Covid-19 #42 Nu Tsunami Incoming

[Zorral]

"FDA advisers narrowly recommend authorization of first antiviral pill to treat covid-19"

https://www.washingtonpost.com/health/2021/11/30/merck-covid-pill/

Quote

 

... The drug could have an immediate impact on the pandemic if authorized — just as the ominous new omicron variant has emerged, jolting the world with the prospect of a longer and more complicated pandemic.

Merck has pledged to manufacture enough medicine to treat 10 million patients by the end of the year, and the United States has preordered enough medicine to treat 3.1 million people. There are other treatments, monoclonal antibodies, that are harder to administer but are more effective, which led experts to debate who should receive the drug. An easy-to-use medicine that could be taken at home would offer an additional tool to reduce the strain on hospitals as a potential winter surge looms.

When given to people at high risk of developing severe illness, molnupiravir cut the risk of death or hospitalization by 30 percent in patients infected with a range of variants including delta, gamma and mu. Molnupiravir has not yet been tested against the omicron variant, but because it works in a different way than vaccines and monoclonal antibodies that train their firepower on the coronavirus spike protein, it is expected to hold up against a wide range of variants.

“As new variants have been becoming available, we have been testing them for the activity of molnupiravir,” said Nicholas Kartsonis, senior vice president of clinical research for infectious diseases and vaccines at Merck. “We expect, based on what we know about the omicron variant, that molnupiravir would be effective against this particular variant.”

But one committee member cautioned that it was an assumption that the drug would be more variant-proof than vaccines or other treatments. ....

 

 

[Clueless Northman]

Having a variant that is at least 10 to 20 less dangerous and lethal than Delta, Alpha or even Vanilla covid Wuhan 2020, which would also be even more contagious, would be actually great news, and indeed, it would be quite useful to drop most restrictions, make sure the vulnerable and elderly have been boosted or vaccinated just a few months ago, and let it spread across the people. That would be a gutsy move for the first few countries to try such an approach though.

Still a dream, I don't expect Omikron to be that kind to us, though hopefully it genuinely is less lethal and is still mostly vulnerable to vaccines.

[The Anti-Targ]

Approval of vaccine for 5-11 year olds expected here in January. 

Interesting that a colleague who is on the COVID-19 expert group / taskforce /  panel / thing smentioned to me that if people are wearing (properly) N95 masks the evidence suggests that there is very low risk of transmission. That's of course if the infected person and the vulnerable people are all wearing the mask properly. In the workplace (like factories with no public entry) it is easier to make sure everyone is using a N95 mask and wearing it properly. Not so easy in public settings where the quality of mask and adequacy of fitting will not be so reliable. But businesses with public facing staff should really be looking at providing N95 masks for staff and making sure they wear it properly. I see most customer facing workers using the fairly cheap version of disposable mask,

[Fragile Bird]

You can’t get on a train or plane in Canada now if you are over 12 and unvaccinated.

[Mudguard]

7 hours ago, The Anti-Targ said:

There seems to be growing optimism / speculation that omicron will both become the dominant strain everywhere as well as being a much less pathogenic virus effectively spelling the end of the seriousness of the pandemic. Like a lot of the miracle cures that have been promoted throughout this pandemic I would not want people to get ahead of themselves when it comes to declaring omicron to be our saviour. But if it is it creates quite an interesting situation here.

Right now we are still pretty much keeping introduction of more COVID into the country at bay by keeping our border tightly controlled with very limited entry, so we are a delta exclusive population for now. Hence we may be very successful in the short term at keeping omicron out. If omicron quickly becomes the dominant strain and proves to be not much worse than the common cold or at least considerably less severe than seasonal 'flu, then it would behove our govt to completely open our borders so that omicron can quickly become the dominant variant here as a measure to eliminate delta from the community. But if we become one of the last enclaves of delta would that suddenly put us on a no-fly list, as most countries would not want to re-introduce delta into the population, and a lot of people probably would rather not come to a country where you could catch delta?

It's likely that if you get infected and recover from Omicron, or any of the other SARS-Cov-2 variants, you'll have a very good level of immunity to Delta.  Otherwise, I don't think you would see much crowding out effect if you could just be infected by both viruses.  So if the rest of the world besides New Zealand gets to a point where essentially everyone has immunity through either vaccination or recovery from infection, then there should be little risk from exposure to Delta from New Zealanders.  

Hofefully, there will be good news with Omicron.  We are due for some good news after 2 miserable years.

[Impmk2]

I would not assume Omicron is more transmissible than Delta. If it’s substantially immunoevasive it doesn't need to be (and could be by quite a bit less) by virtue of being able to reinfect far more readily. Indeed the initial ACE2 binding modelling indicates a decease in affinity, though there may be some epistasis that's being missed as there's so many novel mutations.

Frankly I wouldn't be surprised by either scenario (increase/decrease in transmissability) at the moment. Need more data.

 

[Impmk2]

21 hours ago, rotting sea cow said:

Do you have a link on that?

I have the feeling (backup up by the large fraction of infected coming out of airplanes) that S. Africa has a far larger outbreak than they know and community transmission is probably widespread in many other countries.

 

This was the Twitter thread;

Link to the site with raw data down a few posts

[rotting sea cow]

56 minutes ago, Impmk2 said:

This was the Twitter thread;

Link to the site with raw data down a few posts

Thanks a lot!

Indeed the outbreak is likely larger than cases indicate. We will see soon whether they do materialize into clinical cases or there is significant asymptomatic spread.

 

 

2 hours ago, Mudguard said:

It's likely that if you get infected and recover from Omicron, or any of the other SARS-Cov-2 variants, you'll have a very good level of immunity to Delta. 

Yes. I'd take these reports about "milder disease" with a good dose of salt (and hoping they are true. The reason is that reportedly the outbreaks have been associated to student parties and we know that young people get milder disease anyway. Besides, there is significant level of natural immunity in S. Africa (only place with enough data points) after three waves and a decent level of vaccination that is probably skewed towards older people. Even with significant immune escape, that might be enough to protect against a health crisis (knocking wood about it).

I'd say the same about other scattered reports of hospital being "filled up".

The most probably scenario is  that the disease is not significant worse or better than current circulating strains, but previous immunity might be bypassed for infection but not for clinical outcomes, so we need to watch for the elderly.

There is also a good thread explaining how Omicron can displace Delta, even if it's less infectious, thanks to immune escape.

 

 

 

 

 

 

[A Horse Named Stranger]

Sorry, but this has to be a joke, right?

[Luzifer's right hand]

47 minutes ago, A Horse Named Stranger said:

Sorry, but this has to be a joke, right?

You wish.

[Zorral]

49 minutes ago, A Horse Named Stranger said:

Sorry, but this has to be a joke, right?

Twas the news yesterday.  There are some legal challenges to this in some areas in some states.

[rotting sea cow]

I think we should start praying about these reports of milder disease turn out true

Using the available data, it seems that Omicron can outcompete Delta by margin in any population immunity scenario, either by high immune escape and modest transmisibility or smaller immune escape and similar infectiousness.

I see possible biases, like the necessary comparison with current S. Africa Delta transmission, which was at a very low level, the contribution of superspreading events and preferential attention to the most affected region. But, as we saw with wastewater samples, it's likely that SA has a significant outbreak.

 

[Deedles]

Just paid for the 4th private test for my kiddos. Theoretically everyone can have free tests but in practice, it’s getting very hard to book tests. Previous ones had been €99, this was €69. Yes it’s out of pocket but results in 8 hours rather than 2 days and very convenient timing made it worth it. 4 cases in my daughters class though, so very nervous about it. Discon isn’t happening now, and I’m really hoping we do manage our post Xmas trip to the Canaries. I would do bad things to get a vaccination into my 6 year old (and, frankly, the 3 year old too)

[Impmk2]

7 minutes ago, rotting sea cow said:

I think we should start praying about these reports of milder disease turn out true

Using the available data, it seems that Omicron can outcompete Delta by margin in any population immunity scenario, either by high immune escape and modest transmisibility or smaller immune escape and similar infectiousness.

 

 

As there's a pretty logical (and is somewhat backed up in the literature) correlation between average viral loads / tranmissibility / disease severity, it does follow that a less transmissible variant may also be somewhat attenuated as far as disease goes too. That's what I'm clinging to (and that celluar immunity shouldn't be effected) in the event we see the expected pretty extreme* neutralising antibody escape.

But after a couple years of this shit fully expecting the worst. Also there's the possibility Omicron could further evolve to gain the mutations known to give Delta increased fitness. And if it is antigenically distinct enough, the possibility of co-circulation with Delta comes on to the table.

*Lots of these substitutions are surface exposed and clustered around the sites neutralising antibodies are known to bind - decent likelihood this is reasonably antigenically distinct from Delta / Alpha / Wuhan.

[Deadlines? What Deadlines?]

On 11/29/2021 at 5:13 PM, The Anti-Targ said:

Just looking at our vaccination situation, we are at 78% of the total population single dosed. I think 80% is within reach, which I was doubtful about without the 5-11 year olds being eligible for vaccination. We're at 72% of the total population double dosed. The gap between single and double dosed is closing with second vaccinations outpacing first vaccinations by about 2:1. 94% of the eligible population is either single dosed or booked to have the first dose. I wasn't too confident of getting to that kind of number before the end of the year.

Told ya. 

Not only that, but NZ's regional parity is phenomenal. About 75% of them are over 90% and the remainder are very close. Parity by age cohort is also excellent. You guys are doing great on the vaccination front. 

[Padraig]

3 hours ago, Deedles said:

I would do bad things to get a vaccination into my 6 year old (and, frankly, the 3 year old too)

The EU announced today that vaccines for those 5-11 would arrive a week earlier than planned (the 13th Dec).  There hasn't been much of a reaction here from the government.  It hasn't been formally approved by the Irish regulator but should't that be expected before the 13th?  Is there a plan to start vaccinations before Christmas?  Or are they going to wait till January?  Its a big difference.

I'm sure some countries will be offering kids vaccines before Christmas.  And given that this age group has by far the highest COVID rate, there is a good reason to offer them asap.

In other news, very lukewarm thumbs up from the FDA on Merck's anti-viral.  It sounds like they stopped the study too early.

https://www.politico.com/news/2021/11/30/fda-merck-covid-pill-523565

Pfizer's option may end up far stronger if its numbers hold up.

And the first Novavax vaccine have been exported.   Might get the first actual vaccination soon!

https://www.reuters.com/world/india/indias-serum-institute-delivers-first-novavax-shot-through-covax-2021-12-01/

[The Anti-Targ]

5 hours ago, Deadlines? What Deadlines? said:

Told ya. 

Not only that, but NZ's regional parity is phenomenal. About 75% of them are over 90% and the remainder are very close. Parity by age cohort is also excellent. You guys are doing great on the vaccination front. 

We just crossed 93% actual first dose today. We could well get 95% as a Christmas present.

While I live in a fairly low population region with the population spread over quite a large area (for the size of the population - population density 0.4/km², 0.7/mi² ), just reading our local vaccination stats today there are only 3000 eligible people in my region who have not yet received their first vaccination dose. Percentage-wise we're at 93/84.

On the other side of the vaccination coin. One of our recent deaths was of a (locally in his region) well known retired journalist / editor in his 80s. He was not only an outspoken anti-vaxxer, but also a general pandemic denier. He got the COVID by being at a gathering attended by infected people, and even while he was getting some significant symptoms he was unrepentant about being anti-vax and made the comment "I have an immune system, you ever heard of that?". A few days later he was in hospital, not long after that he was dead.

[rotting sea cow]

10 hours ago, Impmk2 said:

As there's a pretty logical (and is somewhat backed up in the literature) correlation between average viral loads / tranmissibility / disease severity, it does follow that a less transmissible variant may also be somewhat attenuated as far as disease goes too. That's what I'm clinging to (and that celluar immunity shouldn't be effected) in the event we see the expected pretty extreme* neutralising antibody escape.

But after a couple years of this shit fully expecting the worst. Also there's the possibility Omicron could further evolve to gain the mutations known to give Delta increased fitness. And if it is antigenically distinct enough, the possibility of co-circulation with Delta comes on to the table.

Yep. The preliminary data doesn't look good at all (stress on preliminary). This has the potential to send us to square one in terms of transmission, but possibly there is enough immunity around to protect us from severe disease. Maybe also other mutations make the virus intrinsically less pathogenic. We will see soon enough.

Notice that the main bias here is the comparison with the low level of Delta transmission in South Africa, something that epidemiologists struggle to explain (see for example the exhausting wave in Romania vs the high level of transmission in the UK).

I tend to think that Omicron acquiring mutations similar to Delta to increase infectiousness is not going to happen (again knocking wood here). This hasn't been observed with other variants. Beta never got more infectious than Alpha. Delta never got so good at immune evasion. Even their offspring, like Alpha with the eek mutations, never took off and Delta+ doesn't seem a bigger threat than Delta-plain. I see somehow these variants as specialized species with little room for further evolution, whereas more generalist ones are better adapting to the new environment. Species tend to evolve under stress, not under periods of abundance despite that their environment is suitable for high reproduction (and mutation) rates. But, ok, virus might be different.

 

[Luzifer's right hand]

Daily positive cases are going down. The peak in the hospitals has not been reached the experts agree though especially because the voluntary unvaccinated are the group that ignores that other measures the most.

Austrian point of view here I'm aware the the overlap between anti-vaxxers and anti-maskers is not as big as in some other countries(not the USA or Germany though afaik).

[RhaenysBee]

We seem to be peaking as well. At least in terms of daily new cases. No decrease but no increase either and sewer samples indicate stagnation too. I suppose we’ll see if we start slowing down or there’s another upward jump in store for us in the upcoming weeks.