's First Law of Robotics says that a robot may neither harm a human through its actions nor allow a human to come to harm through inaction. Here, they've gone to considerable lengths to do no harm to the test subjects through their actions, but through their inaction, thousands of people die every day.

It sounds like you are suggesting that they should be deliberately infecting clinical trial subjects with SARS-CoV-2, when we don't have any really effective treatments yet.  That's crazy, and was never seriously considered anywhere in the world, as far as I can tell.  Such a clinical trial where subjects are challenged with a potentially deadly virus with no cure would violate numerous ethical rules and guidelines, and I can't imagine such a trial actually getting approved.  Old people and other types of susceptible people would need to be tested too to see if the vaccine protects these types of people.  You are OK with deliberately infecting all these people?  Maybe the vaccine doesn't work.  A large portion are also getting a placebo.  Bunch of people would die during such a trial.  

I don't have a problem with how the clinical trials have been set up.  They are being completed at record speeds, as it is.  They've compressed down the timeline from years, to months.  

[The Anti-Targ]

It seems pretty trivial in the grand scheme of the pandemic, but this week we had our first death in someone under the age of 60. It was almost someone in their 40s (the person was 50). The age distribution of cases here is, I guess, normal in that the vast majority of confirmed cases is in the under 60s. Only 7% of confirmed cases are in the 60+ age group, and until this week 100% of deaths.

55 minutes ago, Old Zog said:

What do you suggest they should do instead?

My interpretation of the attempted point is that to speed things along with vaccines it would be scientifically robust to actively infect people as part of the process. The quality of data you can get from actively infecting people is as good, arguably better, than the quality of data you can get by just sending people out into the world and relying on probability to get you the data you need. But you are going to deliberately make some people in the placebo group sick and potentially die, and some people in the vaccine group also, since it is not expected that the vaccine will be 100% effective. So it would be ethically, and probably legally proscribed to do this.

In terms of Asimov's laws of robotics it becomes a paradox for the robot, because either decision leads to harm, which would require a robot to then try to make a moral judgement. The robot would probably make a simple calculation of which option will most likely cause least harm and then do that. The course of action likely to do least harm is to infect the volunteers, esp since you could have a much smaller group of volunteers. This is the opposite of what our ethical and legal system allows. 

Individually, without a legal or professional ethics consideration it's the people tied to train tracks dilemma. My guess is under Asimov's law the robot would pull the lever. A lot of people would not pull the lever because they believe that doing nothing = not choosing. 

I forget my moral philosophy lessons from The Good Place, but I assume moral philosophy would suggest the correct course of action is the one the pharma companies are not allowed to take. Of course, how many people would sign up for a trial where you have a 50% chance of getting infected with a deadly virus with no vaccine protection? I might consider it, but I would want to get paid a fair bit up front, and have a lifetime compensation package for my family if I die, or if I suffer serious chronic sequelae from getting the infection.

[Clueless Northman]

Infecting volunteers could be considered if we had a clearer view of the viral load required to infect, and to infect nastily. If we knew better, it might be borderline possible to give just a minor load and compare how well the vaccinated ones react - at least for younger volunteers. Not sure if I would argue for such a strategy though. For older people, I suppose it's actually simpler; no need for volunteers, you just pick nursing homes in badly hit areas and vaccinate half of them - we alas know how exposed they are.

That said, if pharma firms manage to get a vaccine that can be widely used before winter is over, even though they will be lauded for the effort and it would be an amazing achievement, they might face some questioning later on - as in, why does it so long to get vaccines against so many other diseases? I get that they probably rerouted a lot of their global resources on covid, and that it might be a way simpler vaccine to create than against other bugs, but they should be prepared to do some serious explanation/teaching so that people understand a bit - and in some cases, they might be pushed to actually more serious work, instead of working on minor improvements of some of their cash-cows so that they can license them for a few more decades.