Get Real: no drug or vaccine will avoid a very big coronavirus epidemic | Hacker News Reader

Get Real: no drug or vaccine will avoid a very big coronavirus epidemic

blogs.sciencemag.org

197 pointsdaddylonglegs244 comments

I know Derek Lowe is an expert. However, sometimes, experts think that because things have always been a certain way throughout their career, they will always be like that. Drug development has been very conservative especially in the US for the past several decades. The FDA is all about making sure they never have a thalidomide incident and would rather lose a lot of good drugs than approve a bad drug. This is the steady state.

However, a global pandemic is more akin to wartime footing. During WWII design and production ramped up to an unprecedented degree. There is a possibility that Covid19 will spark such a global response.

`...would rather lose a lot of good drugs than approve a bad drug.`

Thanks for saying this, and rightfully so! Approving a bad drug in the world where distribution channels are very well set up could have disastrous effects.

We can point to things like the opioid crisis in the USA right now - a drug that is so addictive it should have never been put into use the way it was.

Also see thalidomide in Europe

Wow looks like there are still people around who suffered deformities because of the mistakes in approving thalidomide.

https://www.bbc.com/news/magazine-15536544

It's also still used successfully as a medicine for a number of uses.

I sure they take more precautions like make sure women who take the medications are not pregnant.

Yes, exactly. Seems better than a blanket ban. As pointed out elsewhere, the FDA is basically trying to keep dramatic risks/outcomes low, to maintain confidence in approved drugs, but tends to have a high false negative rate. What's interesting is that Vioxx was approved, but later appeared to have huge negative impact when it was given to large numbers of people (and apparently, it was also evident in the raw clinical trials data which was submitted to FDA).

It's an entirely non-trivial, multi-dimensional, systemic problem.

I don't understand the "rightfully so!" There is a real cost to not approving good drugs in order to avoid approving bad ones.

of course there is, it's just a lesser cost than the cost of approving bad ones

How can you possibly know that?

It's about psychology, not numbers.

the parent post referenced Thalidomide. a disaster like would seriously shake public confidence in medicine, across the board

The public seems able to understand that there is a cost/benefit tradeoff in driving cars. They could probably understand that idea in the case of drug approval also.

The anti-vaxx movement would like a word...

People accept the risk of driving because they feel like they're in control and can prevent a bad outcome. The same is not even remotely true about a drug.

I agree. I think this is why self driving cars will be difficult for society to accept. It's an odd topic because most people would never want to drive their own plane, yet willingly get on airplanes with some % chance they will crash.

The notion that there is some % of cars that will crash seems more palatable when you're the one driving rather than some robot. Or maybe that's just because I pretend I'm a better driver than the self driving cars. This sort of "I could do it better..." psychology is probably what drives these behaviors.

I can't build a better drug; .'. I trust that medical professionals will keep me safe. I can't fly the plane in a safer manner; .'. I trust that pilots will keep me safe. I might be able to drive in a safer manner; .'. I don't trust a self driving car.

> There is a real cost to not approving good drugs in order to avoid approving bad ones.

Do you have any evidence for this? Seems to me like a classic shibboleth of the pharma guild.

Not sure what sort of evidence you're looking for. There are certainly approved life-saving and other valuable drugs. If they had been approved sooner they would have had a greater benefit. There is an institutional bias towards avoiding costs due to approving a bad drug versus delaying approval and incurring unseen costs.

This seems like a difficult thing to test maybe even unethical. In order to detect the rate of false negatives you would have to re-test drugs that were shut down for being too risky.

It is a matter of diminishing returns already somewhat accounted for in the approval process. Cancer drugs are under far more lax standards given the alternative is death by cancer as even an ironically carcinogenic cancer treatment which gives it again later is preferred to dying of it now.

As opposed to a slightly better allergy pill which more caution may be afforded. Not perfect by any means but it isn't totally blind.

>Thanks for saying this, and rightfully so! Approving a bad drug in the world where distribution channels are very well set up could have disastrous effects.

Denialism's Michael Specter disagrees. Vioxx was one solution to the pain problem but 2.4% of participants showed heart problems when using it, so it was pulled off shelves. That's like saying no, 97.6% of the population can't have penicillin because 2.4% are allergic to it.

That’s about the current death rate of Coronavirus and there is panic so yeah

> Drug development has been very conservative especially in the US for the past several decades

That is actually not what I hear from people who know this stuff. In fact many are very concerned that the FDA is far too quick with drug approval based on weak outcomes. (Big recommendation: Follow Vinay Prasad on twitter, he's spot on on these issues.)

> During WWII design and production ramped up to an unprecedented degree

This isn't production, this is science. There's only so much you can do. You need to do trials to know if things work. You need people for that. If you want to test a vaccine you need to have an at-risk population that you can test and you need to wait till you get the results. Yeah, there are certain ways to improve that and do things faster. But only so much. There are hard limits. You can't develop a drug or a vaccine over night.

America did a lot of science to produce a nuclear weapon quite quickly once given the resources to do so.

It didn't involve clinical trials on humans. That's the one thing that takes time in medicine and can't be optimized away. You can't do medicine without clinical trials.

You can speed up clinical trials by running larger ones at earlier stages. This risks more deaths from bad medicines, which may still be worth it in a pandemic.

Though the people dying (or losing their friends and families) from the bad medicines might not see it that way.

When people are dying in mass numbers from not being in the trail though...

Large clinical trials require large numbers of patients, which thankfully we don't have, and also what we're trying to avoid.

If things get bad enough that this is worth the risk, we will have large numbers of patients

Human trials cannot be optimized away, but they sure can be optimized. For example, you can do away of IRB reviews, which require lots of effort on the side of researchers, take lots of time and heavily restrict what researchers can do, but which ultimately aren't necessary to run a human trials. Of course, IRB reviews have their purpose, and doing away with them altogether in normal times is most likely a non-starter, but in emergency pandemic time having drug earlier might justify lots of risk of harm to trial subjects.

> very concerned that the FDA is far too quick with drug approval based on weak outcomes

The current FDA requires strong evidence of safety, over a long period. Prasad etc are arguing the FDA should be stricter on efficacy. In a pandemic, it makes sense to lower your standards for safety to get new treatments out sooner.

This is required for good reason. It only makes sense to lower standards when there is going to be a realistic payoff. The general public place a lot of trust in the various parties to make the right decisions. Running with too much risk from adverse events is extremely problematic at different levels.

People in pharma and in authority (FDA and other organizations) are intimately familiar with the need to strike the right balance and have a lot more considerations than you seem to assume they do.

The FDA already allows lesser standards for efficacy for rare things. Which is why there are a lot of treatments for rare things - once you are on the market you can "wink wink" tell doctors about the more common thing you also work on.

Disagree - this isnt 22000 ad its 2020 ad - while we have technology, development of vaccines is still very slow, and of course, even if we did have a much faster process to develop such a vaccine, there is of course, the financials, politics, manufacturing, quality control, distribution, monitoring, etc infrastructure must be put into place.

Production of pharmaceuticals (such as a vaccine, when it's ready) and medical equipment (such as ventilators) can be ramped up by commissioning and requisitioning an arbitrary number of factories, but developing a vaccine is inherently a sequence of trials that can only be "multithreaded" between relatively few research teams trying different approaches semi-independently.

Ummm, not quickly. Vaccine production requires very sterile facilities which take time to build.

You do not want to be taking vaccines produced under non-sterile conditions.

Also, are you assuming that supply chains are intact? How are you getting the raw and the finished materials to build the factories?

Raw materials are not my concern - the industries that supply them can get all the people they need from others. You might find yourself demoted from programmer to some third shift factory labor job, but with a few weeks training you can do it (with okay odds that you won't lose life/limb from missing some safety item)

You are conflating raw materials with trained employees. Which brings up another barrier to scaling up production.

Raw materials: you need pipettes, chemistry hoods, etc, lots of specialized manufactured items, in order to build the production pipeline. Where do you get these? What if some of these components are manufactured in China, guess what is on hold?

Employees. Vaccine production is high-skilled work. It isn't trainable in just a few weeks even if you have reduced workplace safety standards.

Only 10-20% of the employees are highly trained. HR, finance, and other management functions are universal. There are a lot of highly trained people doing those other rolls, but they can be shifted back into the role they are trained in.

By putting 4x as many random people on the problem you can double the amount of work done, but that is about the max you can get.

China is well aware of what is needed, I expect they will let the factories making the needed specialized things run while nothing else does. N95 masks can be made avaiable to thsoe who need them which includes not just medical personal but also manufactures of pipettes. If you make something else stay home.

True, but we can speed it up a lot. There are a lot of researchers currently looking something else that be a great research assistant (I know you are a great cancer researcher - that means you have the biology background to be a lab assistant). Even those who don't have a medical background can do menial data entry tasks, or clean up tasks.

I agree, but the death rate of COVID-19 may not be high enough to justify a huge increase in risk tolerance.

You may be correct about the death rate, but the disruption that it's causing the global economy may change the calculus in the FDA.

We should risk people's lives because doing otherwise may harm the economy..?

Harming the economy is also a risk to people’s lives, though.

To what extent? Please expand because this depends on how people's lives depends on the economy.

You can take good measures that slows down the economy without endangering people's lives. Of course you can also consider social unrest to be a risk but that's another matter.

If people's lives don't depend on the economy, why don't we all stop working?

Wall Street and stock prices are detached from day to day life for most people.

"The economy" isn't just what happens on Wall Street.

Well, for one, I depend on the economy for my food. I also depend on it for my drinking water. Oh, and in winter, for my heat.

Leaving that aside, I've also found the economy helpful in providing me with clothes and shelter.

And when I have gone off in the woods and played survivalist (and yes, I have), I depended on the economy not only for much of the gear which enabled this, but also for keeping me safe from attack by other tribes while off in the woods. No-one was fighting me for a particular foraging/hunting ground.

So you’re in favor of policies that aggressively redistribute wealth to help mitigate such risks for the most vulnerable (the poor)?

Man, where have you been?

I'm not saying that, but I'm sure there are people in the Government who are taking that point when making these decisions.

Dearh rate for sever cases is huge.

We'll get the first test results at end of march/start of april.

If I have 30% chance of dying I take anything that lowers the chance significantly.

Even if the side effects are cancer in a year? Strong, consistent headache? Organ poisening? Permanent weakening of immune system? ...

And you would have to be very old and with strong preconditions, to have a 30% death chance with corvid-19. And then any side effects would be even more fatal.

Why would I get those side effects?

Remdesivir has already gone through safety trials years ago, it's in phase 3 now.

"If I have 30% chance of dying I take anythingmthat lowers the chance significantly. "

That's arbitrary. What's the death rate for severe flu? If I define severe to be "throwing a fever of greater than 42 C" it'll be really high.

flu mortality is about 0.1% though, like Covid, varies by age group/pre-existing. Also varies by strain/year

The parent's point is about the metric of "death rate for severe cases", which is ambiguous depending on how you define severe. You could pick a definition of severe such that the death rate is 100%, but that wouldn't be super useful.

The running trial gives the definitions, it's not ambigous as you wouldn't be able to run a Phase III trial without it.

That's true. A higher risk vaccine may be worth it for folks at high risk or with high exposure.

Risk tolerance should be seen as a sliding scale, not as a binary.

By the way, the DJIA lost trillions of dollars. That's like 100 Manhattan Projects ($20 billion adjusted for inflation).

EDIT: Don't know why I'm down-voted, but my point is that an extremely aggressive development project is easily justified if it can reduce the health and economic impact. 10 Manhattan Projects worth of effort to accelerate mass treatments, if it even just halved the economic impact, would easily pay for itself.

That's not the rate limiting step. It takes time to determine if the vaccine works. Getting this wrong would be disasterous.

Very true for example Mefloquine was developed by the United States Army in the 1970s

The obvious risk here is that you're combining a rush job with limited oversight, and large-scale distribution. So any mistake that would have been caught by the existing process will instead have the potential to roll into a global disaster.

Compared to 2% chance of death from the virus? I'll take a 2% chance of blindness over 2% chance of death for example. Of course we don't know what the odds are for the negative side effects.

like, for example, if the vaccine is made from chicken eggs and a non-sterile batch gets through because we scaled up the pipelines faster than what was safe...

BTW, your 2% chance of death is assuming you catch the bug (and that the 2% figure is accurate). vs a much higher chance that you take the vaccine.

Do you prefer a 0.02 * 0.8 == 0.16 chance of blindness over a 0.02 * 0.05 == 0.001 chance of death?

Nobody knows what the real numbers are, so it is pointless to ask that question.

2% might be the overall death rate if this thing keeps coming back until eventually everybody has been infected. Or maybe it mutates to be less deadly. Maybe the hypothetical vaccine is only a .2% chance of deafness not blindness - or a 10% chance of your little toe falling off...

Just to be clear, a 2% mortality rate does not apply to everyone. It hits the sick and old way harder. As a healthy person in my early 30s, my best guess for my own mortality rate is 0.4%. However, that does mean it is extremely dangerous for the elderly or otherwise compromised.

its time in logistics dude!

Your are making the same bad assumption that our President is making.

Let me clue you in,

Any idea how ,many test kits we need for 400 million?

400 million for one time use but there will be more than one time use...ie more than 400 million.

any idea how much money it takes to get just 40 million test kits out to Americans for free?

One Billion dollars...

Now here comes the logistics bite in the ass.. how many trained US Health Public Service workers do we have skilled in showing how to use such test kits?

Oh damn Trump cut CDC funding and public health funding...

It snot rocket science if you cut public health funding than you cut the very fabric of the future response to such an epidemic in the first place..ie cannot spend even the demo price of 7 billion to immediate fix no immediate fix is there its been cut already!

Rant mode off

Your statements about the FDA are way off mark. There's plenty of very dangerous drugs in use now riddled with misinformation around their safety. Fluoroquinolones and statins are some of the worst offenders with terrible irreversible cumulative side effects and the fda barely has done anything for them. Many in the know believe they're conplicit on the matter since those drugs go out to basically everyone now at some point.

I feel like I should mention SV40 now https://en.wikipedia.org/wiki/SV40 When you do mass inoculation the last think you want to do is rush something out the door that could cause even more problems. Granted SV40 did not harm much at all, depending on who you talk too.

The article makes it very clear that he is speaking of the immediate forecast (next 3-6 months) not the longer term (6 months to 1 year or more). The virus is already all over the globe, so technically it's already edging near a pandemic. The question to ask (and the article asks it) is do we have something that will materially alter spread in hand today or at most within the month. If the answer is "No" then the virus is likely to spread. "No" is a correct reading of the facts as they stand today.

This isn't about FDA conservatism or anything like that, it's "what do we have in hand?" No matter how promising current experimental treatments might be (perhaps Remdesivir will work well), they WILL NOT stop the spread in the short term. They WILL MAYBE help with treating acute cases and lower fatality rate. Still, good confirmation is a few months out, so for March/April we're still looking at very little.

The only therapeutic that could stop the spread is a vaccine. That's even further out, they're just starting some tests, but it's not going to be ready for wide deployment for another year. You don't want to inject things into healthy people on a massive scale without doing a few controls.

All of these approaches suffer from production questions too: it takes a while to ramp, but yes that could be helped by a massive effort.

In short, wash your hands. A lot. Don't touch your face. If you're sick, quarantine. In 6 months we'll hopefully be better equipped therapeutically, but don't expect that to solve the immediate problem.

The Pandemrix vaccine against the latest pandemic (the swine flu) caused narcolepsy in some individuals -- seemingly with a propensity for affecting young people and possibly related to the choice of adjuvant.

We're in a similar situation now. Early vaccines may have side effects and a forced introduction of a vaccine may increase the risk.

Lowe was a proponent of intravenous vitamin C under a specific set of circumstances for immune response during oncology (https://blogs.sciencemag.org/pipeline/archives/2020/03/02/vi...), and in China and Korea claims are being made that similar intravenous (not oral therapy) has positive results: (https://www.youtube.com/watch?v=6-elCYFhqJs&feature=emb_logo) and (https://clinicaltrials.gov/ct2/show/NCT04264533)

It would be ironic if the most overhyped supplement of all time had efficacy here.

Yes. It is worse than a regular flu. But, if you look at statistics from S. Korea, the only country with a substantial infection and trust worthy numbers (as in they test heavily), the death rate is around 0.6% overall. So not the end of the world, but nothing to be complacent about either. If the White house will get out of the way and let the system work, we may still have time to mitigate the worst here in the USA. But of course, we don't even want to cancel SXSW. What more needs to be said? <insert Darwin thumbs up gif >

Addition: No, I "trust" the reported numbers from Italy. I think they are missing a lot of mild cases that are not being reported or tested. When I checked a few days ago, it looked like of the tests that South Korea ran, only 5% or so were positive. So, their infected numbers are probably more accurate. The death rate may still be higher, because we don't know how many in the infected population as of today will recover. One could for example calculate the death rate as [Number_of_deaths.today]/[Number_infected.x_days_ago] I don't really know the "x" to use in this circumstance, but just using 7 days (since a lot of deaths occurred in 7-9 days from positive detection), the death rate may be about a factor of 2 higher. So about 1% overall. I have been looking at so many different sources in the last few days, I can't seem to find the sites where I got the numbers for the above calculations from. So I might be off by a bit.

You don't trust Italy with their numbers?

Last time I checked it was around 3% there.

https://www.aljazeera.com/news/2020/03/coronavirus-deaths-ch...

In the linked figure in the article, the SK tests have about 5x more per million people so their denominator is likely a better idea of the true number of cases.

I don't disagree with the idea that the total number of cases is unreported but the WHO said yesterday it's actually 3.4% globally.

https://www.cnbc.com/2020/03/03/who-says-coronavirus-death-r...

The WHO is reporting the Case Fatality Ratio. This is a well defined number, just not a very useful one in the early stages of an outbreak.

You're making a somewhat dangerous mistake in your analysis. South Korea's death rate is not well established yet: 7% of their cases were new just in the last day, and they've had very few people with confirmed recovery yet. There are likely to be more deaths to come.

Agreed. I had tried to account for it, but did not write it since I was hoping to avoid a longer comment and those calculations are more fraught with errors.. Edited my parent comment now to include all of it.

To correctly analyze the morality rates you have to take a lot of things into account: hardly anyone is being honest (South Korea is better, but not perfect), testing is rate limited, death rates are a lagging indicator, etc. etc. etc.

Lots of experts have made guesses with these assumptions factored in, but at this point, there is so much uncertainty it's hard for anyone to tell.

So some comments here say 60-70% global infection [0] and 3-4% death rate [1]. Is this really possible? That would be like ~150 million deaths.

0, https://news.ycombinator.com/item?id=22485485

1, https://news.ycombinator.com/item?id=22485692

It could be worse than that once the hospitals are overloaded / out of equipment needed for artificial respiration. From the numbers coming out of China ~20% of cases are "serious," ~5% "critical."

"if" we get to 70% of the world contaminated and "if" the death rate really is that high globally then yes the maths checks out. But that's already a lot of "ifs".

Outcome of critical cases is heavily reliant upon whether the medical system can handle the number of infected. If someone requires a ventilator and you're out of ventilators they're kinda fucked. There's also evidence that lots of people show little to no symptoms. There's probably a large number of people that simply don't know they had it. Which is both good and bad.

If we manage to keep it from spreading too far too fast, from the variety of studies I've seen then anywhere from .5% to 1% is probably more realistic. But if we don't, expect something higher. This is why waiting for "enough" people to die as evidence of severity, then responding is a poor response.

FWIW the Spanish Flu infected 27% of the world's population. 60-70% seems really high.

Commercial aviation had barely begun when the Spanish Flu occurred, and the world was nowhere near as connected.

I have personal reasons to hate the current administration. However, even an incompetent government is better than no government during times like these. I hope we can stay united in our plight against the common enemy.

I've edited the sub-title (that I added) from "no COVID-19 drug or vaccine in the short term" to "no drug or vaccine will avoid a very big coronavirus epidemic." The author or magazine nailed their colours to the mast with the title "Get Real," so I think that should stay in the title. Lowe doesn't use "COVID-19" or "SARS-CoV-2" or "nCov" in the article so I've used "coronavirus epidemic."

I did not expect the title detract from the discussion to the extent that it has, sorry.

Scientific agreement seems to be that ~60-70% of the population will get infected. It is just not sure if within months or (hopefully!) years.

And no drugs within at least one year.

Edit: Source => Original in German here: https://www.sueddeutsche.de/gesundheit/krankheiten-experte-e...

Express UK translated it here: https://www.express.co.uk/news/science/1249963/Coronavirus-n...

The guy interview is Prof. Drosten. He is the co-discoverer of the SARS virus, and is one of the top 10 guys in this field.

PS: Sorry for not adding the source right away.

Sources? It seems far too early and there isn't enough reliable observational data, much less scientific trial data, available for broad "scientific agreement".

Although obviously the accuracy of China's data is in question, it's promising that they were able to get the reproduction rate below 1 pretty quickly. And within Wuhan itself the spreading seems to have slowed with something like 0.6% of the population of 11 million infected.

Not to mention in China outside of Wuhan/Hubei, which have conditions much more similar to most of the rest of the world in having some advanced warning of the virus, the spread seems also to have slowed down at a much much lower infection rate.

Based on this information it's not clear to me where the "40-70% of the world getting infected" idea is coming from, though I've seen a few headlines reporting that too.

Source added in my post above. The number comes from this guy: https://www.charite.de/en/service/en_person_detail/person/ad...

Wuhan is your reference? China too? Aren't they putting pretty severe quarantine in Wuhan? Aren't their quarantine outside of Wuhan still quite strong?

The Diamond Princess had a quarantine, and yet the infection reached 706 peoples, in a boat with 3711 peoples. Sure that's "only" 20%, but that seems to me like 40% isn't that far out if we are considering that it's hard to quarantine a whole country.

The timeframe is important too, as long as we don't have developed any vaccine, the only way to develop immunity is by being infected... thus if the virus spread that easily, it's only a question of when will we reach 40-70%, not if.

Yeah I’m in Beijing now and there’s no way most of the world could implement this kind of quarantine. I can’t leave or come back home without presenting a special card at the gate of my apartment complex.

But it’s working, and at this point I’d rather be here than in many other countries.

Will definitely need to link to a source that specifically mentions the 70% figure to stop the downvoting.

I have not seen speculation like that only numbers about the virality and mortality rate (both much lower than that)

Source added, excerpt here:

Professor Christian Drosten from the Charite clinic in Berlin, Germany, estimates the virus could infect up to 70 percent of the world or 5.2 billion people.

He said: “Presumably between 60 and 70 percent of the people will get infected but we don’t know in what timeframe.

“It can be two years or even longer. It will be more problematic if the infections occur in a short amount of time.

“That is why authorities are doing everything to recognise the origin of infections and slow down any further spread of the infection.”

According to Professor Drosten, the coronavirus epidemic could even match the Asian flu pandemic of 1957 and the 1968 flu pandemic, which began in Hong Kong.

In the former case, the Asian flu is estimated to have killed between one and two million people.

Professor Drosten said: “If the whole pandemic process lasts two years, we will manage.

“If it is only a year, it will be much more difficult because many more cases will occur all at the same time.

“The necessary number of beds for patients requiring intensive care unit therapy is difficult to predict.

Presumably between 60 and 70 percent of the people will get infected

Professor Christian Drosten, Charite clinic

“If we don’t do anything now, they may not be enough.”

It's important to know where the 60-70% number comes from. He's basing it off of the evidence that the virus spreads at a ratio of 1:3. So every infected will spread it to 3 others and a pandemonium will only last as long as it can spread to >1 other person. Therefore, if 2/3 (66%) of the population is infected (hence immune), the virus won't be a pandemonium anymore. He's also assuming that nearly everyone will be infected at some point in time.

Source: NDR podcast 02.03.2020 @ 11:55

https://mediandr-a.akamaihd.net/download/podcasts/podcast468...

You linked to the estimate of one scientist. It's stretching things to say "scientific agreement" with the implication that there's a consensus in the narrow band of 60-70% based on a data set of one.

I've seen estimates quite a bit lower than that, like 20%.

Although it is disturbing that 20% is about the lowest estimate I can recall seeing. I don't believe there are many (or any) scientists saying this will be a minor blip that only infects 1% or fewer. And 20% would be devastating, let alone 60-70%.

For those suggesting that a COVID-19 vaccine can somehow be fast tracked, consider what happens if something goes wrong during deployment to the population.

The US has an active, very vocal anti-vax community. They've been growing and gaining ground for decades.

The first sign of trouble of any kind with a new COVID-19 vaccine would result in a backlash of biblical proportions. It could be so strong as to derail any attempt at a follower.

For this reason, I expect to see two things:

1. withering pressure from the current administration to cut corners on testing any new vaccine

2. a good chance for disastrous consequences resulting from (1)

Vs what? a million dead? They might have some opinion on whether its worth risking a black eye for a quick vaccine.

I believe OPs point is about considering the longer term effects. If we prevent a million Covid-19 deaths with a rushed vaccine, but the vaccine kills even a few people and brings anti-vaxx into full swing and we get a nationwide diphtheria outbreak instead, are we really coming out ahead?

And as evidence, there are numerous known bad side effects from prior rushed vaccines. The risk is very real.

I think a much more likely scenario in the event of a bad plague would be that angry mobs will put anti-vaxxers up against the wall and shoot them.

(I am NOT advocating this! Looking over history that seems to me to be a more likely reaction.)

Then again, the longer we wait to deploy a vaccine, the more likely a novel strain will emerge and make itself endemic and seasonal like the flu, in need of yearly vaccinations and persistently high CFR.

I hear more people talking about anti-vaxxers than I do from any actual anti-vaxxers. I don't think they are all that powerful.

Huh. Wonder where you heard this?

Perhaps you missed the recent American Academy of Family Physicians survey on the topic?

Here is the NBC recap: https://www.nbcnews.com/health/cold-and-flu/millennials-leas...

This survey did not find that anti-vax had a meaningful impact on vaccination rates. The NBC article is poorly written and misleading.

They're powerful enough.

https://www.theguardian.com/us-news/2019/nov/16/vaccines-mea...

> More than half the states in America have seen a decline over the past decade in the take-up rates among kindergarten children of vaccines against diseases such as measles, mumps, hepatitis B and polio, as unfounded anti-vaccination theories have spread.

> The measles, mumps and rubella vaccine (MMR), which is the focus of much activity by the so-called anti-vaxxer movement, is especially vulnerable. Alarmingly, the study finds that more than half of the states – 26 in total – have vaccination rates that have fallen below the target of 95% which experts state is needed to provide maximum protection against the diseases.

> first sign of trouble of any kind with a new COVID-19 vaccine

Like what?

Vaccines do not cause autism.

Like serious side effects? If you want to vaccinate virtually the whole world and your vaccines turns out to have serious side effects in 1% of people because you rushed its development and didn't go through the regular extended long term tests it wouldn't be that good

> Like serious side effects?

Like what? What can a vaccine do that's worse than a pandemic?

Anti-vaxxers aren't rational people rationally concerned about real side-effects of vaccines, they are superstitious fools who think vaccines give kids autism. (There is NO scientific evidence for this idea whatsoever.)

Remember the Mayan Apocalypse? Remember how everybody stopped talking about it about fifteen minutes after midnight on Jan. 1st? That's what will happen to anti-vaxxer BS if^H^H when a real plague hits.

The original rotavirus vaccine caused intussusception. Vaccines are not magical risk free things, even if they don't cause autisim.

There's a reason we say "risk vs benefit". Current vaccines clearly fall under the reward part of that. A new vaccine? Who knows. That's why you have to test.

Right, I get it. I agree with everything you said. You are rational and correct.

However, none of that is to my point.

The OP said, "The US has an active, very vocal anti-vax community." and then said "The first sign of trouble of any kind with a new COVID-19 vaccine would result in a backlash of biblical proportions. It could be so strong as to derail any attempt at a follower."

That's what I am objecting to, I don't think that anti-vaxxer superstition would be increased by a bunch of scientists saying, "yeah, there's a side-effect" because that's not superstition, eh?

I'm finding it hard to articulate my point, which is weird because it seems to clear to me in my mind.

I don't think the masses would chuck science in the bin and huddle in fear, unvaccinated, waiting to see if they live or die from covad, just because there is some side-effect of the vaccine, unless it was somehow more horrible than, uh, huddling in fear, vaccinated but with some side-effects, waiting to see if they live or die from covad.

I'm in Italy, and we had a very vocal no-vax movement in recent years. Since coronavirus they disappeared

This post has 164 points and 204 comments in 3 hours, and is on the second page?

Do I fundamentally misunderstand how this works?

Yes, HN heavily penalizes posts with votes lower than number of comments

alright, thanks.

Check out hckrnews, It's Hacker News but sorted chronologically.

How does this differ from the "new" link on vanilla HN?

just HN, this is not javascript

Virtually every COVID-19 story here for the last month has suffered the same fate. I suspect there’s a dedicated group of users here who think this is no big deal and are flagging every mention of it.

a vaccine might be 18 months away, if we're lucky and divert resources to the effort. if we're unlucky, it could be four to five years or even longer. remember, there's no guarantee that we can even make a vaccine for any arbitrary viral disease. we can't do nothing while we wait for a vaccine.

placeholder antiviral therapies are also a non-starter. we can't manufacture the drugs at the scale we need them unless we massively expand our production capabilities, and that takes time as well as money.

---

as things stand currently, there has been no substantive response by the US federal government to the coronavirus which will lead to the lessening of infections or mortality.

china and south korea both explicitly stated that they were transitioning to wartime footing to combat the virus. we need to follow in their footsteps. we need billions of dollars in spending, suspension of normal daily life, and requisitioning of the necessary resources from private entities if needed. and we need to do this today. now. this afternoon. preferably before 5 PM. this isn't a problem to be left until tomorrow.

yet we're still here, conducting life as normal as the infection reaches the exponential part of its spread. people are still going to work, going to church, and riding the subway. hospitals and prisons don't have any special measures in place.

we aren't even testing people after weeks of knowing that we are at risk for local transmissison. we have no extra resources queued up. as of today, our congress can't even agree to pass a funding bill to combat the disease. we have no leadership, and it's going to kill quite a few people.

if you think i'm being "alarmist", please revisit my here comment in six months, when we'll have a clearer idea of the death toll. i don't know if this virus will kill a million americans, or only a few hundred. either way, if we act with more vigor over the last few weeks, i can say with confidence that more people will live.

I totally agree with you.

>china and south korea both explicitly stated that they were transitioning to wartime footing to combat the virus. we need to follow in their footsteps. we need billions of dollars in spending, suspension of normal daily life, and requisitioning of the necessary resources from private entities if needed. and we need to do this today. now. this afternoon. preferably before 5 PM. this isn't a problem to be left until tomorrow.

This won't happen in North America. As a Chinese who reads Chinese and English news sources everyday, it appears while China is very heavy handed in censorship for anything coronavirus related, in NA there is too much misinformation floating around, to the point that people cannot agree on anything. Specifically western media have been producing outrage porn for clicks around Covid 19 for a while, resulting in much misinformation on how China's measurements in combatting the virus are inhumane and in violation of human rights, that even talking about those options will bring so much negativity into the discussion. Apparently inaction and incapability of the government and every one only takes care of themselves are not human right violation.

Even we don't have a cure, slowing down the spread is a huge win in for the healthcare system as a whole.[1]

1. https://www.vox.com/2020/3/2/21161067/coronavirus-covid19-ch...

Unfortunately, while that may be what's needed, many do not trust the current administration to execute on such extreme measures properly or appropriately.

Most comments seemed to be responding to the title, which misses the point. The title is quite editorialized.

The real point of the article is that there's no drug or vaccine in the works that will be able to prevent the impending U.S. epidemic, so don't pin your hopes on them.

I'd go so far as to suggest a new title of "Get Real - Drugs and Vaccines won't Prevent a U.S. Epidemic".

its too late to prevent an epidemic in most places

there is no star trek solution that will suddenly prevent epidemic anywhere that is apparently free of virus for the time being.

the virus is not so lethal as to justify suspension of safety and efficacy trials. the potential to kill far more people with a mistake than the virus would kill, is very real.

I see a lot of panicky comments, both in real life and in this very thread.

I know COVID19 is different from a regular flu, but is it more serious? "Regular" flu is very contagious and kills lots of people every year. It's ok to study coronavirus and to try to find ways to effectively manage it, combat it or prevent the disease -- but why are we panicking? Nobody panics about the flu and it's proven to be fatal for a lot of people every year. Why the panic with coronavirus, why are people in this very thread worrying about "the death toll"? Is there any projection that the death toll is going to be higher than usual for a flu?

For what it's worth, my doctor told me "it's like a flu, don't worry". A doctor friend of mine told me the same.

The death rate of COVID-19 is at about 3.4% on average. In comparison, the death rate of seasonal flu is about 0.1% in the US. No, it is not "like" the flu.

https://www.cnbc.com/2020/03/03/who-says-coronavirus-death-r...

Thanks for the reply. So my doctor is wrong then? (It wouldn't be the first time...)

"Globally, about 3.4% of reported COVID-19 cases have died"

The keyword here is reported. We don't know how many unreported cases there are, it could be 10x the reported ones. In the US it's much more than that, given that almost nobody has been tested. We have 9 deaths so far and probably thousands of infected people.

https://en.wikipedia.org/wiki/2019–20_coronavirus_outbreak#/...

Also, the death rate is 1.6% outside of China

* https://en.wikipedia.org/wiki/2019–20_coronavirus_outbreak#D...

I think most doctors make it a point to instill calm in their patients. And, the nature of their work is that they have likely dealt with emergency situations and dying patients, so they have seen the worst and have to have a way to handle these things. So they are coming from a different position than you, perhaps (maybe, maybe not).

Symptom-wise, as far as I can tell, COVID-19 can be similar to the flu. Especially for most people, who may not have much in the way of symptoms. So your doctor isn't wrong per se. But yes, the deadliness of the virus is much higher, unfortunately. So it is not quite similar in intensity, and it is a serious thing.

To be clear, the article says "Globally, about 3.4% of reported COVID-19 cases have died." The issue is with reporting (the denominator). The bar for "reporting" COVID-19 positive is very high relative to the flu, especially as some countries (ahem USA) don't / didn't even permit testing of all symptomatic patients.

So yes maybe it is orders of magnitude more deadly than the flu but it doesn't seem clear at all that we have sufficient information to say that it is 3.4%

Not just the US. Crucially, Wuhan and I think also the rest of Hubei pretty much only tested patients who showed lung abnormalities on CT scans, so only the more severe cases were diagnosed. The WHO knows this. In fact, they've been appearing in the pages of the New York Times and anywhere else that'll have them and gushing about how great this Chinese testing methodology is and how everyone should copy it.

They test much more widely but only those with pneumonia are counted as confirmed. But this is a viral pneumonia. So the undercounting is not that much.

It was 1% in diamond princess, and cruises are known to be full of retirees so it should be a lot lower than that in the general population. I believe the reason it looks so high is severe lack of testing.

it wasn't anything in the diamond princess. The diamond princess is ongoing, and the rate of hospitalization is more important if the infection rate becomes too large.

3.4% of reported cases have died. That doesn’t mean the actual IFR is 3.4%.

Data modeling suggests it’s closer to 0.98%. It’s also important to note that age plays a significant factor. The IFR is about 0.2% for young healthy people, while it is quite dangerous for people over 60 with existing conditions.

https://institutefordiseasemodeling.github.io/nCoV-public/an...

Thanks! That's interesting. I suspected there's a methodological flaw in assuming actual death rates from the sample of detected cases who died.

We need this voice of reason. Otherwise we're just panicking.

Just curious, what is the mortality rate of the regular flu for young healthy people?

For US adults ages 18-49, it varies (depending on the severity of flu strains) between .01% and .02%.

https://www.cdc.gov/flu/about/burden/2016-2017.html

0.98% seems to assume your medical system doesn't get overloaded:

> evidence to date points toward 2019-nCoV having the potential to have comparable severity to the 1918 flu pandemic in the absence of effective control and treatment, when averaged across all ages.

Early detection and isolation is key. Much of the world seems to be doing a poor job of it, and that is what is causing people to be concerned.

.2% if you are 30, .2% is greater than your cumulative risk from driving. It's a huge risk.

It's still a very small number.

BTW most of the deaths caused by the flu are not direct deaths.

It kills about 10 thousands of people a year in Italy (58 millions residents) while covid-19 has killed only 59 people and recovery rate is very high

Meanwhile pneumonia alone in Italy kills 13 thousands people/year

The real difference?

With the regular flu people stay home and die there, with this one they are being taken to the hospitals, even if there are no symptoms, and the healthcare system is under a lot of pressure for that

Draconian measure are just for that: avoiding a total crash of the healthcare system

It's 1-2 orders of magnitude more deadly than the flu. Some estimates are between 2 and 4% fatality rate for the Covid-19. Flu is 0.1%.

That fatality rate average masks that it is far deadlier for the elderly and high risk patients, with as much as 10-20% fatality rate for that demographic.

Thanks for the reply. What is the fatality rate among the elderly and high risk patients for seasonal flu? (say, in the US if there are no worldwide statistics).

I understand the real problem with any flu-like disease is precisely with the elderly and high risk patients. Usually, of course there are always cases of healthy people who die from a flu.

https://www.worldometers.info/coronavirus/coronavirus-age-se...

These are worldwide statistics. Breakdown is by age, but I don't recall if there's other categories.

Somewhere around 1%. The 10x multiplier on fatality rate seems to be fairly consistent across age groups. Note that the CFR for this virus is still largely unknown, and is vastly different in different regions.

https://www.cdc.gov/flu/about/burden/2018-2019.html

you are getting that number by dividing reported infections by reported deaths.

The reported infections number is not accurate. Its a major underestimate of the actual number of infected

Spanish flu was also "just a flu" and killed between 17 and 50million people world wide

Covid19 is more contagious and more deadly than "regular flu"

But that's what I'm saying. The flu is already a serious deal and nobody panics.

In any case, surely there are some differences between the 1918 world of the Spanish flu and the current world, both in actual medicine and what we learned about how to manage contagious diseases? Maybe the Spanish flu today (I mean, if it started today and hadn't happened before) wouldn't have as many victims.

On the flip side, we're traveling farther in greater numbers than in 1918.

1918 was the height of ww1 btw.

1. It is both more contagious and lethal than flu. There were estimates that 40% to 70% of the world population will eventually get infected. Depending on how the world responds to this - millions might die.

2. This isn't flu. The same amount of people will die from flu this year as last year. COVID-19 deaths are additional deaths on top of that. Saying that we shouldn't worry about it because every year many of people die of flu, is like saying that we shouldn't make a big deal of the 2004 Indian tsunami because many people die of drowning anyway.

To be clear, I'm not saying we shouldn't worry. We should worry about the flu too. And if COVID19 is more dangerous, we should definitely look into it.

I'm just questioning the panic-mongering. We should be scientific about this, not panic like those guys in the media.

Apparently it's quite a bit more infectious. This coronavirus is something like 1:2.5, whereas the typical flu is about 1:1.

People do worry about the flu, too. This past flu season in Australia was particularly rough, and it was all over the media. It came up in day-to-day conversation.

Part of the reaction is political, too, ostensibly to appear to be actively doing something, e.g., Los Angeles declaring an emergency for 9 infections.

Seasonal flu has an R0 value of ~1.2 [1] while the estimate for COVID-19 was estimated at 2.2 [2]. This can be interpreted as each person infecting 2.2 other people vs. 1.2, the spread of the virus will probably be exponentially faster.

1: https://bmcinfectdis.biomedcentral.com/articles/10.1186/1471...

2: https://www.ncbi.nlm.nih.gov/pubmed/32097725

The coronavirus is a magnitude deadlier than the flu, according to all studies I know of that attempt to estimate the Infection Fatality Ratio. The IFR is estimated between 0.5% and 1.6% which is between 5x and 16x deadlier than the flu (0.1%): see links to the 4 studies at https://blog.zorinaq.com/case-fatality-ratio-ncov/#updates--... Given that the flu kills half a million per year, I'll let you image how many could be killed by a disease a magnitude deadlier... But of course the death toll will depend on how the world reacts to the outbreak. If every country implements measures as severe as China by locking down most major cities worldwide, we may limit damages.

Incidentally, the upper end of this range makes COVID19 comparable to the 1918 Spanish Flu (IFR ~2%) according to experts (for example see https://institutefordiseasemodeling.github.io/nCoV-public/an...). And keep in mind the IFR, unlike the CFR (Case Fatility Ratio), is the metric that takes into account undetected mild or asymptomatic cases.

The real danger here is that far fewer people will have immunity to this because it is novel. This means that if we aren't careful the infections could snowball and serious cases could overwhelm healthcare infrastructure. This would lead to the tragedy of people dying not just because they were basically bound to but because there wasn't enough care to go around. 1,000,000 people infected over 3 months looks a lot different than 1,000,000 people infected over 18 months.

Available data points to it being more dangerous than the flu, especially to the elderly and immunocompromised. Your doctor might have been talking about the danger to you in particular, which is very low, similar to the flu, if you're young and healthy.

A single individual getting coronavirus isn't a big deal. Chances are they will be fine.

The problem is that it's very infectious, R0 could be 6+ where the flu is about 1-2. That means it's 3-6 times more contagious than the flu, so it spreads very very quickly.

At the same time, it causes severe symptoms in 15-20% of cases. When these people have access to medical care, they will likely survive. But if they don't get access to timely health care, they might die, which is what happened in China.

The problem with both the above is that you will get many, many people infected all at the same time, and you might get a few hundred people with severe symptoms in a small city. That's enough to overrun several hospitals all at the same time. The US has about 2.5 hospital beds for 10,000 citizens, which is 31st in the world. Japan and Korea have over 12 per 10,000 citizens. the top 2 in the world. And the patients that get severe need ventilators which are even less than this.

Once the hospital beds are filled, people start dying, which causes panic. Then economies will start to suffer because no one will eat at restaurants, people will panic at Costco like we've seen, businesses will go out of business.

People forget that this is simple math. Coronavirus will spread very quickly in the US and across the world. And many people will die and all hospitals will get overrun. What we need is at-home treatment and to somehow get people to avoid getting severe symptoms. If warm summer weather decreases the R0, then we might be able to avoid it, but some parts of the Northern Hemisphere are still in winter and won't be warm for at least 2 months.

where are you getting the info to say only 15-20% percent of the cases show symptoms?

I believe reading that 14% of cases are severe, so it sounds roughly accurate. I think a lot more show symptoms, though, even if they're mild.

15-20% show severe symptoms, not just "symptoms". 80%+ show mild symptoms or are asymptomatic.

I believe the only thing a hospital can offer is a ventilator -- in the worst cases, the disease slashes your lung capacity and a ventilator will keep you oxygenated.

Hospitals will only help if you feel like you can't breathe (and we do not have anywhere near the amount of ventilators that we'll need for this), so the vast majority of people should self-quarantine, take pain killers for fever and wait for it to pass.

Why do people say that warm weather will help, when there are many cases in tropical countries now?

Something to consider: even if it was "just like a flu" (which it isn't, enough commenters already pointed out the differences, but let's just for the sake of my argument assume that it was), it is a matter of fact that this would then be a "second flu" going around at a time at which doctors and hospitals are already well-loaded with caring for patients that have more serious trouble with the "real flu" that happens to be at the peak of its activity just at the same time.

The "real flu" is relatively non-deadly for most people (even though it still kills a lot of people in absolute numbers) precisely because the healthcare system is capable of providing care to those requiring it because of the flu. It can do this because the flu is a relatively well-understood phenomenon, it comes every year, and although the exact mutations of the virus differ between the years, the overall characteristics of the outbreak are relatively well-known in advance. There are also vaccines against the flu (these are a big thing in allowing the personnel in the healthcare sector to do their work, which of course exposes them to flu patients) and there is medication available that's able to quicken the recovery. Nevertheless, the flu still puts a lot of strain on the system, and having a "second flu" of entirely unknown characteristics going around, possibly even infecting the same patients, for which there is no vaccination and no medication at all is not exactly a thing to take light-hearted.

I would not be surprised at all if the "real flu" would later be found to be much more deadly this year than in the years before, not because the virus was any different than before, but because the additional strain due to COVID-19 negatively impacted care for flu patients.

Thanks. The overloading of the healthcare system, which you and others mentioned, is something I had not considered. It makes sense that two flu-like[1] virulent diseases at the same time can overload it and that it would be a very serious matter. I still think panicking is not the answer, but I'm now convinced it's a more serious matter than I first thought.

[1] for the sake of argument, even if coronavirus is not actually similar to any flu strand. I'm not a specialist and I cannot tell the actual differences.

Looking at this thread as an interesting datapoint. Typically HN is thoughtful, well reasoned, and well informed. This thread is not holding that same level.

Wonder what this says about the level of concern over this bug.

This has been true of every HN thread in the past week or two relating to COVID-19. The typical objectivity you see among the usual audience has disappeared.

ok, so I'm not the only person seeing this.

Concerning.

Thanks for sharing.

I read on so many different places on the internet, and I have no idea where this is going. HN is very panicky, 4chan is the same or really in the post-apocalyptic stage. Reddit is extremely conservative / non-panicky (maybe because anything else gets banned). Newspapers and traditional media are all over the place with their panic levels. I don't know what to make of this.

It says approximately nothing unless you're somehow tracking individual users' behavior over time.

- - - -

Don't panic.

Stay home and encourage others to stay home. We can't stop the virus (yet) but we can slow it down and buy time.

"The only way to fight a pandemic is decency." (I'll link to the source if I can find it, I think it was an article in the Atlantic that went by here on HN this week.)

Yes, this is the time for increased concern for your neighbors.

And yes, avoidance behaviors will dramatically slow community spread.

Is it the case that SARS (of many years ago) had a vaccine developed for it, but it had too many side effects or was not effective enough to get past trials?

And that while this virus is different it is similar in many respects... leading me to think that a vaccine may also be difficult to produce.

Yes, the SARS vaccine virtually guaranteed severe lung scarring if you were re-exposed to full-strength SARS:

https://journals.plos.org/plosone/article?id=10.1371/journal...

Would this also the case if someone who had SARS and recovered was re-exposed to SARS?

There was is one paper[0] where 4 candidates were tested on a number of animal species. In all but one variant, immunity was successfully conferred by the vaccine.

However, in all successful cases, the vaccines triggered some sort of autoimmune response wherin upon exposure to the pathogen post vaccination, lung damage resulted[0].

Now I believe this has something to do with another nefarious speculated property of SARS-CoV-2: Antibody Dependent Enhancement (ADE). Can't find the original source but here[1] researchers also speculate about ADE. The gist is that your antibodies, instead of neutralizing the virus, actually enhance its ability to enter your cells[2]. I don't know if this is confirmed, but multiple sources have made the suggestion. If this is the case, typical vaccines actually may be dangerous. Now I'm not not an expert but I believe there is a way to create a vaccine which avoids ADE, but AFAIK that hasn't been done for the previous SARS strain. This was a problem with MERS too btw.

0. https://journals.plos.org/plosone/article?id=10.1371/journal...

Credit to user daxorid for the link.

1. https://www.virosin.org/fileZGBDX/journal/article/vs/newcrea...

2. https://en.m.wikipedia.org/wiki/Antibody-dependent_enhanceme...

By the time the SARS vaccine was nearly completed testing, the outbreak had burned out.

To be fair, it's possible that we discover that an existing, already-approved drug or treatment is more effective at reducing the death rate of people experiencing the worst symptoms than what we're doing now.

A vaccine is probably very far away, though.

Given that this is so similar to the previous SARS epidemic, how did that whole thing eventually end? Was a vaccine created? Did it just naturally fizzle out?

Summer hit the Northern Hemisphere.

So how likely is it that when summer comes the same will happen with the current coronavirus epidemic?

It's summer in Brazil, and other southern countries, so we can just watch them and see.

This theory is silly.

SARS spread in Singapore, where the average high temperature stays at 87-90 degrees twelve months out of the year. They don't have a winter/summer cycle.

SARS was stopped because infectious people were readily identifiable by checking for a fever.

SARS, while more deadly, was harder to spread, so in the end it was able to be contained.

The key may not be a vaccine but simply staying alive. Covid-19 kills with a "cytokine storm":

cytochine release syndrome(cytokine storm):

https://en.wikipedia.org/wiki/Cytokine_release_syndrome

Article discussing coronavirus et al and cytochine storm:

"Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China"

https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

From the article:

"In view of the high amount of cytokines induced by SARS-CoV,22, 24 MERS-CoV,25, 26 and 2019-nCoV infections, corticosteroids were used frequently for treatment of patients with severe illness, for possible benefit by reducing inflammatory-induced lung injury. However, current evidence in patients with SARS and MERS suggests that receiving corticosteroids did not have an effect on mortality, but rather delayed viral clearance.27, 28, 29 Therefore, corticosteroids should not be routinely given systemically, according to WHO interim guidance."

Curcumin has been shown to suppress the cytokine storm.

https://www.ncbi.nlm.nih.gov/pubmed/25600522/

Curcumin is found in the spice turmeric and is available in most grocery stores. Today you can buy a pound of turmeric powder for ~$6. You can buy curcumin tablets in the health & fitness section.

Other anti-inflammatory agents (NSAIDS(aspirin, buprofen, naproxen),prednisone, etc.) are not as effective.

In India children are often given a daily teaspoon of turmeric (curcumin) in milk or water. India suffered much lower SARS deaths (there are confounding factors, e.g. India's high summer heat). I expect the same to happen with covid-19.

I haven’t seen anyone say it kills with a cytokine storm — spanish flu did that.

Title: "Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China"

https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

from the Lancet article:

Look up ARDS and cytokine storm. Cytokine storm is not specific to pathogen.

Lancet Article(February 22, 2020): "Reducing mortality from 2019-nCoV: host-directed therapies should be an option"

https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

from the article:

"In most moribund patients, 2019-nCoV infection is also associated with a cytokine storm, which is characterised by increased plasma concentrations of interleukins 2, 7, and 10, ..."

source?

Take curcumin papers with a pinch of salt. It's a pan assay interference compound (PAIN), prone to misleading results. Pubmed is full of thousands of papers claiming it solves all manner of medical problems, leading it to be dubbed an 'improbable natural panacea'.

See this article, by the same author as it happens.

https://blogs.sciencemag.org/pipeline/archives/2017/01/12/cu...

This article https://www.sciencedaily.com/releases/2014/02/140227142250.h... by The Scripps Research Institute suggests that cytokine storm is more likely to occur in relatively young patients rather than in the very young or elderly. It further states it was the likely major cause of mortality with the 1918 flu (which killed my great-grandfather), the H1N1 "swine flu", and the H5N1 "bird-flu."

SARS-CoV-19 on the other hand seems to cause mortality more often in patients 55+ years of age rather than the relatively young. At least from the data so far. The NIH emphasized this in yesterday's WH/NIH presser.

It is interesting to me that people are so laser focused on test kits and vaccines. In my less than humble opinion, people should focus on improving their immune system. You can reduce the load on your immune system by not eating sugar and reducing carbs as much as you can. We also know from history and science that every plague that killed people from respiratory virus infections was due to a lack of vitamin D3 and over production of the ACE2 enzyme. The virus quickly binds to ACE2 and their adaptive immune systems did not have the time to start producing enough anti-bodies. I do not understand why the CDC is not suggesting that folks increase their D3 intake, cut out sugar and most importantly, take a break from smoking which is know to increase ACE2. There are alternate methods of nicotine sources available.

I mention this because a vaccine is only useful for known viral code. nCoV will have a family of hundreds of variants in no time. Boosting ones built in adaptive defenses will protect against all of the mutations.

as someone on low-carb I find this interresting, but any studies behind it?

This was making the rounds a few days ago in my low carb FB group. I haven't looked into it too much, but it sounded intriguing.

https://www.sciencedaily.com/releases/2019/11/191115190327.h...

I'm sure if you check your spam folder or follow links from Twitter bots, you'll find some soon enough.

Cite every sentence above, please, or cut out the idle speculation; it's foolish at best.

NPIs -- handwashing, avoiding close contact with people sneezing like mad, not touching your face -- are the only things that actually work right now that everyone can and should be doing.

It has been widely reported that CORVID-19 affects the lungs, and that smoking may play a role in the severity of symptoms. Also there have been plenty of studies linking high sugar diets with reduced immune response.

>most importantly, take a break from smoking which is know to increase ACE2

Not going to lie, I'm very very glad I quit smoking before this coronavirus business. I was down to just a vape by June last year and I quit that in December.

Here are three negative results (all randomized controlled trials) for Vitamin D supplementation during the winter:

https://www.frontiersin.org/articles/10.3389/fimmu.2019.0006...

failed to show any effect on wintertime supplementation of D (using pre-registered criteria)

http://www.vitaminedelft.org/files/art/ling2009.pdf "no benefit"

https://pubs.rsc.org/en/content/articlelanding/2014/fo/c4fo0... "did not lower incidence of influenza"

Here's a positive result.

https://www.bmj.com/content/356/bmj.i6583

"Vitamin D supplementation was safe and it protected against acute respiratory tract infection overall. Patients who were very vitamin D deficient and those not receiving bolus doses experienced the most benefit."

Good one (odds ratio=0.88), and it's generally low-risk.

It would be no benefit to anyone that is not already deficient. [1]

[1] - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6075634/

I'm curious how this is the conclusion you made instead of becoming more macro-organized. People are getting more and more stressed (see burn-outs rising), affecting our immune systems. Most of us are still encouraged to go into work when we have a cold. Many could work from home, but are actively or passively stigmatized when attempting to do so. For all its draconian measures, China is showing them to be effective for the time being. In the same way, we could've rid ourselves of many pests, plagues and illnesses ages ago which a simple "get your immune system up bro" couldn't deal with.

> people should focus on improving their immune system

Okay, but for those who cant, underlining conditions etc, what do you suggest ?

This is the world we live in, and that kind of build up you're talking about that would fight off all these strains of virus' would take generations of active measures.

In the meantime, I don't think it's a bad idea to develop vaccines and shots which will aid our immune system.

Our body uses the memory DNA (or memory cells - Not a doctor) after getting chicken-pox so that we (usually) don't get it again. But the COVID strains vary so much it's a little pie-in-the sky right now to imagine naturally fighting all of them.

Our best defense is our ability to maintain good hygiene in this generation. We know all about how these things spread, and that should be the primary focus for the every day to day person.

Everyone will eventually get one of the mutations. [1] Maybe a vaccine will cover all of them some day. In the mean time, everyone, especially those with pre-exisiting conditions should be focusing on removing burdens from their immune system (sugar, carbs, anything that spikes insulin), getting a LOT of sleep, and ensuring they are not deficient in D3, Zinc, L-Glutamine, Magnesium, well, all the essential minerals, vitamins and enzymes. I have not had a vaccine since the 1990's and I have only noticeably had the flu twice (h1n1, h3n2) and even then it just made me gassy. I went home as a courtesy to my coworkers. I have not had a cold in 15 years.

[1] - https://nextstrain.org/ncov

Not sure why this is so taboo, I know there are molecular biologists on this site. Anyway, Zinc is the only thing that will slow the RNA transcoding process of the virus in your lungs, but getting enough zinc into cells is hard. You can use a prescription drug Chloroquine to improve the transport, but it has nasty side effects. Vitamin D3 isn't a vitamin at all. It is a precursor to the hormone 25 hydroxy. That is used by several hundred functions in your body, including your adaptive immune system, in conjunction with L-Glutamine to produce white blood cells and much more than I could cover on HN. The virus binds quite easily to ACE2, so you have to slow that down enough that your adaptive immune system can keep up. Smokers and obese people and eldery have the most ACE2 from lung inflammation.

Some things to watch or look at

CoV Map: https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.h...

CoV Rates: https://www.worldometers.info/coronavirus/

Mutations: https://nextstrain.org/ncov

MedCram: https://www.youtube.com/user/MEDCRAMvideos/videos

The mutations are probably the most interesting. I would be curious what company is going to cover all of them in a vaccine.

This is SARS type 2; please stop using COVID-19.

> distinction between a disease caused by a specific virus and the virus that causes it

The virus is also called SARS-CoV-2.

I dunno, I think that one's on the scientists. Expecting the general public to maintain a nominal distinction between a disease caused by a specific virus and the virus that causes it isn't reasonable.

The concept is well enough understood by the general public I think in the context of HIV/AIDS so I'm not sure why it couldn't be here too.

I think it would be a useful concept for the general public to understand the distinction if there turn out to be significant numbers of asymptomatic but infectious people.

Reply on news.ycombinator.com