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Covid 19 #26: Now is the Winter of Our Discontent

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1 minute ago, A Horse Named Stranger said:

Badly phrased.

There are currently three EMA authorized vaccines: BionTech(Pfizer), AstraZeneca and Moderna.

The Johnson&Johnson vaccine is on the verge of authorization, so that will happen within the next few weeks I think. That will be 4th.

 

Some member states have also certified the Russian Sputnik V vaccine. But that's afaik just Hungary and Slovakia. EMA has started a review process for that one now.

On that note Hungary has started to use the Chinese Sinopharm, I think. But to the best of my (admittedly limited) knowledge, the Chinese manufacturers have not filed for authorization, yet.

Production site is not really an issue, as you pointed, most medicines are produced in India or China anyway.

 

Yes, but my point was about getting AZ vaccine from India. Filippa says no vaccine has been received from India because the plants have to be inspected first. It's March, for crying out loud, how could the plants not have been inspected yet?

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Posted (edited)
12 hours ago, Ormond said:

 Finally, obese people who get more negative comments from others about their "lifestyle choices" actually have a harder time losing weight than do those who aren't harangued about this.

Yeap. The lack of compassion is...quite startling, tbh. And I'd extend it to people who smoke as well. Nicotine addiction is just that, an addiction that needs support and treatment. And I hope those that are at an increased risk of hospitalization, weather they be smokers or not, are offered the vaccine and take it ( I find the whole concept of fuck them they made x, y and z personal choice to be completely ghoulish, if I'm being honest)

 re: vaccines, I think Mike Ryan from the WHO pretty much has it spot on in this interview

Quote

Let’s talk about vaccine distribution and equity. There is zero talk here about whether it’s ethical for the United States to vaccinate its entire population before health workers in less resource-rich countries can get vaccinated.

I think that conversation is starting to happen.

You do?

Yes, I do. I see evidence of it, not necessarily in the U.S. yet, but you can hear there’s nuance language there around that. Leaving aside the U.S., all governments who currently have access to vaccine are in a pickle.

There’s such an extreme limitation on supply it is very difficult for governments to turn around to their populations and say, “Hey we’re filling up a few planes and we’re sending them off.” That’s a tough message.

But India is sending vaccine to Bangladesh and to the Maldives, even though their population isn’t vaccinated yet. So, it can happen.

I think what we need, frankly, is citizens need to give their governments permission to begin to share. Because I think at the moment, politicians are understandably caught in a difficult position. Everyone is saying: “You’re not getting reelected unless you get me my vaccine.”

We want to see people vaccinated so the danger here is that it turns into a polemic argument. The argument isn’t that. The U.K., the U.S. are going to continue to roll the vaccine out to wider and wider age bands. And that’s a reality. And anyone who thinks that’s going to stop while everyone does “Kumbaya” and transfers all of the vaccines into some global pool — it’s not going to happen.

But what can happen is that as countries reach the point where they have vaccinated their most vulnerable and have vaccinated their health workers, that they can begin to share with others. They can go down a dual track — continue to expand their national vaccination campaigns, but at the same time, share a portion of the vaccines, so we can catch the other countries up in terms of vulnerable people.

Do you have any sense that that’s going to happen?

Well, I’m a hopeful person. You can’t do my job and not be optimistic. You wouldn’t last a week.

But if this just turns into a knife fight over vaccines, it’s not going to work. We have to find a civilized way.

I'm hoping once the vulnerable + health workers are vaccinated we end up seeing lots more of the vaccine being shared/ distributed to other countries.

Lastly, re: Age and co-morbidities

I'm not *completely* sure of the specifics of the US vaccination program, but you do have to take both into account, it cannot be just age. Of course, there will be some overlap but there can be lots of severe co-morbidities that will pretty much end your life if you end up getting COVID, some examples would be things like Cancers, congenital heart disease, COPD, Cystic Fibrosis etc - now some of these would be particular to older people ( like COPD), but Cancers, congenital heart disease, cystic fibrosis, people that have received organ transplants - these diseases will have lots of young people that are *extremely* clinically vulnerable.

That's why we need to consider co-morbidities and not just age. I also think a lottery would be a bad idea and I'm glad we're not doing that in the UK..  As would using just age.

Edited by Raja

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39 minutes ago, Raja said:

Yeap. The lack of compassion is...quite startling, tbh. And I'd extend it to people who smoke as well. Nicotine addiction is just that, an addiction that needs support and treatment. And I hope those that are at an increased risk of hospitalization, weather they be smokers or not, are offered the vaccine and take it ( I find the whole concept of fuck them they made x, y and z personal choice to be completely ghoulish, if I'm being honest)

 re: vaccines, I think Mike Ryan from the WHO pretty much has it spot on in this interview

I'm hoping once the vulnerable + health workers are vaccinated we end up seeing lots more of the vaccine being shared/ distributed to other countries.

Lastly, re: Age and co-morbidities

I'm not *completely* sure of the specifics of the US vaccination program, but you do have to take both into account, it cannot be just age. Of course, there will be some overlap but there can be lots of severe co-morbidities that will pretty much end your life if you end up getting COVID, some examples would be things like Cancers, congenital heart failures, COPD, Cystic Fibrosis etc - now some of these would be particular to older people ( like COPD), but Cancers, congenital heart failures, cystic fibrosis, people that have received organ transplants - these diseases will have lots of young people that are *extremely* clinically vulnerable. That's why we need to consider co-morbidities and not just age. I also think a lottery would be a bad idea and I'm glad we're not doing that in the UK.

I think a lottery would be a bad idea and I'm glad that's not what we are doing in the UK.  As would using just age.

To add a bit to that. It's also in the self-interest of the rich countries to vaccinate the poorer countries. As long the virus is allowed to go rampant in the poorer countries, there will inevitably pop up new mutations of the virus. And chances are, that eventually one variant will be found to that will not be stopped by our current vaccines, and we will all be back to square one.

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7 hours ago, Fragile Bird said:

 However, at my last live annual exam I asked about my height and discovered that over the years I’ve shrunk an inch in height, which explained why I had become uncomfortable even when just adding my usual 6 or 8 winter pounds. I’m working hard to get closer to the “normal” range.

 

 

7 hours ago, Chataya de Fleury said:

I’ve shrunk an inch, too!!!! I used to be 5 foot 7. I am now definitely 5 foot 6. 

 

 

All this talk of Shrinking disturbs me.....

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To summarise what others have said.  The EU had a contract with AZ where it would originally get vaccines from 4 factories (2 in the EU, 2 in the UK).  Those factories had all passed the various standards required.  I believe AZ is adding further factories in the EU (or has already added).  But even with those extra factories, AZ is continuing to struggle to fulfill its order.  The EU has seemingly never gotten any doses from the UK.  Instead, AZ has offered to supply vaccines from India.  But there is a whole complicated process around that also.  Its not a one site visit.

5 hours ago, ljkeane said:

Well we don't know obviously but when they were asked about it during the spat with the EU UK government figures were pretty consistent about saying they were 'confident that the UK's order would be met' but wouldn't commit to saying no vaccine would be exported. If the UK just gets the first 100 million doses it doesn't seem worth trying to thread that needle. On top of that the fact that Astrazeneca mentioned UK sites as potential suppliers for the EU suggests they thought there might be at least a bit of capacity for exports.

At the time, I interpreted it to mean that no vaccine will be exported.  That still sounds right to me.  There was no suggestion from AZ that it would also work at improving the factories in the UK to supply the EU.  Instead, AZ made it clear that the issue was with their EU factories.  And when the EU factories are still behind target in March, AZ tell the EU they will provide doses from India instead.  There is no sign of anything from the UK.

I assume the UK is being diplomatic.  Saying "no vaccine would be exported" would sound bad.  Saying the UK order would be met is a far better message.

The UK government has said that it wouldn't provide any of its vaccines to other countries until its population is vaccinated.  I interpret that to mean that the AZ UK factories are exclusive.  The UK factories would only be used for the EU when the UK's original order is fulfilled.  If there is another way for AZ to supply the EU from the UK, the conditions are very onerous.

2 hours ago, A Horse Named Stranger said:

But to the best of my (admittedly limited) knowledge, the Chinese manufacturers have not filed for authorization, yet.

You are correct.  Not sure whether it has any intention to apply.  Unless something goes very wrong, it probably wouldn't lead to that many extra sales in the EU.  By the time it got approval, there will be a glut from other sources.  But it can pick up a few small orders over the next month from individual EU countries.

45 minutes ago, A Horse Named Stranger said:

As long the virus is allowed to go rampant in the poorer countries, there will inevitably pop up new mutations of the virus.

And given very lax restrictions in the US, those mutations will easily sweep the country.  The UK, at least, seems to be trying to keep the variants out

1 hour ago, Raja said:

But what can happen is that as countries reach the point where they have vaccinated their most vulnerable and have vaccinated their health workers, that they can begin to share with others. They can go down a dual track — continue to expand their national vaccination campaigns, but at the same time, share a portion of the vaccines, so we can catch the other countries up in terms of vulnerable people.

Do you have any sense that that’s going to happen?

Well, I’m a hopeful person. You can’t do my job and not be optimistic. You wouldn’t last a week.

Hah.  The poor Irish guy!   I obviously base everything I say off him

2 hours ago, Clueless Northman said:

J/J vaccine was developed in a Swiss lab. Not EU, but still in Europe and not in the US.

Huh.  Didn't know that.  I am really curious to know how much J&J will have available in April.  Hopefully the European links will help!

4 hours ago, Consigliere said:

Also, @Padraig, Canada most certainly did not receive Oxford/AZ doses from SA. The 1.5 million doses we bought from the SII is being sold to the African Union

Good.  I hope they offload them soon!

5 hours ago, Fragile Bird said:

Italy, Germany and France that didn’t take allocations from COVAX.

That was decided months ago.  Would the EU have changed its mind if it knew it was going to have such delays with its program?  Probably not.  It does recognise the need to vaccinate the rest of the world.  And COVAX is only starting to deliver now to any countries.  By the time the EU's turn came, the EU will be seeing a big increase finally from its own sources.

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Posted (edited)
37 minutes ago, Padraig said:

 

And given very lax restrictions in the US, those mutations will easily sweep the country.  The UK, at least, seems to be trying to keep the variants out

The US has already developed a number of variants of their own. None of them that I know of have become “variants of concern” but I expect that is bound to happen sooner or later.

37 minutes ago, Padraig said:

 

That was decided months ago.  Would the EU have changed its mind if it knew it was going to have such delays with its program?  Probably not.  It does recognise the need to vaccinate the rest of the world.  And COVAX is only starting to deliver now to any countries.  By the time the EU's turn came, the EU will be seeing a big increase finally from its own sources.

Canada announced it was taking up COVAX vaccine on Feb. 3rd, just one month ago. Since Canada is the second biggest contributor after the UK, I don’t think European countries were offered vaccine “months ago” and before Canada, I assume they were offered vaccine at the same time.

And correct me if I’m wrong, I don’t think I am, but virtually all the Covax vaccine is coming from SII in India. Some is coming from Korea, note we received 300,000 doses from Korea, but the majority is being produced in India. This explanation that Italy, Germany and France did not accept COVAX vaccine because the plants haven’t been approved yet really, really pissed me off, because it demonstrates what a bloody hit job that damn Guardian article was. “Canada, the only G7 country to take COVAX vaccine, taking it away from the arms of poorer nations”. What a damn hit job.

Edited by Fragile Bird

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5 hours ago, Padraig said:

The UK government has said that it wouldn't provide any of its vaccines to other countries until its population is vaccinated.  I interpret that to mean that the AZ UK factories are exclusive.  The UK factories would only be used for the EU when the UK's original order is fulfilled.  If there is another way for AZ to supply the EU from the UK, the conditions are very onerous.

Well regardless of how you choose to interpret the rest that's not UK production sites they're talking about. That's in reference to what they're going to do with the rest of the vaccines the UK has ordered once the UK population is vaccinated.

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15 hours ago, Zorral said:

It's the same attempting to unravel / understand why Haiti is just not suffering from covid-19.  It just isn't.  Everything is totally open -- well as much as can be in the incredibly volatile and violent conditions of the people attempting to oust the profoundly corrupt and murderous guy who won't leave the presidency.  We live streamed a concert last night from Port-au-Prince.  Nobody is wearing masks, everybody is dancing and singing and parading and eating together. Nobody we know is sick or has gotten sick.  We know a lot of people who live in Haiti.

There are many low income countries where covid-19 is not an issue. Specially considering the difficulties for social distancing and poor health care in those regions. In fact many see the pandemic as a first world problem.

This disease is weird. Yesterday I was talking to the lady who cleans the stairs in my building. She is in her late 50s and plainly overweight. She got covid a couple of weeks ago and she said if it wasn't for the loss of sense of smell and taste she wouldn't have noticed as the worst she got was a headache one evening. On the other hand, a lady married to a relative, barely older than this cleaning lady, was ravaged by covid-19 and was stuck to a wheelchair for months. She is making recovery but very slowly and looks 20 years older than her age from what my mother tells me.

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3 hours ago, rotting sea cow said:

There are many low income countries where covid-19 is not an issue. Specially considering the difficulties for social distancing and poor health care in those regions. In fact many see the pandemic as a first world problem.

This disease is weird. Yesterday I was talking to the lady who cleans the stairs in my building. She is in her late 50s and plainly overweight. She got covid a couple of weeks ago and she said if it wasn't for the loss of sense of smell and taste she wouldn't have noticed as the worst she got was a headache one evening. On the other hand, a lady married to a relative, barely older than this cleaning lady, was ravaged by covid-19 and was stuck to a wheelchair for months. She is making recovery but very slowly and looks 20 years older than her age from what my mother tells me.

That speaks to their ignorance much more than it does to the facts. Clearly there are many developing countries that have had a lot of cases and deaths.

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5 hours ago, ljkeane said:

Well regardless of how you choose to interpret the rest that's not UK production sites they're talking about. That's in reference to what they're going to do with the rest of the vaccines the UK has ordered once the UK population is vaccinated.

True.  It just seems all in the same vein.

10 hours ago, Fragile Bird said:

This explanation that Italy, Germany and France did not accept COVAX vaccine because the plants haven’t been approved yet really,

I don't think that is true.  If Germany, France and Italy really wanted COVAX vaccines, they would have made sure that the plants would have gotten  approved.  The EU is doing it now for other reasons.

And sure, maybe the EU could have changed its mind up to the 3rd Feb about COVAX but they joined COVAX in August last year.  I'm reasonably confident that it viewed it as a way to supply poorer countries.  Its own needs would come from its own factories in the EU.  I would be shocked if it didn't tell COVAX that in Aug (if not earlier).

Canada didn't have that ability to self-supply, so it made a different decision.  I don't blame them for that.

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On the topic of why the US should start exporting vaccine.

Last night on CNN they were listing all the states that are opening up their economies. It’s not just Texas and Mississippi, it’s dozens of states, some without mask mandates, some with voluntary mandates. If you can open bars and restaurants you can export vaccine.

California is opening theme parks and sports stadiums on April 1. If you can open theme parks and sports stadiums, you can export vaccine. Other states are doing the same.

But the most telling event? The mayor of Detroit rejected 6,200 doses of J&J vaccine because he wasn’t going to accept “second rate vaccine” for the people of Detroit, it’s Pfizer or Moderna or nothing. Those 6,200 doses would be welcomed with open arms across the river in Windsor, send them there buddy. If you are so awash in vaccine you can do that, you can export vaccine.

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[mod] There will be absolutely NO MORE fat shaming in this thread, or on this board. End of discussion. Further, please take all talk of weight gain, weight loss, and body composition into another thread. Thank you. [/mod]

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Posted (edited)

Good news on the treatment front.  Merck and a early stage company called Ridgeback, working in partnership, are showing positive phase 2 results for an anti-viral called molnupiravir.  In the study, the pill significantly reduced infection virus in subjects after 5 days of treatment.  It needs more study, and more tests, but (1) it is a pill, so better than remdesivir, and (2) doesn't attack the spike protein, but rather the replicator portion of the virus.  (2) could be particularly important as variants continue to proliferate.  So, not clear yet, but potentially good, non-vaccine news.  My source is WSJ, which I'm not going to bother to link because pay wall.  The idea is that it would be sort of like a tamiflu for covid.

Edited by Mlle. Zabzie

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3 hours ago, Fragile Bird said:

Those 6,200 doses would be welcomed with open arms across the river in Windsor

They'd be damned welcome right here in NYCity too.  We are so under supplied its a scandal.  Not to mention the scandal that every part of vaccinating the city's residents is -- and not for the same reasons as in Florida.

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Posted (edited)

Curious about the Molnupiravir study, I'm sure it will show up in the non pay-walled part of the internet. It's probably already on MedRxiv.

As an aside, the last thing we want is *any* kind of treatment to resemble Tamiflu ( Oseltamivir). The Tamiflu saga is basically the poster child of the issues with Big Pharma, the lack of clinical trials transparency and why we still have a long way to go when it comes to holding companies like Roche to account. Roche took 5 years to be transparent with the clinical data, and in the end, after governments around the world had spent millions stockpiling Tamiflu, we found out that it didn't reduce deaths or hospitalizations, and there was equivocal evidence about preventing flu symptoms/ duration of one's cold. If anyone's curious, here's a more detailed account of the fiasco that is Tamiflu, and an excellent account of how dogged academics and researchers can make such an impact.

Re: Remdesivir - it's not a treatment for COVID anymore. The WHO removed it from it's recommended treatment in late 2020 for COVID 19 as it didn't improve mortality, intubation, or hospital length of stay. We do not use Remdesivir here at all.

We currently have 3 inpatient therapies for COVID, these are the backbone of managing inpatients - Dexamethasone, Tocilizumab and Oxygen. Dexamethasone and Toci have *slightly* different indications among COVID patients. Always hoping for more though.

Edited by Raja

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3 hours ago, Raja said:

Curious about the Molnupiravir study, I'm sure it will show up in the non pay-walled part of the internet. It's probably already on MedRxiv.

As an aside, the last thing we want is *any* kind of treatment to resemble Tamiflu ( Oseltamivir). The Tamiflu saga is basically the poster child for the issues with Big Pharma, the lack of clinical trials transparency and why we still have a long way to go when it comes to holding companies like Roche to account. Roche took 5 years to be transparent with the clinical data, and in the end, after governments around the world had spent millions stockpiling Tamiflu, we found out that it didn't reduce deaths or hospitalizations, and there was equivocal evidence about preventing flu symptoms/ duration of one's cold. If anyone's curious, here's a more detailed account of the fiasco that is Tamiflu, and an excellent account of how dogged academics and researchers can make such an impact.

Re: Remdesivir - it's not a treatment for COVID anymore. The WHO removed it from it's recommended treatment in late 2020 for COVID 19 as it didn't improve mortality, intubation, or hospital length of stay. We do not use Remdesivir here at all.

We currently have 3 inpatient therapies for COVID, these are the backbone of managing inpatients - Dexamethasone, Tocilizumab and Oxygen. Always hoping for more though.

If you find it would be curious on your take on the study. Was worthy of prominent placement on WSJ app but I fear that mainstream journalism does medical reporting about as well as they do any kind of science reporting....not well. 

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Regarding the 6200 doses of J&J, the Detroit mayor retracted his position after getting a call from the White House. One way Biden can use his executive power is to strong arm Democrats through a simple phone call (something Trump probably did well). Here's a link that explains the saga: https://www.cnn.com/2021/03/06/politics/what-matters-march-5/index.html

Quote

What does Duggan say now? In a statement Friday, he said: "I have full confidence that the Johnson & Johnson vaccine is both safe and effective. We are making plans now for Johnson & Johnson to be a key part of our expansion of vaccine centers and are looking forward to receiving Johnson & Johnson vaccines in the next allocation."

 

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The EU is asking the US to release AZ vaccines made in the US.  Funny. :)

It actually could be a good news story.  No idea how many doses AZ has produced in the US (there was no reason to rush, since it knows it isn't getting approval till at least April) but the EU could offer to take what is already produced and replace it with EU produced doses when AZ is approved.  But no idea is that actually the suggestion.  By April, the EU side should be much improved.  

https://www.cnbc.com/2021/03/06/eu-reportedly-seeks-access-to-us-produced-astrazeneca-vaccines.html

The US plant is already approved by the EU.

It is mentioned in the above article too but there is also concern about a lack of ingredients. Although, who knows if the story is overblown.

https://www.fiercepharma.com/manufacturing/u-s-focus-pfizer-production-could-delay-manufacturing-other-covid-19-vaccines-serum

In fairness though, if there is a major shortage of ingredients, you can't blame the US for keeping their own ingredients.  Other countries really need to start fixing their own supply chains.  Unless, it turns out that the US has now stockpiled huge reserves of those ingredients.  But you'd imagine some reserves could be released then.

It just shows how complicated everything is!

I am seeing some really bad reporting also.  A BBC article recently.

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