Covid-19 #17: Covid Is For Ever

[Fragile Bird]

Well, a fan who was at the Kansas City Chiefs home opener tested positive for Covid-19 the day after the game and ten fans who sat near him have been ordered into quarantine. Fans could only sit with people they knew and KC kept track of all attendees so their fan-tracking system worked to identify people at risk.

[Kalbear]

Well, they say it worked. Given that there's tons of egress and ingress in the same places, there are bathrooms being used by lots of different people without sanitation breaks, etc - I suspect that this is really wishful thinking, and in about a week or two you're going to see major spikes in every single metropolitan area that allowed fans to watch. 

Lots of spikes for college too.

[Fragile Bird]

1 hour ago, Kalibear said:

Well, they say it worked. Given that there's tons of egress and ingress in the same places, there are bathrooms being used by lots of different people without sanitation breaks, etc - I suspect that this is really wishful thinking, and in about a week or two you're going to see major spikes in every single metropolitan area that allowed fans to watch. 

Lots of spikes for college too.

I agree.

[Zorral]

3 minutes ago, Fragile Bird said:

I agree.

It was foretold, fore-ordained, predicted.  It was written.

But it is our gawdgiven right to be idiotic yellers in person watching men hurt each other in person for our entertainment as the idiots we are.

[The Anti-Targ]

Ugh, I hate to bring gloaty sounding good news into the discussion because I feel for people's pain at the situation in their own countries, and I wish you all well. We've had 4 days straight with no new community cases, which hopefully is a good sign that the cluster and it's expanded sub- and mini-cluster in Auckland is well under control and even spread within the cluster has completely tailed off. So we may be back to a state of elimination by election day. Quite fortunate for the govt's re-election chances.

I think it is overly pessimistic for people to think that the vaccines currently in phase 3 trials will only meet the minimum standard for approval. The phase 2 trials showed strong neutralizing antibody response in a vast majority of recipients, so one can expect the vaccine to be significantly more than 50% effective in the gen pop, perhaps with the exceptions of immune compromised people. My main concern is duration of effective immunity, with confirmed reports of small numbers of people already getting reinfected (though with mild to asymptomatic response) the vaccines may prove to only be good for up to 1 year of immunity. Somewhat perversely, we need to see more cases of re-infection to get some sense of whether everyone who gets a second infection has a mild to asymptomatic response or if moderate to severe disease can occur in re-infected people. I was a bit gung-ho on the vaccines a few weeks ago, I'm back to being more moderately optimistic about them.

[rotting sea cow]

13 hours ago, The Anti-Targ said:

Ugh, I hate to bring gloaty sounding good news into the discussion because I feel for people's pain at the situation in their own countries, and I wish you all well. We've had 4 days straight with no new community cases, which hopefully is a good sign that the cluster and it's expanded sub- and mini-cluster in Auckland is well under control and even spread within the cluster has completely tailed off. So we may be back to a state of elimination by election day. Quite fortunate for the govt's re-election chances.

Oh man, you should be silent. Corona is listening it seems

 

Quote

I think it is overly pessimistic for people to think that the vaccines currently in phase 3 trials will only meet the minimum standard for approval. The phase 2 trials showed strong neutralizing antibody response in a vast majority of recipients, so one can expect the vaccine to be significantly more than 50% effective in the gen pop, perhaps with the exceptions of immune compromised people. My main concern is duration of effective immunity, with confirmed reports of small numbers of people already getting reinfected (though with mild to asymptomatic response) the vaccines may prove to only be good for up to 1 year of immunity. Somewhat perversely, we need to see more cases of re-infection to get some sense of whether everyone who gets a second infection has a mild to asymptomatic response or if moderate to severe disease can occur in re-infected people. I was a bit gung-ho on the vaccines a few weeks ago, I'm back to being more moderately optimistic about them.

Both Pfizer and Moderna have opened their protocols for all the World to see in a transparency effort

https://www.modernatx.com/sites/default/files/mRNA-1273-P301-Protocol.pdf

https://pfe-pfizercom-d8-prod.s3.amazonaws.com/2020-09/C4591001_Clinical_Protocol.pdf

There are rumours that at least 8 participants of the AstraZeneca trials have experienced stronger than usual adverse effects although no need of extra hospitalization.

It might well be that many vaccines will not fully protect of the infection but they will prevent the serious disease (pneumonia and associated complications), which of course is a public health goal. Will this people be infectious? Which kind of symptoms will they experience? Yes, anyone with suspected reinfection needs to be looked carefully. This also put questions in what is a SARS-CoV-2 positive case and what COVID-19 case. Not necessarily the same thing.

 

 

 

 

[HoodedCrow]

Back to modest optimism. I wrote a scientific paper on Parkinson’s disease. Strangely, people were more likely to have Parkinson’s disease after having had the Spanish flu, except it developed decades later. Long term effects are just that.

[The Anti-Targ]

12 hours ago, rotting sea cow said:

Oh man, you should be silent. Corona is listening it seems

 

Both Pfizer and Moderna have opened their protocols for all the World to see in a transparency effort

https://www.modernatx.com/sites/default/files/mRNA-1273-P301-Protocol.pdf

https://pfe-pfizercom-d8-prod.s3.amazonaws.com/2020-09/C4591001_Clinical_Protocol.pdf

There are rumours that at least 8 participants of the AstraZeneca trials have experienced stronger than usual adverse effects although no need of extra hospitalization.

It might well be that many vaccines will not fully protect of the infection but they will prevent the serious disease (pneumonia and associated complications), which of course is a public health goal. Will this people be infectious? Which kind of symptoms will they experience? Yes, anyone with suspected reinfection needs to be looked carefully. This also put questions in what is a SARS-CoV-2 positive case and what COVID-19 case. Not necessarily the same thing.

 

 

 

 

Any asymptomatic person who is infected is a SARS-COV-2 case, if you have any symptoms at all with the infection then you have COVID-19. Re-infection doesn't really change those definitions. I don't know if the official case definition for COVID-19 would include an asymptomatic person who is infectious or not, that's really the only shade of grey between the two, but again re-infection or first infection doesn't make a difference.

Good on Moderna and Pfizer for being transparent. I think with the whole vaccine thing starting to become political it is a good move to be a lot more open than they would usually be.

Re this new case with an unknown source, from today's update.

Quote

"The case reported yesterday was tested after developing symptoms on September 16, and returned a positive result. He and his household contacts self-isolated when he developed symptoms. They were all moved into the Auckland quarantine facility on September 18, when the first case returned a positive result," the Ministry of Health says.

"All identified close contacts have been isolated and tested. 

"The source of the case’s infection is still under investigation, but genome sequencing is consistent with two confirmed cases from the same flight from India to New Zealand that landed on August 27."

...another update

The ministry says it is possible that this case was infected during that flight from India and has had an extremely long incubation period – there is evidence that in rare instances the incubation period can be up to 24 days.

 

"This person developed symptoms 21 days after he arrived in New Zealand.  If this is the case, it sits well outside the standard incubation period of the virus."

Could be this person is one of those 2% of people with an incubation longer than 14 days. That sort of border leakage is likely with the number of people coming into the country. I just hope they get on top of it quickly with contact tracing and isolation.

 

[Makk]

22 hours ago, The Anti-Targ said:

Could be this person is one of those 2% of people with an incubation longer than 14 days. That sort of border leakage is likely with the number of people coming into the country. I just hope they get on top of it quickly with contact tracing and isolation.

It is the same genome sequence as two other people (strangers) who had it from the same flight in and same managed isolation facility, so he would have caught it from one of those places. The managed isolation facility seems much more likely given the time frame (21 days) which far less than 2% of cases.  

[The Anti-Targ]

They are very careful with contact at managed isolation facilities. A friend of ours just came out a couple of days ago and it's compulsory masks as soon as you walk out of your room and social distancing anywhere there are other people. Picking it up at a MI facility is more probable, but being an outlier incubator is also probable. If 2% of people are outliers with >14 day incubation then with the thousands of people who've been through MI since we opened up to people returning from overseas there was bound to be someone slip through and bring the infection into the community. Was it this person? Maybe not. But if something is probable, then it is inevitable given enough time and flow of people.

I was worried we'd get one of these cases, so I was a bit disappointed that there was no semi-intense follow up with people between day 14 when they are released and day 21, when the probability of being an outlier drops off to a very small %. I think they should maybe have a 3rd mandatory test at day 18, and for people to self-isolate at home until day 21.

Despite this new potential cluster, Auckland is moving from level 2.5 to level 2 on Wednesday, for 2 weeks, reasonable I think. The rest of us are at level 1. I just hope level 2-ness moves with any Aucklanders who go elsewhere in the country (mask, social distancing). I'm going to Auckland on 7 Oct, which is right when it will either be moving to level 1 or staying at level 2 depending on what happens. My son is graduating from university, but if level 2 stays beyond 2 weeks the ceremony will be postponed, it was already postponed once. They announced 8 Oct as the new date back when we were all feeling smug at level 1. My other son's graduation in Wellington was shifted to Sept, so that has already been postponed to December, but he can't go then because he will be on a course.

[Clueless Northman]

Just wondering: Don't they test people in the quarantine facilities? If you test everyone after 5 days and another time a couple of days before quarantine ends, odds are that you'd caught pretty much all cases - the virus will show up days before symptoms appear.

[Makk]

6 minutes ago, Clueless Northman said:

Just wondering: Don't they test people in the quarantine facilities? If you test everyone after 5 days and another time a couple of days before quarantine ends, odds are that you'd caught pretty much all cases - the virus will show up days before symptoms appear.

They test them on days 3 and 12. One thing that is worrying however is that if someone returns a positive test, they cannot be tested again before they leave. It is just up to them to say when they are feeling better.

I also don't have quite the same faith in how careful they are at these facilities. It is completely anecdotal, and it may have improved in recent times, but we have heard stories and seen photos with mingling between people who are quarantining there and staff and/or even members of the public. Typically happens during exercise or check in. Or in rare cases when they break out and go awol.

[rotting sea cow]

On 9/20/2020 at 4:12 AM, The Anti-Targ said:

Any asymptomatic person who is infected is a SARS-COV-2 case, if you have any symptoms at all with the infection then you have COVID-19. Re-infection doesn't really change those definitions. I don't know if the official case definition for COVID-19 would include an asymptomatic person who is infectious or not, that's really the only shade of grey between the two, but again re-infection or first infection doesn't make a difference.

These definitions matter a lot for the upcoming vaccines. From a clinic only  perspective, one would like a vaccine that reduces hospitalization and deaths by ~2 order of magnitude (maybe even 10 time less is sufficient). There is no reason to think the vaccines cannot do that.

However, it's completely unclear whether they will able to prevent infections, mild symptoms or people becoming infectious. And this matters a lot for policy perspective. What if a large fraction of people refuses to be vaccinated? What if a good fraction of people cannot be vaccinated due to safety concerns? What if falling ill regardless of the vaccine defeats the appreciation for the vaccine? I had that feeling myself back in February when I fell sick like a dog despite getting the flu shot for first time in my life.

Finally, it seems that the vaccines themselves produce a range of mild reactions (fever, headaches, etc), which means that people may fall (mildly )ill from the vaccines and from the illness.

Yes, looking at the reinfections (which has been suspected for a while already) will help to answer that.

 

[rotting sea cow]

On the same topic

Quote

These observations suggest that we cannot assume COVID-19 vaccines, even if shown to be effective in reducing severity of disease, will reduce virus transmission to a comparable degree. The notion that COVID-19-vaccine-induced population immunity will allow a return to pre-COVID-19 “normalcy” might be based on illusory assumptions.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31976-0/fulltext

Maybe, it's wishful thinking, but I think the author paint a too bleak scenario.

[DireWolfSpirit]

Scientist ALARMED Trump will use emergency powers to declare a late October vaccine ready for the public.

https://www.nbcnews.com/health/health-news/signs-october-vaccine-surprise-alarm-scientists-n1240617

I'll say it again, there's no way I can trust anything, let alone a vaccine, that is rolled out from this regime. To do otherwise would be the heighth of foolishness.

I mean how many times can people fall for the repeated lies upon lies, these crooks cannot be taken for an administration that cares about public safety. It's quite obvious they will take any shortcut, no matter how unsafe, to try to manipulate the election. I will not fall for the lie.

[The Anti-Targ]

The HHS Secretary (and thus the President) technically can't approve an emergency use vaccine unilaterally because the FD&C Act requires consultation with:

Quote

consultation with the Assistant Secretary for Preparedness and Response, the Director of the National Institutes of Health, and the Director of the Centers for Disease Control and Prevention (to the extent feasible and appropriate given the applicable circumstances described in subsection (b)(1)),

Of course consultation does not mean actually following the advice received from any of these people. Even if all of them say don't do it, the HS secretary can just say, thanks for your input but we are going to do it anyway.

But it's likely to be an empty political gesture because actual practical roll out of any vaccine probably happen since there won't be the doses available to do it. 

I would certainly not line up for the vaccine if it was authorised under an EUA. There is no epidemiological or public health reason to do it, and if there was it should have been done by now already. So the only basis for an EUA is for political gain. If a vaccine gets approved under the normal regulatory process I'll line up for it whenever that happens.

[Castellan]

more on long term side effects - Parkinson disease 

https://www.abc.net.au/news/2020-09-23/covid-19-may-cause-parkinsons-disease-research-finds/12688384

[Kalbear]

1 hour ago, The Anti-Targ said:

The HHS Secretary (and thus the President) technically can't approve an emergency use vaccine unilaterally because the FD&C Act requires consultation with:

Of course consultation does not mean actually following the advice received from any of these people. Even if all of them say don't do it, the HS secretary can just say, thanks for your input but we are going to do it anyway.

But it's likely to be an empty political gesture because actual practical roll out of any vaccine probably happen since there won't be the doses available to do it. 

I would certainly not line up for the vaccine if it was authorised under an EUA. There is no epidemiological or public health reason to do it, and if there was it should have been done by now already. So the only basis for an EUA is for political gain. If a vaccine gets approved under the normal regulatory process I'll line up for it whenever that happens.

Trump is perfectly fine - even better than fine - with empty gestures. They don't require any actual action!

[Lady Anna]

I have to say that Sweden's approach to the pandemic doesn't seem that effective when compared to a country like Portugal, where I live. We both have a population of 10M, but Sweden has 4x the number of deaths.

According to this site Portugal has 69663 cases and 1925 deaths. Sweden has 89436 cases and 5870 deaths. 

It's true though, that maybe the virus has already circulated throughout more areas of Sweden than in Portugal and that autumn and winter are still to come (not to mention the reopening of schools and universities). We'll see.

Overall I think Portugal has done a reasonable job handling this pandemic; unfortunately the situation in care homes for the elderly was disastrous. About 40% of deaths come from people from these care homes, most over the age of 80. We've also discovered that some homes weren't as clean and caring as they should have been and some of them weren't licensed to be open. I think this could definitely makes us think about how our society, not just in Portugal, treats the elderly.

In fact, this pandemic has really shown how there's a lot of failings and flaws in our societies; I doubt, however, that things are going to change and be improved, unfortunately. As for the near future I think this comes down to people's responsibility in wearing masks and doing everything we can to minimize the effects of the virus.

Also, I just want to say that the situation in Spain, especially in Madrid, is pretty dire and I don't know how things spinned out of control again.

[The Anti-Targ]

I think if a country comes out the other side of this with less than 100 deaths/million they will be able to congratulate themselves on a public health job well done, or for being bloody lucky, or a bit of both. Every other government will need to have a reckoning to account for its public health failings that lead to unnecessary excessive deaths. Some govts will have more to answer for to their people than others.

But even those countries who get to be smugly self-satisfied at how well they've done would be stupid not to take some lessons from those countries who did not do so well by their people.

WHO has some hard lessons to learn too. And at some point the global community will need to bring China to account if for nothing else but a lack of transparency early on which could have lead to the pandemic being significantly less severe than it is.