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Fragile Bird

Covid-19 #38: As the Worm Turns

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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

Quote

"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.

Quote

"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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16 minutes ago, Padraig 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.

Yes, I agree, if you are going to administer a booster, you may as well tailor the booster to the variant that's currently out there.  Initially, that's what I thought they were going to do, but it became apparent they just meant giving another dose of the old vaccine.  It never made much sense to me to administer a third shot of the old vaccine.  To be honest, the messaging from the health agencies regarding the need for boosters is pretty muddled.  The science and justification for administering the booster using the old vaccine is pretty weak in my opinion.

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8 hours ago, BigFatCoward said:

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. 

Doesn't mean it's right to not give a shit. For now we are doing a good job of saving people from their own stupidity. A society is not judge by how it treats the best of us, it's judged on how it treats the least of us. That applies equally at a material and intellectual level. 

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And yet, you know, They never die.  They just take up all the space as people need to care for Them forever.

 

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Somewhat random thoughts on the booster conversation:

1) The variants which have really taken off so far (D614G, alpha, delta) seem to have had a fitness advantage largely brought about by increased transmissibility rather than immune evasion. Ie the virus is evolving to become more human adapted.

2) The major antigen (spike) can only mutate towards increased ACE2 affinity so far - it cannot infinitely evolve towards increased transmissibility and will get to a point of increasingly diminishing returns. When it gets towads that point (if we're not already there, which my gut says we might be*) further mutations will likely be towards immune evasion & reinfection. These may be less (not more) transmissible.

3) Almost all of the variants so far share a half dozen or more of the same substitutions. That includes the potential escape mutants.

4)  This virus is not evolving particularly quickly. A dozen or so amino acid substitutions in billions of generations isn't a high rate of mutation for a virus.

So with all of this in mind it seems insane not to tailor booster shots to Delta like, yesterday.

*I also thought this last year. That turned out well.

Edited by Impmk2

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2 hours 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. 

Technically a dead delta virus vaccine could be put out to market in a very short space of time. As an adjunct to people already vaccinated with first gen viruses it may well give a significant immunity boost, specifically for Delta.

There is another left field possibility: inoculation. That is simple infection with the virus. But in this case with the OG virus. Vaccine was proved to be very effective at preventing infection and illness with the OG virus. Therefore it should be safe, in theory, to inoculate healthy, non-elderly, double jabbed people, a couple of months after their second vaccination, and this would give a major boost to immunity which may prevent breakthrough infection by Delta in a large proportion of people.  I don't know what the stats say about infection, illness and death in healthy non-elderly vaccinated people with the OG virus. I believe soon after the second jab the overall stat with the mRNA viruses was 96% effective at preventing infection. But that would be across all ages. For the younger and healthier that may be a much higher effectiveness. Also, given it appears most countries are resigned to everyone being exposed to Delta, it could be argued that it is better to be deliberately hit with the OG virus than to wait until you are hit with Delta, if a very high degree of cross immunity is confirmed. The dose can be managed to be just at the infectious dose rate, and ti doesn't necessarily need to be a jab. It could be orally administered like the polio vaccine. Of course the conspiracy community would go absolutely nuts, moreso than it is now. 

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2 minutes ago, Impmk2 said:

4)  This virus is not evolving particularly quickly. A dozen or so amino acid substitutions in billions of generations isn't a high rate of mutation for a virus.

There have been many, many variants, thousands by now, but the vast majority are not of concern because they do not appear to increase infectivity or severity of disease.  There were dozens of known variants all within the first several months of the pandemic, when the numbers of infected was much smaller.  I think this virus mutates at a normal rate that is typical of RNA based viruses, which is relatively high, at least compared with DNA based viruses.

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On 9/14/2021 at 8:33 AM, The Marquis de Leech said:

Jacinda pursuing anything other than Elimination will lose her 2023. The public (apart from David Seymour) are right behind Elimination, even if it means extended lockdowns. After all, we can see the alternative... Sydney.

We have to keep the border closed, because anything else means the destruction of our health system. People understand that.

Well I'm glad there is not an election anytime soon. By 2023 it will probably be settled on whether or not elimination is still a viable option, but without superior vaccinations it is probably not.

People support elimination because of the freedom it offers within our regular lives (outside of international travel). People will not be supporting extended lockdowns, I feel this will be the last one that is complied with. Many companies can still operate at level 4, but there are plenty of others which are causing their owners to lose their entire livelihoods as well as burdening future taxpayers with debt.

This one is particularly bad, much worse for Auckland than last years, and is not working particularly effectively other than to reduce transmission speed. We don't know the exact details over why there are continuously more and more community exposure events that keep leading to more cases. But there are about a dozen previous exposures that are waiting on day 3 tests over the next couple of days, and if that goes badly it will be back to square one. We need some luck now.

I don't think there is any doubt we needed to go ahead with this lockdown, the vaccination rate was far too low, ICU capacity far too low, and I have no doubt that if there was not a lockdown we would have seen many, many deaths and a lot of others seriously ill. But even though the vaccine seems much less effective at reducing transmission than we were hoping for, it does seem very effective at reducing the severity of the disease.

My gut feeling is we will be living with covid inside the community sometime next year. And that will be broadly supported by the public while future lockdowns will not.

Edit - as an aside I had my first vaccination yesterday. Was pleasantly surprised at how efficiently it was being run. I counted 15 staff who were vaccinating roughly 6 people every minute. If that rate was kept up around all the vaccination centers, the country population could be vaccinated in a couple of weeks then the 4-6 week wait and then the second shot. After seeing it in action I'm not entirely sure why I had to wait 3 weeks from the date I booked.  

Edited by Makk

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4 minutes ago, The Anti-Targ said:

Technically a dead delta virus vaccine could be put out to market in a very short space of time. As an adjunct to people already vaccinated with first gen viruses it may well give a significant immunity boost, specifically for Delta.

There is another left field possibility: inoculation. That is simple infection with the virus. But in this case with the OG virus. Vaccine was proved to be very effective at preventing infection and illness with the OG virus. Therefore it should be safe, in theory, to inoculate healthy, non-elderly, double jabbed people, a couple of months after their second vaccination, and this would give a major boost to immunity which may prevent breakthrough infection by Delta in a large proportion of people.  I don't know what the stats say about infection, illness and death in healthy non-elderly vaccinated people with the OG virus. I believe soon after the second jab the overall stat with the mRNA viruses was 96% effective at preventing infection. But that would be across all ages. For the younger and healthier that may be a much higher effectiveness. Also, given it appears most countries are resigned to everyone being exposed to Delta, it could be argued that it is better to be deliberately hit with the OG virus than to wait until you are hit with Delta, if a very high degree of cross immunity is confirmed. The dose can be managed to be just at the infectious dose rate, and ti doesn't necessarily need to be a jab. It could be orally administered like the polio vaccine. Of course the conspiracy community would go absolutely nuts, moreso than it is now. 

I'm not sure a single inactivated virus vaccine has been approved yet for coronavirus.  Maybe one in China or Russia?  If China has approved one, I would bet that it performs relatively poorly.  The inactivation process, typically heat, chemical, and/or irradiation, generally alters the physical and chemical structure of the virus proteins, which can render them less effective at generating an effective immune response.  It can take a lot of trial and error (years) to come up with an adequate process that results in sufficient inactivation or attenuation of the virus while not damaging the critical proteins too much to allow a good immune response to be developed after inoculation. 

mRNA vaccines and DNA vaccines on the other hand only require you to update the nucleic acid sequence you are delivering to the new variant.  This can be done immediately as soon as the variant of concern has been identified, assuming that an updated spike protein is a sufficient target for new variants.  Theoretically, other proteins can be included in the mRNA or DNA vaccines, but that doesn't appear necessary right now.  Then it's a matter of growing up a batch of the new nucleic acids and packaging it into a lipid vector for the mRNA vaccines, or genetically modifying the adenovirus in the DNA vaccines.  It would not be difficult for the manufacturers to make an updated mRNA or DNA vaccine.

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