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Covid-19 #38: As the Worm Turns


Fragile Bird

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Lets hope future cases remain siloed within households and those households have the right support.
 
However, the most important information to come out of today's NZ Covid-19 announcement is... What to name the covid-19 vaccination bus?  Ardern thinks we can come up with a better name for these buses than Australia's Jabba the Bus. Yes, yes we can, though Bang is already taken - and would invite the wrong kind of social interaction. Mr Whippy is trademarked, but in a pandemic Dr Whippy may fly. 

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2 hours ago, The Marquis de Leech said:

Seymour beats that drum because if he can hoover up the 15% of the population who want the plague to run free, he's laughing. The Nats have to be much more cautious.

Really, a choice between lockdown and Sydney is no choice at all, and it'll only become more apparent come Christmas, when the corpses in the Northern Hemisphere start piling up again. I fully agree with Bernard Hickey that we're looking at long-term border closure. My only quibble with him is that I think plenty of people would actually be just fine with opting out of an increasingly insane international environment.

My personal preference aligns with Hickey. But it seems voices that are at odds with Hickey, including many academics in the field, are more publicly prominent, and the way the PM spoke today in some interviews seems at odds with what Hickey has been hearing from the corridors of power. We also have the media in general seeming to be tacking towards creating a narrative of needing to face up to letting the virus in and living with it. That may be beacue the truths Hickey talks about are not well understood or appreciated by a lot of people in the media.

One interesting thing to note is that according to this https://www.oecd.org/coronavirus/en/data-insights/intensive-care-beds-capacity New Zealand is hopelessy under resource for hospital space with a substantial outbreak. With 3.6 ICU beds per 100,000 (meaning only 180 beds in the whole country) it would only take a moderate outbreak to overwhelm our capacity. This is compared to over 9 ICU beds per 100K in Aus, over 10 in the UK, and nearly 26/100K in the USA. Even with the highest high vaccination rate in the world (if we ever got there) because of our low number of ICU beds NZ wouldn't cope with an outbreak more or less confining hospitalisation to the doggedly unvaxxed.

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LGBTQ broadcaster Dan Savage tweeted that he actually "teared up" at the news, saying, "My friends who died of AIDS were mocked and condemned by this asshole and others like him. Each and every one of my dead friends would've been first in line to get vaccinated against HIV to protect themselves and others. AND OTHERS. Not just themselves. And this guy couldn't be bothered to get vaccinated against COVID even to protect himself. He encouraged others to put themselves at risk. To put others at risk. He was the moral equivalent of some as*hole poking holes in condoms in 1986."

Colorado pastor who mocked AIDS deaths and spread vaccine conspiracy theories dies from COVID-19

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He was "one of the smartest, and without question the wisest person I've known," said Williams.

No, he wasn't.

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11 hours ago, The Anti-Targ said:

My personal preference aligns with Hickey. But it seems voices that are at odds with Hickey, including many academics in the field, are more publicly prominent, and the way the PM spoke today in some interviews seems at odds with what Hickey has been hearing from the corridors of power. We also have the media in general seeming to be tacking towards creating a narrative of needing to face up to letting the virus in and living with it. That may be beacue the truths Hickey talks about are not well understood or appreciated by a lot of people in the media.

One interesting thing to note is that according to this https://www.oecd.org/coronavirus/en/data-insights/intensive-care-beds-capacity New Zealand is hopelessy under resource for hospital space with a substantial outbreak. With 3.6 ICU beds per 100,000 (meaning only 180 beds in the whole country) it would only take a moderate outbreak to overwhelm our capacity. This is compared to over 9 ICU beds per 100K in Aus, over 10 in the UK, and nearly 26/100K in the USA. Even with the highest high vaccination rate in the world (if we ever got there) because of our low number of ICU beds NZ wouldn't cope with an outbreak more or less confining hospitalisation to the doggedly unvaxxed.

From an outside view it is really hard to understand why you in NZ are still discussing elimination. Yes it was right to close the borders at the beginning. It is admirable how you saved by this thousands of people. And I wish you luck with the latest outbreak which you fight so hard and decisive. But on the long run this is futile , because it is now the majority (by far) opinion of the virologists that the Coronavirus will not go away again, ever. that means that while it is prudent to wait until everyone gets the chance to vaccinate , and while it is also prudent to slow the spread by lockdowns if necessary to not overwhelm the health system, in the end the coronavirus will be endemic in NZ as it is in the rest of the world. and it will be managable and life will go on, and after a year or two life will even go back to normal. this is at least what most of the virologists say: we will achieve some balance because at a certain point everyone will either have had it or are vaccinated. You can delay this by an elimination strategy, but will you not want to have contact with the rest of the world in 2 years or 5 years or 10 years (timepoints at which it is likely that most of the rest of the world is back to normal)? I do not see an endgame here.

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I thought it was pretty simple (and repeated) - get as many people vaccinated as it's realistically possible, and then open up; but not before when it's going to run rampant and kills tens of thousands of people.

It's not like the closed borders policy is hurting the country particularly badly; so it's really not like anyone else's lockdowns have been

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28 minutes ago, JoannaL said:

From an outside view it is really hard to understand why you in NZ are still discussing elimination. Yes it was right to close the borders at the beginning. It is admirable how you saved by this thousands of people. And I wish you luck with the latest outbreak which you fight so hard and decisive. But on the long run this is futile , because it is now the majority (by far) opinion of the virologists that the Coronavirus will not go away again, ever. that means that while it is prudent to wait until everyone gets the chance to vaccinate , and while it is also prudent to slow the spread by lockdowns if necessary to not overwhelm the health system, in the end the coronavirus will be endemic in NZ as it is in the rest of the world. and it will be managable and life will go on, and after a year or two life will even go back to normal. this is at least what most of the virologists say: we will achieve some balance because at a certain point everyone will either have had it or are vaccinated. You can delay this by an elimination strategy, but will you not want to have contact with the rest of the world in 2 years or 5 years or 10 years (timepoints at which it is likely that most of the rest of the world is back to normal)? I do not see an endgame here.

What's an acceptable death rate to end elimination? If you were in this situation would you be OK with a family member or two dying so that people can move across the border more freely, and come here for a holiday? What is wrong with a strategy of holding out for as long as possible to see what the endgame is out there, before we decide on an endgame in here? If we can beat back Delta once, then we know it can be beaten back again. So in theory we can hold out indefinitely until an endgame emerges that does not mean a great deal of pain and suffering. Improved vaccines and therapeutics may come along that mean COVID is only a death sentence or a life sentence if you are very unlucky, rather than guaranteed for a certain percentage of cases. The longer we hold out the more options will present themselves.

6 minutes ago, Which Tyler said:

I thought it was pretty simple (and repeated) - get as many people vaccinated as it's realistically possible, and then open up; but not before when it's going to run rampant and kills tens of thousands of people.

It's not like the closed borders policy is hurting the country particularly badly; so it's really not like anyone else's lockdowns have been

The trouble is, the vaccination rate required to avoid thousands of deaths is too high to be achievable. If we get 90% vaccination, which seems unlikely, that's still 500,000 people completely vulnerable and that's a potential death sentence for 1500 people. Doesn't sound like a lot, but that's because people have become desensitised to that kind of number because some countries were getting that many deaths in a day during the worst of it.

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39 minutes ago, The Anti-Targ said:

 

The trouble is, the vaccination rate required to avoid thousands of deaths is too high to be achievable. If we get 90% vaccination, which seems unlikely, that's still 500,000 people completely vulnerable and that's a potential death sentence for 1500 people. Doesn't sound like a lot, but that's because people have become desensitised to that kind of number because some countries were getting that many deaths in a day during the worst of it.

Most of the rest of the world, who have had it much worse than you dont really give a shit about the voluntary unvaccinated anymore. 

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Well, over here nobody seems to give a shit about the pandemic itself anymore. Yes, stats are still published, and yes, sometimes someone drops a line about how important vaccination is. But the general public is over restrictions, caution and worry and the one and only thing anybody seems to think or care about is the upcoming election. Which is well all right, but simultaneously we are also forgetting that stuff exists beyond politics too. Oh well. 

The strategy appears to be staying fully open without restrictions as long as the ICUs hold out.
 

We launched a hibrid-working schedule at my job and they are determined to not close fully again, come hell or high water. Still haven’t given up on trying to convince my father to get a third shot. It’s been nearly 6 months since his second and I’m confident that any side affects he is worried about are less dangerous than his catching delta. 

 

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On 9/9/2021 at 9:26 PM, Deadlines? What Deadlines? said:

In Alberta, right now:

15,997 active cases, 679 hospitalizations and 154 in the ICU.

Compared to values I posted in this thread on Monday:

13,495 active cases, 515 hospitalizations and 118 in the ICU.

They have six days worth of bribe-window vaccination numbers on the Alberta health website. I think we can confidently say the $100 bribe hasn't increased the poke-rate at all over the previous trend. However, it looks like the rate of first doses may have increased slightly compared to a month ago, but that trend started before the bribe was even announced.  I'm being careful with how I phrase all that because, if I'm charitable, its possible the rate could have declined this week without it. Back to school and all that. 

As of today: 18,395 active cases, 803 hospitalizations and 198 in the ICU. Clearly trending the wrong way. 

The $100 bribe has still not resulted in a significant uptick in doses administered. The number of people getting first doses has risen somewhat. On September 10 there were 5200 first doses administered, which is the highest peak we've seen since June. The partially vaccinated percentage should crack 80% by the end of the month (for 21+). We're at 79.2% now. 

The percentage of the total population (all ages) that is fully vaccinated is 60.5%. Some of the more rural areas have vaccination rates on par with the southern USA. 

The 12+ population of Alberta is 3,761,140 according to the Alberta Health website. Of that, 2,979,886 are partially vaccinated. 781,254 eligible so-and-so's haven't gotten their first dose yet. 

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I am curious about the vaccine manufacturers' gameplans and are they under any pressure from governments to change that plan?  They have all worked on developing adjusted vaccines that would be more focused on variants.   But there is no obvious rush in releasing this next generation.  Instead, they have said that the current vaccines still works very well against serious illness.

But would an adjusted vaccine be even better?  And also reduce the spread of disease?  I'm beginning to see some people arguing that boosters are wasted until they are targeted at Delta.

One argument may be that we have just optimised the manufacturing process and if we change the vaccine, it will take months to return to current levels.  Better to have a decent vaccine now than a better vaccine in 5 months.  Mayhaps.  But i am surprised there isn't more discussion about this at government level.

Another variant may emerge, which will further complicate things.  But still, you'd think Moderna/Pfizzer etc would have a few scenarios thought up.  What are they?  Right they, they are simply getting very very rich.

36 minutes ago, RhaenysBee said:

Well, over here nobody seems to give a shit about the pandemic itself anymore.

That corner of Europe has amazingly kept numbers low.  It could still hit but Poland/Hungary/Czech remain the best countries in Europe for COVID.  Hope it lasts!  Other countries have had their spike and have come out the other side.  Very contrasting experiences.

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56 minutes ago, Padraig said:

That corner of Europe has amazingly kept numbers low.  It could still hit but Poland/Hungary/Czech remain the best countries in Europe for COVID.  Hope it lasts!  Other countries have had their spike and have come out the other side.  Very contrasting experiences.

Maybe in this 4th wave, but overall some of those countries have been hit pretty hard. Hungary oddly has a low overall infection rate (84,712 cases/million) and the highest mortality in Europe (3,126 deaths/million) according to Worldometers. Czechia is also up there (156,883 cases/million & 2,834 deaths/million). Those numbers are comparable to the hardest hit American states.

Anyway, both countries are still well off their peaks. Well done. Hope they keep it up. 

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1 hour ago, Padraig said:

I am curious about the vaccine manufacturers' gameplans and are they under any pressure from governments to change that plan?  They have all worked on developing adjusted vaccines that would be more focused on variants.   But there is no obvious rush in releasing this next generation.  Instead, they have said that the current vaccines still works very well against serious illness.

But would an adjusted vaccine be even better?  And also reduce the spread of disease?  I'm beginning to see some people arguing that boosters are wasted until they are targeted at Delta.

One argument may be that we have just optimised the manufacturing process and if we change the vaccine, it will take months to return to current levels.  Better to have a decent vaccine now than a better vaccine in 5 months.  Mayhaps.  But i am surprised there isn't more discussion about this at government level.

Another variant may emerge, which will further complicate things.  But still, you'd think Moderna/Pfizzer etc would have a few scenarios thought up.  What are they?  Right they, they are simply getting very very rich.

The vaccine manufacturers would love to be allowed to sell an updated version of the vaccine that is targeted for Delta.  They would be able to sell new doses to everyone, particularly the large portion of the population that are already vaccinated but are eager to get an updated vaccine, and in countries with the most money.  I think there are various clinical trials underway testing updated vaccines and combination vaccines.  For at least the mRNA vaccines, and likely for the adenovirus based vaccines, it is relatively trivial to update the mRNA or DNA portion to cover the new variant.  There really aren't be any safety concerns if you keep everything else the same. 

But it's a bit of a moving target.  First it was Alpha, then delta, and probably a new variant will arise, if it hasn't already.  You can get into a game of whack-a-mole if you try and make a new vaccine for each variant of concern.  I think that's part of the reason that government health agencies are not moving forward with the updated vaccines.  Until the vaccines lose effectiveness for protection against serious disease, the government agencies will hold off on approval of a new vaccine as long as possible.  They don't want to start the process of vaccinating the entire population again with a new vaccine, unless absolutely necessary.  It's been hard enough just trying to convince everyone to get the first vaccine.

From a global perspective, it also would slow down the vaccination of the rest of the world, if the focus shifts to providing an updated vaccine to people that have already been vaccinated.  The vaccine manufacturers still have a limited capacity to make vaccine doses, so it's better for the world that they focus on delivering the original vaccines to the rest of the world, at least until the original vaccines are proven to longer work well.

But at some point, it will make sense to update the vaccine.  An updated vaccine would definitely be more effective against the currently circulating variants, and would help slow down the infection rate and reduce illness and deaths.  We have a new influenza vaccine every year, so I don't see why we can't have a new coronavirus vaccine every year too.  Manufacturing capacity needs to increase a lot though if we want to go down this route.  Many countries should start thinking about providing generous incentives to encourage new manufacturing facilities to be established within their territory.

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1 hour ago, Padraig said:

That corner of Europe has amazingly kept numbers low.  It could still hit but Poland/Hungary/Czech remain the best countries in Europe for COVID.  Hope it lasts!  Other countries have had their spike and have come out the other side.  Very contrasting experiences.

Well perhaps in this wave so far and the first. Waves 2-3 were pretty bad. 

38 minutes ago, Deadlines? What Deadlines? said:

Maybe in this 4th wave, but overall some of those countries have been hit pretty hard. Hungary oddly has a low overall infection rate (84,712 cases/million) and the highest mortality in Europe (3,126 deaths/million) according to Worldometers. Czechia is also up there (156,883 cases/million & 2,834 deaths/million). Those numbers are comparable to the hardest hit American states.

Anyway, both countries are still well off their peaks. Well done. Hope they keep it up. 

This is indeed so. The overall low infection rate has a lot to do with the fact that Hungary also ranks 35th in Europe in the number of tests per population. If we tested more, that infection rate could and would be much higher. But PCRs are expensive so people are hardly liberal with testing themselves and GPs also treat subsidized PCRs as a scarce resource, not only due to their cost for the healthcare system but also their strain on the distribution system and labs.  I have no idea how the mortality rate is calculated, but the general health (or lack there of) of people, the general quality of healthcare facilities and the insane strain covid put on them are all contributing factors.

If the we do manage to keep wave 4 relatively flat, it’ll probably be down to the combined protection of vaccination and previous infections and/or luck but nothing else. People aren’t disciplined or naturally careful, policies and strategies aren’t any more consistent or insightful than anywhere else and instead of salt water, we have Schengen boarders all around us. 

38 minutes ago, Mudguard said:

But at some point, it will make sense to update the vaccine.  An updated vaccine would definitely be more effective against the currently circulating variants, and would help slow down the infection rate and reduce illness and deaths.  We have a new influenza vaccine every year, so I don't see why we can't have a new coronavirus vaccine every year too.  Manufacturing capacity needs to increase a lot though if we want to go down this route.  Many countries should start thinking about providing generous incentives to encourage new manufacturing facilities to be established within their territory.

Can an adjusted vaccine be developed as fast as new variants pop up? We had two major new variants along with two minor ones just in 2021. As for getting an adjusted vaccine yearly, people are apprehensive about cross-vaccinating for the third shot already. 

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we’re in Scotland now and went to a shopping mall. Around 10% of people weren’t wearing masks which was really bizarre. I didn’t realise how much of an outlier Luxembourg is in Europe but over here I’ve never seen someone NOT wear a mask in a place where it’s mandated. OTOH in Poland apparently nobody wears them.

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58 minutes ago, RhaenysBee said:

Can an adjusted vaccine be developed as fast as new variants pop up? We had two major new variants along with two minor ones just in 2021. As for getting an adjusted vaccine yearly, people are apprehensive about cross-vaccinating for the third shot already. 

Yes, it just takes months to update the mRNA vaccines.  I think it only took about half a year to enter clinical trials the first time, so it should be even quicker now.

Actually, yearly probably isn't necessary, but it just depends on when and what variants pop up.  Influenza vaccine is yearly because frankly the influenza vaccine is a relatively shitty vaccine and also because there are many, many influenza variants in circulation.  Coronavirus could get there in time though.

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Here's what happens when the approach to Covid is entirely reactive and our provincial leaders decided to "re-open" when vaccination rates  were only around 50%. We are so screwed.

https://www.cbc.ca/news/canada/calgary/alberta-icu-fourth-wave-internal-modelling-icu-capacity-1.6174329

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"Alberta hospitals really are on the brink of collapse," said Dr. Ilan Schwartz, a physician and assistant professor in the division of infectious diseases at the University of Alberta.

"I think it's important that Albertans know just how deep we are into this disaster. This isn't something that we are projecting. This isn't something that is potentially down the road. We are in the midst of a disaster."

Schwartz was one of 67 infectious disease physicians to sign an open letter to Alberta Premier Jason Kenney on Monday, calling for stronger actions to curb the spread of COVID-19, in particular restrictions on non-immunized individuals to access non-essential public, indoor spaces.

"This measure can immediately decrease new infections, thereby alleviating pressure on hospitals, while avoiding widespread lockdowns, now and in the future," the physicians wrote.

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"I think the reality is we're looking at triage," he said. "And we're looking at preventable deaths that will be occurring over the next few weeks in Alberta."

 

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1 hour ago, Mudguard said:

...

That all makes sense.  But given more and more countries are going down the booster role anyhow, isn't it tempting to look at a booster that is focused  on Delta rather than another dose of the same thing?  Maybe it is too late for this discussion, since boosters have already started in some countries, and it would take some time to approve a modified vaccine.  But the current vaccines still work fine against serious illness, so we did have time.  If countries knew a new vaccine would be available in a couple of months, I think more would have holden off going down the booster route immediately.

I get the concern about further mutations.  But if you hadn't gotten the first vaccine, you'd just get 2 doses of this hypothetical one instead.  There is a chance that this new vaccine would work better on the next big variant than the current one.

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Getting a booster shot designed for a variant and not for Vanilla Covid would improve even more the global immune response against coronavirus than a 3rd shot of the same vaccine. We've seen it with people getting shots of 2 different vaccines and having first covid, then a vaccine: the immune system widens the scope of designated covid enemies, which can only help against future variants.

One issue, I suspect, is that if any major vaccine is manufactured in a handful of huge factories, then it's tricky: you don't want to convert them all at the same time, you might even want to keep production of the original vaccine.

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