Covid-19’s stop-gap solution until vaccines and antivirals are ready | Hacker News Reader

Covid-19’s stop-gap solution until vaccines and antivirals are ready

globalhealthnow.org

264 pointsrsfern195 comments

This crisis is the first event in my lifetime that's given me any optimism about our ability, as a global civilization, to solve problems and get things done. I don't feel like we've seen humanity at its best in several decades. Shame it always takes a catastrophe (and an immediate one at that; see climate change) to bring it out.

I think it has the potential to, but so far, there hasn't really much of it, or have I been missing it? Obviously progress is slow, but I think there's also a lot of fluff being thrown around, so we won't really know for some time.

I haven't noticed any extra amount of cooperation though between countries, more so than the usual.

I guess I primarily mean the people on the ground. Not the politicians - the best that can be said about them is that they're getting out of the way (in some, not all cases) - but the doctors and nurses, the scientists, the grocery store workers, the companies converting their factories to make medical supplies, and yes, even the bureaucrats who are pushing this stuff through. There are still lots of people out there to be disappointed in, but we're also seeing those who do care about the greater good coming out of the woodwork and really taking real action, and it's inspiring.

Not to bail Trump out because I have found his reactive leadership bad (all he had to do was get out of the way of the experts), but America--in my humble opinion--has always been bottom up. The idea that >300 million people can agree on anything always amazes me, and the design of the country is to allow as much autonomy to localities as possible while maintaining broad collaboration and cohesion. This is already shining where the US testing capacity has gone from basically zero to the highest in the world (>40k per day) in a matter of 2 weeks. Yes, the Federal government dropped the ball (tapping Scott Gottlieb instead of Pence would have made a big difference), but the private sector stepped up big. Two weeks from now I expect N95 masks, other PPE, and vents all being made in huge capacities.

So back to your "people on the ground" comment. I totally agree. It's the bottom up Americanism that will get us through this, as usual. It reminds me of the famous Abba Eban quote often misattributed to Churchill, "Americans Will Always Do the Right Thing — After Exhausting All the Alternatives". This totally holds true right now, and likely always will.

The really amazing thing is going to be three American companies proving through clinical trials in the next 6-8 months that we invented a new technology (genetic-based vaccines) that produced a functional vaccine by the end of the year (Moderna), that we have a potent anti-viral compound ready to use in two months (Giliad), and antibody therapy ready 8 months (Regeneron). That's nuts. If we go through the motions this time, we will be prepared to dramatically increase the speed of approvals and testing when the the next viral pandemic comes.

>This is already shining where the US testing capacity has gone from basically zero to the highest in the world (>40k per day) in a matter of 2 weeks.

Do you have any sources/links for this? I've struggled to find credible info.

I found it here: https://twitter.com/johnrobb/status/1241555048540372992

But now that I look more closely, I can't find source data. Let me know if you find any more details.

Yeah, I agree, unfortunately. Best examples: To my best knowledge no other European country has pledged massive help to Italy. China did a bit.

Germany has sent a few hundred thousand masks and other equipment. But it’s obviously easier for China since they are past their peak.

There are also some French patients being treated across the border, in both Switzerland and Germany.

This was after preventing mask supplies that were scheduled for other countries (Swiss company selling and masks travelling through Germany) to reach other countries

I am 100% sure, if this didn't reach France, was an Italy/Spanish problem, the EU wouldn't give a shit about it and do nothing.

While this is true, I wonder if this is not partly because the European countries were quite busy organising themselves and were anticipating an urgent but unknown need for their own population.

China has a retrospective of three months and has stabilized the situation. They know what they are facing and the resources needed, and have even started to dismantle the temporary hospitals they set up in January.

What can the individual European countries offer? They, like the Americans, have outsourced their production to China. Any masks, nurses or respirators they have, they will need themselves. They can offer 'money', which may not buy more masks but can help against the economic impacts.

And this is what is happening. The EU has both released monetary aids, and indicated that fiscal restraint rules will be waived.

You are probably right. I think they could have sent at least doctors and nurses to prepare for their own epidemic.

I remember reading that some countries did. That said, there are shortages of doctors everywhere in the EU, and no country in their right mind would send out staff and supplies knowing they'll need them all back in two weeks.

Baden-Württemberg in southwest Germany just pledged to take intensive care patients from northeast France:

https://www.deutschlandfunk.de/covid-19-baden-wuerttemberg-w...

Russia too now

Also Cuba is sending doctors and nurses to Italy:

https://www.reuters.com/article/us-health-coronavirus-cuba/c...

The EU did not have strategic reserves for a pandemic. This took us all by surprise and the speed with which this evolved into a clusterfuck was breathtaking. Everyone has been freaking out about their own situation. Nobody has enough masks, ventilators, hospital beds or trained staff.

Consider that the first cases in Rome were confirmed on January 31 to my knowledge. We are less than 2 months in.

Also this news about China providing aid whereas the EU refused to do so is probably one in a long chain of fake news promoted by Russia, meant to destabilize EU. Shame on you for spreading it.

https://www.reuters.com/article/us-health-coronavirus-disinf...

Why do you say it's probably fake news? China's aid to Italy is well-documented and widely reported; do you know of other stories where the EU has provided a comparable amount of aid?

There is fine, but very important line between being unable to help and being unwilling to.

Which makes propaganda so much more powerful.

It’s easier for China because they have supplies in abundance. But in for example the US, there’s no question of willingness vs. ability; each individual state is building up its own healthcare system, but things still cross state borders easily as needed.

The criticism isn’t, I don’t think, that the EU is being uncommonly cruel or heartless. It’s just that the EU isn’t a union. When the chips are down, when there’s some crisis that actually matters, other countries in the EU won’t make sacrifices for your sake. Which is fine, there’s no reason a trade organization shouldn’t have a flag or declare itself to be a single entity in economic rankings, but it means members need to be careful about how dependent they allow themselves to become.

The EU provided 50 tons worth of medical equipment to China in January.

The exchange was mutual.

---

What is fake is the way this story is portrayed, i.e. the EU does nothing, provides no aid, whereas look at China and Russia, our would be saviors.

Never mind that Chinese authorities lacked transparency, censored whistle blowers, were late to admit the problems of human to human transmissions and allowed millions of people to fly out of Wuhan to all corners of the world, thousands of them being infected, ultimately this early inaction being in part responsible for the pandemic.

I see China's efforts of late and I appreciate them, in the end we're all human, we all make mistakes and this is a time for all of us to work together. But that's NOT the tone set by such posts, or the intent.

My Facebook feed is filled with fake news that is clearly targeted at destabilizing the EU, a crisis like this being the perfect opportunity and my tolerance for it is really low.

> This crisis is the first event in my lifetime that's given me any optimism about our ability, as a global civilization, to solve problems and get things done.

Based on what?

What I see is the same scenario play out over and over again, from one country to another, delayed by a week, or two, or three, with most of them making the same mistakes that their predecessors made.

Nobody in the West lifted a finger to prepare themselves until mid-February. We didn't jump-start mask production. We didn't start building hospitals. We didn't start building ventilators.

If this is what the world's reaction to global crisis is going to be like, my sole reassurance is that I'll likely be dead before the worst of climate change hits.

Too little too late sums it up in Australia. Schools are still open (there are good reasons, but by the time those reasons become not-good, it will be too late).

At least the states and cities are taking over leadership where the federal level has failed.

What was expected? We've seen time and time again our politicians are incapable of action. Any moderately unexpected situation seems to be brushed under the rug or gets palmed off to the capable Canadians. The true 'dole bludgers' who have metastasized themselves in the sea of bullshit bureaucracy. Fine they steal from the country and waste tax payers funds incessantly. If they could atleast be capable of making decisions.

At the very least, absences should be excused for students whose parents are at home to watch them. Parents who must still go to work for essential jobs will still have some place to put their kids, but the amount of spreading going on in schools would be lower. Instead in California, absences were unexcused except for children already showing symptoms from sickness all the way until the day that schools were closed for everyone.

> This crisis is the first event in my lifetime that's given me any optimism about our ability, as a global civilization, to solve problems and get things done.

would you mind elaborating? because i find it extremely difficult how one could hold such an optimistic and apparent naive opinion.

from where i sit, this crisis is showing the exact opposite. there is very little international communication and cooperation, and even internal to countries, like in the u.s., there is very little communication and cooperation. aside from a few outliers, the while thing has just been wave after wave of delayed and reactive actions that were underprepared to begin with.

people keep thinking we'll solve this with technology (the typical human way), but what would have been better is if everyone simply communicated, listened, and cooperated.

the human race could not face a dumber enemy. think about it. if everyone on earth just sat still for a couple of weeks, this thing would just vanish. can you imagine a more simple foe? and yet, this thing is crippling econmies, healthcare, and more.

If you are focused on the U.S., then I understand your sentiment. But if you look beyond, it is really promising. Medical science and biology are producing new scientific knowledge about CoViD-19 and SARS-Cov2 at break neck speed. That alone is amazing to see. On the other hand, you really see that people get it and that they have to do social distancing to help them and everybody else. On top of that you see, e.g. China helping European countries in their crisis. That is unprecedented. The outlook for the U.S. might be more grim, at least as seen from Europe. It seems pretty obvious that medicine as a business is not the right setup to tackle a pandemic. Germany moved into that direction into the last 20 years. And everybody is realizing the downsides of that move, now. Although it could be seen for 20 years if you bothered to look. Back to the U.S., I find it deeply worrying that people started to buy guns. Do they believe they could shoot the virus? Or do they expect looting and civil uproar? That would be the worst people could do in such a crisis. I hope it doesn't come to that. And finally, Trump. I think I don't have to write anything about him by now.

I know it’s OT but would love to understand more about the health insurance situation in Germany and what’s happened in the last 20 years. Ideally in English which is a big ask I guess.

Moved to Germany in 2011 and still can’t work out the whole insurance thing (and don’t understand German enough to read and figure those nuances)

To make it short, 20 years ago most hospitals were privatized, before they were run by universities, cities, and states and some other public actors. There were already some private hospitals, but not too much. Since, then most hospitals were sold to companies or in the better case transformed into companies, partly owned by their previous owner. Companies optimize for revenue, so they don't spend money on stocks of masks or reserve capacities that are only needed once in a lifetime. Nevertheless, there are significantly more ICU beds per capita in Germany than in most other european or western countries.

The insurance system is split in two almost separate systems. One for everybody, the public health insurance system, where you can choose and switch between a range of public insurers. You must have health insurance in Germany. E.g. you cannot spend a semester as an exchange student without health insurance. If you earn above a certain amount per year, you are assumed to be able to provide for your own health insurance. You can opt-out of public health insurance and get a private one. They are very competitevly priced for young and healthy individuals. And they usually have way wider coverage. But you cannot go back after a certain age. So it is a risk, and there have been insurers that raised the cost of private insurance for elderly people by multiple hundred percents. On the other hand, the cost of public health insurances depends on your income and not on your health. If you are unemployed and you show that you try to get a job, your public health insurance is free as well. And children are free, if both their parents are in public health insurance. Then, there are private insurance policies that add on top of public health insurance coverage. Most people are in the public health insurance system in Germany.

I have public health insurance, but if you need some better treatment you can always pay for it by yourself. Some minor surgery for 300€ isn’t big deal. Or one can get additional insurance packages to mandatory insurance for all the special needs. My all older colleagues tell me, that private insurance is kind of scam. You pay almost nothing when you are young, but with age it costs more and more. You pay for kids on top and barely get better treatment than regular insured.

An insurance lawyer (friend of mine) also advised me to stay on a public plan and add up private addons where needed - those can be canceled very easily. I’ve not regretted that decision since.

I’d love to talk to you or your friend if you don’t mind. My contact details are on my HN profile.

Probably not better treatment but my private insurance almost always gets me faster appointments. I just mention the magic word and suddenly there’s an available slot next week (otherwise only in a few months). Happened more than once.

My insurance broker said that the price I pay now should cover future payments and increases are only allowed if there are some overall increases to the treatment options. ie new more expensive treatments become available... so cost can increase but within certain boundaries. Was I misguided on that one?

I think the Dutch system gives you the best of both worlds. Everyone is required to have at least basic health insurance. Every year, there's a new definition of what "basic insurance" entails and all insurance providers are required provide a "basic insurance" package at a specific cost. Of course, there are all sorts of addons to increase your coverage.

If you are unemployed or earn below a certain treshold, you get a monthly stipend to pay for basic insurance.

In the end, I can choose where to get my insurance from, but "basic insurance" is the same price everywhere and if I lose my job or I have very little income, I am guarenteed to get that stipend to help pay for it.

Basic insurance is roughly ~100 euros/month.

As others stated, you have the public and the private system. The latter is accessible after you earn above a certain threshold for a certain number of years (no idea about the specifics as I would have been eligible but never bothered to change). You also have niche solutions for certain free professionals (doctors, artists,...).

I would call the system pretty robust, as you cannot be uninsured. From personal experience: Having my kids insured under my name, under my wife's name when I earned less than her, being insured under my wife during a certain time of a sabbatical, insured through unemployment and now as an entrepreneur I never changed insurance provider. Only the status changed.

Interesting detail, even the public health insurance sector is run by commercial insurance companies. The minimum plans are defined by the state. Regardless of how many people are insured under your name, premiums don't change and stay at a certain percentage of your salary. Again, slight differences between providers but usually around 15 or so percent. Currently I pay much less, as there is no revenue yet.

Also nice, premiums don't change with previous sickness and preexisting conditions. Also 6 weeks of paid sick leave per sickness, resets for each sickness after a certain number of months (again, don't ask the exact number).

One important insurance to add is continued salary after the six weeks are over. Costs close to nothing when done early and can save you. Non serious things tend to be over well within 6 weeks. But serious ones can take considerably longer. And the last thing you want is money problems the. I spend 6 months on sick leave once, didn't have to worry about my job nor money. Was a nice thing.

Unemployment in the United States is not like unemployment anywhere else in the world. This situation is exposing all of the gaping holes in the American system.

Mass layoffs already, leading to mass loss of health insurance, and bills for COVID treatment already surfacing in the many thousands of dollars.

If people start to have trouble putting food on the table, shit could get ugly real fast.

Though the employer-tied insurance issue is a problem generally, it’s somewhat less dire for the situation you describe above because of COBRA. (Especially less dire for the first 60 days, because you can retroactively opt-in for some period.)

https://www.healthcare.gov/unemployed/cobra-coverage/

Have you seen COBRA prices? You could easily go from $400/month (group rate + employer subsidized) to $2k+ for a good plan that covers a family.

No.

If I were laid-off, I would receive a maximum of $1600/mo from unemployment in my state for 6 months.

So, the trade-off is either COBRA or mortgage payment.

I doubt the US medical system will get better in the short term.

As someone outside of the US, news about people of the City of Corona queuing to buy guns was quite shocking. Things are difficult everywhere but a rush to buy guns, not least in the most powerful country, is probably one of the most shocking of all the responses I have read and seen so far. I hope none of those guns will need to be used. The virus is already enough of an enemy

Eh calm down people always buy guns and ammo on every crisis that happens, even after every elections. It's nothing new.

Strangely there can be a calming effect, with many people armed. Believe it or not, unscrupulous folk may hesitate to act in times of shortage if their neighbors are armed.

I’d be much more worried they’d be carrying out the looting if layoffs continue with no relief.

Again, that'd be short-lived. Literally.

"It seems pretty obvious that medicine as a business is not the right setup to tackle a pandemic" . . Hospitals have already put a virtual "lock" on the supply chain of chloroquine and hydroxychloroquine to make sure they get the bulk of it and you have to come to them to get the drugs . . they are sharpening their teeth and their billing offices are humming. I bought my chloroquine before all the independent pharmacies got raided, with medicare and suppl. insurance it cost me 70 cents for the entire prescription - - what do you think hospitals will be billing for that same 'script ? From what billing gouging examples that are posted on the 'net likely $700.00

"I find it deeply worrying that people started to buy guns" . . . Look at history, what do you expect when you have 20% or more of the lowest tier of the working population laid off for months or more (60 million people) . . . crime will definitely increase and there won't be adequate police to control it. It could get real bad - - real fast. Only liberal Dems want to take away all our guns and then risk our families to be raped, robbed and plundered . . . buying guns and ammo and 99% a defensive, preparatory, and protective reaction - - not offensive. It is completely within the rights of Americans to protect their families and their property from criminals.

I think you're paying too much attention to Trump and politics. The people actually getting work done are cooperating and moving at a pace that has really never been done. The articles I've read and podcasts I've heard with scientist all echo the same sentiment. Ignore Trump and the politics, the science is happening at a pace unseen before.

> the while thing has just been wave after wave of delayed and reactive actions that were underprepared to begin with.

I do agree the US has been slow to ramp up, but that is quickly changing. Although, I would once again offer up to ignore Trump and watch the governors. They have been acting quickly and decisively.

Underprepared with respect to supplies is always easy to say in hindsight because now we know the war we are fighting. There is a saying that armies are always tooled to fight the last war. Until you know what the next war will be, it's impossible to fully prepare.

> if everyone on earth just sat still for a couple of weeks, this thing would just vanish.

IMO, that is naive and optimistic. The problem, for lack of a better word, is that the large majority of cases (80-90%?) are mild. For many, it's mild enough that they would have not deviated from their normal routine. Once this thing escaped China, and definitely once it got out of SEA, it was going to be incredibly hard to stomp out without herd immunity either through infection or vaccine.

> The articles I've read and podcasts I've heard

I share your optimism, but I don't think this bit helps your argument. Podcasts in particular do not scream "credibility"

> Podcasts in particular do not scream "credibility"

Except when they have on doctors who are experts on viral disease. For example: https://peterattiamd.com/category/podcast/

Parent means that everyone should sit still whether they have symptoms or not.

I too share a dim view of the world's ability to work together. Even now when faced with such a disease that is essentially everyone's problem, countries first and foremost chose to safeguard their own interests at the expense of others. It is a situation where if we survive, we did so because we worked together and if we die, it is because we only cared for ourselves and nobody else. If course this is oversimplifying a very complex interplay of things but my drift is that no country seems to be able to look beyond their borders and see that if we were to win this, we have to work together.

Even more dismaying is the refusal to lift sanctions on Iran. Even a narrowly crafted exception to the sanctions for supplies needed to combat the onslaught of the virus would be good but so far nothing. This is according to what I have read this far and if this is in error, I would be happy to be shown that.

I know it’s hard to believe but the regime (who any lift in sanctions would have to flow through) hates America enough to kill their own people.

https://twitter.com/ap/status/1241658649224925184?s=21

Aid is the only way to help Iran.

I view a pandemic like what happens in an airline emergency. The first thing you do is put on your own oxygen mask to make sure you are stabilized before helping others. It sounds selfish, but if the most powerful options lose control because they are busy helping others then they can cause everyone to lose.

Also, let me say that I'm not saying it's all rainbows and butterflies out there. I just think about all the things that were going to end humankind in my lifetime alone, yet here we are arguably in the best position we have ever been to fight something like this. As a kid we were genuinely afraid of nuclear war. Then there was the HIV epidemic. Y2K, tech bubble busting, 2008 financial crisis, and all the smaller things in between I'm forgetting about.

I look out and see the people on ground sharing information, being incredibly cooperative, and trying to stabilize their situation so then they can effectively help others. That is why I'm optimistic we'll work through this.

> I think you're paying too much attention to Trump and politics. The people actually getting work done are cooperating and moving at a pace that has really never been done.

A pace that is constantly hindered by wrong/misleading statements made by Trump. You cannot pretend he is not actively making their jobs harder and thus putting us all in more danger.

> Although, I would once again offer up to ignore Trump and watch the governors. They have been acting quickly and decisively.

Not all of the governors have and that is in part because they themselves or their constituents will do just about anything Trump says and/or anything to avoid his ire. We still, to this day, have people parroting things from Trump/Fox about how it's just the flu, it's not bad if you are young, vacinee is right around the corner, we already have drugs to fight this, etc. That is because of one man caring more about his reelection/markets than the people of the United States. Period.

His comments have been and continue to be extremely detrimental to fighting COVID-19. Even now, he is more concerned with re-writing history ("I always took this seriously") and downplaying the threat suggesting we don't have to worry because we already have a vaccine in testing (without saying it's ~14mo out) and by talking about the malaria drugs as if they are cures (we still have to test). Look at how they spend insane amounts of time in press briefings: attacking the press, talking about how the markets will boom after this, repeatedly having the POTUS make false/misleading statements that have to be corrected, and having almost every official start by "I'd like to thank Trump for his leadership...".

> Underprepared with respect to supplies is always easy to say in hindsight because now we know the war we are fighting. There is a saying that armies are always tooled to fight the last war. Until you know what the next war will be, it's impossible to fully prepare.

That's just not true though. They knew about this as early as Jan 3rd and waited months before doing anything substantial, they had a team designed to spearhead the fight against a virus like this and they disbanded it, they had a simulation of a virus outbreak just last year and failed spectacularly but decided to make zero changes.

One more thing to leave you with, /yesterday/ he suggested the reuse n95 masks and just clean them with "very good liquids". And 2-3 days ago he gave the /wrong/ set of symptoms for COVID-19. To ignore "Trump/Politics" is pretty naive as it's not like the experts are in control, he is actively making the situation worse.

> I think you're paying too much attention to Trump and politics

not at all. there are plenty of things wrong beyond him, and i have personally been dealing with the outbreak for months. i don't think you or most understand how some of the government's inaction has truly got us to where we are today and has been harmful. everyone complaining about a less than week long "quarantine" hasn't dealt with this for two months. that being said, one can also not ignore trump and the sycophantic government. he is blatantly misleading people and is ridiculing china for no reason. it's childish and petulent and extremely harmful in the long. we have a senator that says "gag and vote for it anyway" to provide support for people. that tells you the sentiment. and these are things they say in public! it amounts to treason in my book. you cannot ignore the massive narcissitic nature of our "leaders".

> IMO, that is naive and optimistic.

it was hyperbole, although it does have a ring of truth to it. the point is that our enemy is not complex, and as with most things, the true enemy is ourselves. humans laud ourselves for being above animals and our ability to predict the future. however, we don't. we have very short term views and rarely deal with something unless it is right on our doorstep. i don't care about the reaction afterward. it isn't good enough to be this way.

and the idea is that there are far deeper problems than just dealing with and reacting to viral outbreaks when they happen. a more organized society could start preventing or reducing the frequency of the outbreaks in the first place, although i doubt we ever get there.

this is a good article: http://m.nautil.us/issue/83/intelligence/the-man-who-saw-the...

> there is very little international communication and cooperation

Indeed. The EU didn't really mind about Italy's problems and potential economic unease until it started affecting other european countries too.

If you assume the european union being based, fundamentally, on cooperation then that really make you question the whole thing.

Yeah, and you can't really leave things to be some other country's problem -- especially a transmissible disease -- when that country shares a (for the time being) open border with you on land.

I've become more pessimistic about the human race to work together to solve problems now. So much jingoism around me, and around in the news. I understand that's not everyone, but to be it seems like it's every country for themselves.

> if everyone on earth just sat still for a couple of weeks, this thing would just vanish.

Actually that in itself would cripple economies, despite being a really good idea (sitting still for a while I mean).

The whole world is operating under an economic paradigm that requires infinite growth forever; the model is decoupled from reality. If we all sat still for a couple weeks, everyone would be better off, but the economy would tank. Better get back to work!

I would focus on the actual words and actions of decision makers at the state and federal level. The communication and collaboration is happening, agreed it’s still reactive.

At this point the media is in an abusive relationship with their audience, sitting around all day trying to think how they can scare them, leading to deeply dishonest headlines like this

https://www.bloomberg.com/news/articles/2020-03-21/nigeria-r...

I've also felt very encouraged by this. To see my own town almost completely shut down before any legal order even required it shows me that people will still voluntarily make sacrifices for the benefit of the whole. Everyone I know is doing their part. And beyond that to see the scientific community come together, to see that even with the blunders there is real cooperation between the various states and the federal government (I'm in the U.S.---we have gigantic hospital ships in the ports of two of our largest cities right now, federal troops mobilized, hundreds of billions of dollars authorized, and that's just part of what the federal government is doing), to see that individuals, corporations, research institutions, universities, foundations, etc., are all stepping in to fill the gaps, the ingenuity of people finding ways around resource limitations, debunking myths, providing encouragement and guidance and hope in a challenging time... and to have something as simple as a virus so powerfully remind us that we're all in this together, yes we could do much better, but I've been heartened by all of it.

> I'm in the U.S.---we have gigantic hospital ships in the ports of two of our largest cities right now

Not true. The west coast one is deploying soon, but the east coast one was undergoing repairs at the time and is weeks away from deployment.

yea, and they are missing the point. those ships are being deployed because shit is hitting the fan. it isn't a positive thing.

The Comfort is already in NYC. It was undergoing maintenance that was scheduled to take weeks, but they got it done in 8 days.

The Mercy is also already in LA.

This crisis has mostly been a massive demonstration of how capitalism undermines society's ability to prevent and cope with disasters. We're seeing individual people show their best while profit motive leads to people sabotaging others' hope of success. A few examples:

* A particular politician prioritizing low numbers (to look good) over actual infection reduction

* A particular government not issuing orders for needed equipment - we still haven't placed orders and handed money to for-profit ventilator manufacturers, so they can't afford to just manufacture more

* A particular government failing to fund ongoing mask manufacturing to guarantee a stockpile in advance for pandemics despite being advised to do so, as a result manufacturers had to cut staff and lower capacity

* For-profit hospitals being on the verge of running out of money due to treatment for uninsured patients not being funded

* Governments having to contemplate sending out massive checks to citizens and/or provide financial assistance in exchange for employers not laying off all their staff

* Price gouging for emergency essentials like masks and hand sanitizer, forcing local governments and marketplaces to act aggressively to punish it

* Government officials delaying necessary containment measures like closing beaches or banning gatherings as an attempt to preserve local businesses at the expense of public health

* Cruise ships... just cruise ships in general. The idea that they are still operational as floating incubators for hundreds of new cases is just obscene.

* COVID-19 spreading more rapidly among the elderly in WA because care home workers have to work multiple jobs to pay rent, resulting in them taking it between care homes

Other less-capitalist nations are still struggling with COVID-19 but capitalist responses to it have so far been wildly insufficient.

It will be also a big blow for individual freedoms worldwide.

When those of us who survive will look back at it, they won't be able to ignore the fact that sending police to beat up people at a few mass gathering on beaches and streets, and then putting military out to enforce quarantine measures, would result in exponentially less loss of life and damage to the economy.

Yeah, that is a very good point. The emergency reactions to societal failure (not entirely due to capitalism, but in some cases due to capitalism) are by nature very authoritarian, which leads to the erosion of normal governance. My home country is already putting in place emergency measures that are likely to last until after the emergency is over and are conveniently very useful for maintaining a grip on power.

We've been looking at deploying the military too, which at the very least is going to increase tensions and potentially lead to unrest.

I mourn the potential damage to democracy almost as much as I mourn the lives lost because democracy being severely damaged by this incident will hurt future generations.

I meant something a tad different.

Survivors will look back at how badly the West handled the pandemic and vote authoritarians in willingly. And it will be fully justified at that moment. The danger being, of course, that authoritarianism is hard to root out and gets worse over time.

Because it will be hard to deny that a faster, stronger reaction and a few beatings here and there would've spared a lot of future suffering and loss of life. You won't be able to say with a straight face that letting idiots do their idiocy is a small price to pay for freedom.

To be clear: I don't like the authoritarian future I predict. But I would love to see military on the streets right fucking now, instead of reading every single day a story about some idiot breaking quarantine to run some errands, and in process shutting down a store, a clinic or a hospital ward.

I don’t think so. People are all agreeing on that based on good judgment. As someone who accepts the current restrictions, there’s no way I’ll accept some random other abuse afterwards.

I reckon our society will be in for majors discussion in who takes the rewards and who is critically important.

Which non-capitalist countries have handled it better?

China, Vietnam, Cuba.

China: yes.

Vietnam: it's gone exponential, so no. https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_V...

Cuba: too early to tell.

South Korea: looks to be under control, despite having patient 31 who is the worst super spreader of covid-19 on the planet. They are a capitalist economy.

Taiwan: a capitalist country that looked to have it under control early (like Vietnam) but it now seems to have escaped and gone exponential.

So far I'd say whether a country has got it under control depended on a whether a few key individuals in power decided to enact expensive decisive and control measures immediately. (Of course in hindsight they weren't expensive compared to what was to come, but it took a lot of balls to do it nonetheless.)

The rest of us (including the USA) had to wait until most of civil society understood the risk and took action. I think that's happening on a large scale in every democratic capitalist nation now. Even if you have a Trump in power, the forces that unleashes are irresistible - everyone moves as a group to protect themselves. A hallmark of capitalist economies is they are very good at self organising. Those same forces aren't so irresistible in a non-capitalist non-democratic country, and they aren't so practised at self organisation.

We now have a benchmark for how fast that happens in the internet age. Apparently in one month you can go from zero to the bulk of population on the same page, providing the facts are reasonably clear. (The highly infectious nature of SARS-Cov-2 was pretty clear from the start. The implications of what that meant were also clear to those who understood the math - but most had to learn and that takes time.)

I find that speed kinda amazing, and it's a blessing bestowed on us by the Internet.

Some of these bullets are a result of shortcomings with democracy not capitalism (or even capitalism by extension of democracy). Whether it's worth giving up democracy in attempt to address these shortcomings, I'm not so sure; seems that would typify a hyperfocus on the bad times.

I think it is basically inevitable that a cure/vaccine will be found. That's not to downplay it, obviously the teams involved will deserve huge congratulations and will have done something great and it is badly needed. But the real test is how we handle it until that cure/vaccine becomes available, which is certainly something that a lot of places are struggling with, particularly here in the UK where we spent weeks spectating on our neighbours struggling with it and racking up deaths (particularly in Italy) before realising that exponential growth also works here.

Some emerging theories of pathology suggest that lung function can be increased by reinflating collapsed alveoli with constant pressure: https://emcrit.org/pulmcrit/cpap-covid/. It describes cases where oxygen supplementation could be reduced or eliminated.

This development (https://www.isinnova.it/easy-covid19-eng/) looks very promising for 'sub-intensive' cases -- adapting decathlon mask/snorkel with a 3D printed valve to provide positive air pressure (to help reinflate lungs) without intubation or leaking contaminated exhaust. If the closed mask method could be used successfully to prevent serious cases from progressing to ICU (or more importantly, keep people in their homes a little longer), it could have a huge impact on reducing load in the hospital system.

I don't know where to ask.. is vaporized cbd helpful ? it's said to be a potent anti inflammatory compounds and also help cleansing cells through apoptosis.

I doubt it, though I don't have any references. Do you have any peer reviewed papers on CBD and lung function?

I'm not on my laptop but the are a few studies on cannabinoids and lung tissue. I'll edit this later

I am not a doctor but if it is indeed anti-inflammatory and causes apoptosis it sounds more likely to be harmful than to be helpful. I suspect apoptosis (or rather what happens is that cells get hijacked by the virus and then the immune systems kills the hijacked cells) is what causes most of the lung damage and inflammation is an important part of the response from the immune system so I would not mess with that more than necessary.

good point, although reduce inflammation would clearly help respiratory distress.. I'll dig further

Exercise due caution with regard to CBD, megadose Vit C, “MMS” (aka industrial bleach), etc, etc. The people advancing these miracle claims are almost always either indulging, selling, or both. Ego and money corrupt even good science when we let them; imagine what they do in presence of unquestioning, evangelical Beliefs. And they are out in force right now, putting even the most venal pharma corp to shame. Panic is no reason to bypass robust replicated research, or even more will die.

Best thing is not to catch COVID-19 in the first place. Next best is not to catch it all at once. And if you do catch it, follow the latest treatment guidelines and do your best not to pass it to anyone else. Be safe.

this is unrelated to snake oil, also this was for people already infected to help SARS

also most readings on the topic are from ncbi/pubmed or springer books

CBD is interesting but regularly overhyped; lots of “believed” and “may”, personal testimonials and pilot trials; not a lot of robust large-scale trials to really sift out the truth. PubMed is just an index of published research, not a measure of quality.

https://sciencebasedmedicine.org/cbd-oil-the-new-miracle-cur...

What’s the current medical recommendations where you are? I’m not going to guess—too much dodgy advice going around as it is—but best to follow that.

Just wondering, I use a CPAP machine... If I were to get this, could I use that to keep going at home? (Perhaps with a higher setting).

It sounds like the same thing. CPAP masks do leak air but contamination doesn't really matter as I live alone.

I don't have medical advice for you (not a doctor), but if you need assistance breathing you should call a doctor immediately. Hopefully, we'll get more guidance as we learn from what is working.

What an awful response.

He's clearly talking about the context in which medical staff are overwhelmed and unavailable.

Formal writeup here: https://www.jci.org/articles/view/138003

Edit: lots of interesting details. a couple takeaways:

1. “Depending on the antibody amount and composition, the protection conferred by the transferred immunoglobulin can last from weeks to months.”

2. One of the proposed deployments is to protect frontline health care workers from infection (and remove their need to quarantine) until a vaccine can be developed

3. This treatment was apparently used for quite a few other outbreaks, including the 1918 flu epidemic, MERS, and there is a report of it being used against the novel Coronavirus in China

It's really only a solution for healthcare workers due to the amount of work required to harvest and transfer immunoglobulin.

I think a far more scalable solution for the general public is the use of existing anti-viral drugs.

This may be a stupid question. But can the antibodies be synthesized based on samples from recovered patients? If not, why?

Definitely not a stupid question

Following your train of thought, could the synthesis be done in the same way that insulin is currently created? i.e. Have some germs synthesize the antibodies.

Yes, that’s a possibility and currently many monoclonal antibodies are produced that way (basically all drugs ending in “-mab”). However the process is costly and current capacities are not sufficient to supply a whole population regularly with antibodies which is why we still use some older drugs for certain diseases (think MTX for rheumatoid arthritis) and reserve monoclonal antibodies for treatment-resistant cases. I hope that it’ll be possible to protect high risk HCW and ICU patients through antibodies and thereby bring down Covid’s mortality soonish but we still need to buy some time until then and work on a vaccine to protect the population long-term. Right now what we need to do is stay at home and invest in medical care and drug development but with emphasis on the staying at home part because it’s the necessary condition for everything else to work.

Thanks for your reply. Very informative.

Not stupid. NOTE: Not my field, so speaking off basic knowledge here. Happy to be corrected.

Tl;dr: because biology at scale is complicated.

Longer-form, because antibodies and immunological response are somewhat complicated. Knowing what an antibody looks like, how to produce it, and how to scale that production in a safe and reliable way are all very different things.

Older article, but general concepts: http://neobiolab.com/research/in-vitro-and-in-vivo-productio...

... And because the in vivo methods we know of are ethically dicey. To rephrase it in rough terms -- creating custom cancers that produce the thing we want and giving them to mice, then harvesting concentrated antibodies from the tumors.

See: https://en.wikipedia.org/wiki/Hybridoma_technology

Yes, and there are companies working on exactly this. Abcellera is furthest along: https://www.fiercebiotech.com/biotech/lilly-taps-abcellera-t...

https://www.fiercebiotech.com/research/fast-moving-regeneron...

>Regeneron scientists have isolated hundreds of neutralizing antibodies against the SARS-CoV-2 virus from a humanized mouse model as well as from humans who have recovered from COVID-19, the company said Tuesday.

Yes. Synthetic antibodies are a thing, but they are very expensive and very hard to produce (from what I inderstand).

Using animals when possible (for example horses, for the production of snake venom antidotes) seems more efficient in cost, volume and time.

Take for instance this crisis. They just need the plasma of immune individuals to give temporary immunity to sick or at risk individuals. It doesn’t scale but it works.

Some good basic reads:

Antigens - https://en.m.wikipedia.org/wiki/Antigen

Humoral Inmunity -https://en.m.wikipedia.org/wiki/Humoral_immunity

Synthetic antibodies -https://en.m.wikipedia.org/wiki/Synthetic_antibody

Antibodies memetic - https://en.m.wikipedia.org/wiki/Antibody_mimetic

Protein synthesis is complicated. Antivenom is still produced in the same way: inject an animal with small doses of venom, collect the antibodies from the plasma.

[1] https://en.wikipedia.org/wiki/Antivenom

That's basically what a https://en.wikipedia.org/wiki/Monoclonal_antibody is - and those are by far the most expensive drugs there are, with costs in the $100,000/person range.

What would the costs look like if the market scaled up by 1000 or 10000x?

The cost comes from the nonscalability of both the production and the use.

What are the main obstacles to scalability of production and of use?

Could the former be amenable to treatment as an engineering problem? There are a lot of motivated engineering minds right now.

I'm not a professional in that area, just based on what I've read, so in case of doubt, check better sources:

If you use human donors, you need trained doctors spending time and equipment to select the donors, handle the donors, take care of them during the donation which takes hours (the needle is stuck in their vein during that time), trained professionals using expensive equipment to process the donation, and then trained doctors to perform the infusion on the patient, an hour or two, but you still want keep the patient in the hospital overnight in case of complications, which do happen often enough that it was practice to do so: as in, once in thousand. At the end all that work, it is relatively sure that the described work could result in protection of exactly one patient more than before you started. The percentage of known complications and the potential for failure in every step is what makes it non scalable.

With non human donors you can avoid some work, but the second part remains: it's not "just a shot" like when you do a vaccination which is scalable.

And while vaccination is scalable, if you're going to vaccinate billions, you also want to be very sure you aren't harming them, that's why speeding up vaccine production is not scalable. Even producing the vaccines is not easy at all to scale.

It's not that nobody has attempted hard to achieve this up to now.

Thanks, that's quite informative.

In a critical situation such as the pandemic, it seems to me, from a project management and engineering perspective, that it might be worth ramping up production of a vaccine (or several) even before it has passed later stage trials, and maybe even pre-distribute it a bit to national storage facilities. So if the trials look great and the side effects are sufficiently minimal, the delay for manufacture and distribution will be reduced after the trials.

But I guess I see all sorts of political problems with that, if the trials are good but the side effects are a problem, or say it causes a horrible desease for 0.1% of people down the line. The pressure to use the product would be immense, despite the trial saying no this is not safe.

Long term, THE major problem is the expectation to profit every time, stupidly, nobody with the money cares if one of that times the whole world gets infected:

https://www.newyorker.com/news/news-desk/how-long-will-it-ta...

"There may never be a market for a vaccine at the end of the development process, because the epidemic is contained, or never comes to pass. Then, traditionally, if there is an epidemic, it may take hold in a developing country where the costs of research and development cannot be recouped. “The resources and expertise sit in biotech and pharma, and they’ve got their business model,” Grant said. “They’re not charities. They can’t do this stuff for free.”"

The "investors" just want the growth of their money, even the money they make would become meaningless after the pandemics that's efficient enough. The nature is indeed capable to set its own growth not caring about the "interests of investors."

Obviously the whole structure as well as the priorities just have to be set differently. The next time could be even much worse than now.

Which must be a political decision for change, not a technological "invention". The technology is not a "deux ex machina" -- the natural limitations are real. Some solutions exist but simply can't be expected to "make profit every time." So how can it be done? Taxes. What was too dangerous selling point for generations of politicians? "Less taxes."

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

But the taxes are even now used, and spent in mind boggling amount, just for other priorities, year after year:

https://www.nytimes.com/2019/08/21/magazine/f35-joint-strike...

You need to create a cell line.

Many medicines today use murine (mouse) monoclonal antibodies.

A monoclonal antibody (-mab) already existed in a lab in the Netherlands, because it had been developed for SARS and turned out to work for SARS-CoV-2. But it will take weeks before this can be industrialized, let alone approved.

Not really in time.

In principle, yes, but antibodies are more complicated than normal molecules (glycosylation, protein folding) so you can really only industrially prepare them in certain types of cells (pretty much Chinese Hamster Ovary, last I checked).

Another problem is retrieving the correct antibody gene sequence. All immunoactive antibodies have been subjected to a process of internal evolution and artificial selection. Their DNA is not the same as your germline DNA, through shuffling and active mutation events, and indeed every immune cell that produces antibodies has different DNA than the other ones (that haven't been told to clone themselves) so it's really difficult to retrieve the correct gene sequence.

In practice I wouldn't estimate it to be possible to do this in the 4-6 month timeframe. Maybe in the 6-12 month timeframe under emergency duress situations.

My knowledge about industrial manufacturing is slim to none so can someone explain please why is it not possible to (globally) ramp up production of face masks and ventilators to a virtually unlimited quantity?

What exactly is the bottleneck? Are we lacking materials, labour or the technical know-how? Are the factories currently producing them so advanced and hard to reproduce?

I think you can ramp production of those but it will still require people to work them and the most severe cases are still fatal even with the ventilators.

Well, there is no silver bullet here is it? If we're to solve this we'll probably need to tackle it from all sides - isolation, vaccine and treatment.

AKA there's no 100% guarantee for anything.

Your point being what?

My point is that you don't need to scale production of ventilators beyond the capacity of the medical system of deploying them.

Same as many other problems (eg global warming) - the market economy can't deliver a solution because it's not short teem profitable for the relevant actors.

It could be priced to be short term profitable, but then the sellers would get accused of price gouging.

And poor countries would get nada.

Not all countries have laws against price gouging (e.g. I am pretty sure it is legal the price gouge the government in my country) and there is still a lack of face masks in those countries.

If manufacturers sold direct-to-consumers, they wouldn't. Problem with price gouging happens because of resellers, and that money does not work as a signal for manufacturers.

The solution for undersupply in times of emergency is, IMO, to ban resale. Some countries, including mine, went that route now.

We are expecting a global economy crisis, much bigger than the last wallstreet crash. There needs to be a solution in the next 6 weeks, not 6 months. Because by then we'll have a bankrun and global shutdown of social behavior.

Profitability needs to look into the next 6 months, not just 2 weeks. And btw, we don't do market economy here anymore. The UK tried and gave up 2 days ago. They are all in centralized crisis mode.

I don't agree here. There's the economy as we know it, which might crash/malfunction but then there is the Real Life™. It might seem that the two are very interconnected and society cannot function without a healthy banking system. Reality however proves different.

Let's take a look at Iran, a country under heavy financial and commercial sanctions (for quite a few years), partially at war, with widespread riots brewing up until just one month ago and with little control over the virus's spread. Life goes on, people still eat, speak to each other and most continue their day to day activities. Same goes for Venezuela or Lebanon.

Sure, some people will need to adjust from selling derivatives to more 'core' activities, but the world will not end. The social system is more resilient than it looks.

EDIT

From a longer-term/big picture point of view, I think it would be healthy to debunk this 'myth' that somehow the world cannot survive a big bank going bust. Let's not mistake preserving status quo for a functioning society as a way going forward.

I feel like you've lost the thread here. Real Life™ is the part of the economy that's being shut down; over a billion people are no longer allowed to go to a cafe or speak to friends or continue their day to day activities. The concern isn't that an extended shutdown will be bad for Goldman Sachs, but that it will make ongoing life intolerable and resuming normal life impossible.

I think everyone agrees (govs included) that this situation is temporary. As soon as the balance inclines the other way as in less damaging overall to actually let the virus spread than current lockdown, the restrictions would be lifted. Why would people not resume life?

We need to get the timing right, how much we can bend the curve without causing more harm. A matter of choosing the lesser evil.

I broadly agree with what you're saying, but I also agree with the original comment that the right timing is necessarily within the next six weeks. So when Cuomo goes up and says "two, three, four months", or when governments impose indefinite stay-at-home orders that need to be specifically revoked, that worries me.

Indeed, I've also seen some scary declarations. I was thinking if it wouldn't have been better to be more upfront about the planning fe.:

Guys, we either let things run as usual and wait for the virus to spread - and it will spread and damage the economy + the health system to an unknown degree - or we do our best for a while to delay things until we get better prepared to handle the ills.

Emphasise on 'our best' because if we don't then the lockdown will be both bad and useless.

We got your back through fiscal stimulus during this time. As soon as we see that the lockdown causes more harm than it solves we will obviously lift it and try other measures.

EDIT

What I meant with Real Life™ is that I believe it cannot be shut down, it can only be changed. Sure, as we speak, people can't have 3$ Starbucks drinks but will still go to the park (groups of 2 max) and have a chat while walking/running.

Some parts of real life are non-negotiable. There will certainly be changes we can and should tolerate. But rules which forbid me from hosting a small dinner party, shopping for non-essentials, or driving down to give my mom a hug are below the minimum requirements of a healthy life and can’t be fully mitigated.

This is incorrect. Someone else in the thread posted the article below. It explained the problem thusly:

1. To make masks, you need a certain fabric

2. The machines to make more of the fabric take 5-6 months to make, and this is a hard limit as they’re quite complex

Basically, all the money in the world likely couldn’t expand capacity of this vital fabric. A Chinese Petroleum company is trying to make new machines quickly, but those in the industry are skeptical.

https://www.npr.org/sections/goatsandsoda/2020/03/16/8149292...

You need time to switch machines and people to different production. The best-suited plants are all in Asia. Supply chain is thoroughly shot and in state of chaos at this point. That said, a lot of efforts are underway simultaneously, so I expect massive-scale production will start very soon.

Regular masks it is possible to ramp up production.

N95 masks, it is not easily possible to ramp up production in a short time frame.

This article explains it well:

https://www.npr.org/sections/goatsandsoda/2020/03/16/8149292...

N95 just means anything that can filter out 95% of nacl in a specific test, the implementation is not constrained to this type of fabric. There are other ways of doing it.

Right. I'd say polypropylene spunbond-meltblown-spunbond design is just a safe choice for non-reusable medical masks. It's not necessary, and especially for general population, for that just spunbond alone should be enough which is in abundance and there are other polymers too. And the masks should be treated as reusable outside of hospitals, polypropylene is safe to boil.

It's possible and it's happening. The bottleneck for face masks is largely getting the right supply chains in place; for ventilators, I'd guess (but don't know for sure) that setting up the actual manufacturing takes more time.

Note that another bottleneck for facemasks is shipping volume from China, which is largely drowning in facemasks at this point. There are a lot just waiting in line to be shipped.

Could somebody with medical knowledge speak to the lifetime of exogenous antibodies in another person's blood?

And, does their presence in any way "train" the host immune system to make more? Or is the benefit solely from the introduced antibodies?

The half-life of exogenous antibodies is around one month:

https://pubmed.ncbi.nlm.nih.gov/3183495/

The benefit is solely from the antibodies attacking and reducing the level of virus in the body, it does NOT induce an immune response from the body (though that will happen anyway as the body mounts it's normal immune response to the virus)

So it does not interfere with the body's own immune response, and in the end the patient should be immune in their own right (for however long that lasts)?

Almost sounds too good to be true. I wonder what the real downside risks are.

We used to use horse serum to treat infections. Inject the horse with the disease and then filter the antibodies out of the blood.

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

IVIG is an extremely common treatment, used for immunocompromised patients, or sometimes after a stem cell transplant to bolster the immune system while it recovers.

It’s not typically used in healthy adults as a way to treat a specific known pathogen because, well, we usually have much better options. Aside from being somewhat pricey, side effects are mild and it should be fairly effective.

How similar is this to the antibodies that are injected to a RH- mother just after the delivery of a RH+ baby to prevent the formation of their own antibodies that would attack the next baby? https://en.wikipedia.org/wiki/Rho(D)_immune_globulin

A mismatch or a rare type would be disastrous. And let not even start on prion diseases.

Interesting — I wonder if that’s the reason the article says that one recovered persons plasma could treat just two additional patients? It’s not clear how much plasma would be needed for the treatment

"Yes. In fact, the Chinese sent 90 tons of plasma to Italy."

That's impressive. I wonder how many individual donations that maps to. And how many people that could treat.

Edit: Trying to answer my own question. Typical blood donation is 470ml. That weighs about 0.5 kilograms. Plasma is roughly half of what's in your blood, so half that again... 0.25 kilograms. So assuming they meant metric ton (1000Kg), 4000 individual donations per ton. 90 tons is then 360,000 donations. Did I miss some math? That's, um...wow. Maybe the 90 tons includes bags, boxes, pallets, etc?

No idea how many that treats though.

There don't exist 360.000 recovered humans at the moment. At least officially.

Yeah, that's why I keep looking at my math, though it seems straightforward. That 90 tons must be off somehow.

Presumably, they also have to keep the plasma cool, I am guessing some of that 90-tonne wait could be attributed to cooling gels/liquids of some kind to keep it stable for transport. Admittedly, I don't know how they would even transport this over long distances like that.

Hmmm, Googling seems to indicate that private donation centers in the US allow donations twice a week. Multiple donations per donor?

Tons of medical supplies have been sent and part of that was plasma. I believe the first shipment was 30 tons in total, but more has been sent since.

Right. The article does say "90 tons of plasma", which is why I tried the math.

While viable and potentially lifesaving, the risks associated with this type of treatment are significant and should not be downplayed.

Edit: This is the line I am objecting to: “it can be used for prevention of infection for people who are being exposed or it could be used for therapy for those who are sick.” This is not something to generally be handing out to people after simple exposure. For one thing the benifit is short term.

For example?

You’re injecting blood products from another person so catching some other deadly disease is a real risk. Plasma is tested for AIDS and several other diseases, but prions for example are much harder to detect. Further, when you consider the risk of someone messing up on the supply side that opens up a host of issues.

That’s why there is comprehensive screening of donated blood which has essentially eliminated pathogen transfer and it’s used en masse everyday.

Screening is not perfect. https://www.redcrossblood.org/faq.html#eligibility-medicaltr...

“ You may not donate if you received a blood transfusion since 1980 in the United Kingdom or France (The United Kingdom consists of the following countries: England, Wales, Scotland, Northern Ireland, Channel Islands, Isle of Man, Gibraltar or Falkland Islands). This requirement is related to concerns about variant CJD, or 'mad cow' disease.”

That’s because methylene blue doesn’t kill prions.

https://www.medscape.com/answers/1389957-195354/what-is-the-...

That is interesting. I have always been told it was stricter than that - basically this:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1116429/

The US Food and Drug Administration (FDA) has imposed a ban on blood donations from anyone who has spent more than six months in Britain from 1980 to 1997 because of the possible risk of transmitting the human form of bovine spongiform encephalopathy, known as variant Creutzfeldt-Jakob disease (vCJD)

Nothing about receiving a transfusion there, just having lived in the UK was enough to make you ineligible to donate.

The American Red Cross restriction is weaker. Can anyone clarify?

Looking at the Red Cross page there is a separate travel section which says “ Persons who have spent long periods of time in countries where "mad cow disease" is found are not eligible to donate. This requirement is related to concerns about variant Creutzfeld Jacob Disease (vCJD). See - Eligibility Reference Material“

So i think there is a travel restriction and a transfusion restriction which are independent.

As you say pathogen transfer and other complications like GvHD are rare, but that’s also in normal situations. In a pandemic things change. This example is using plasma from China which is very much outside of normal channels.

Further, in a pandemic when staff are overworked and possibly sick, mistakes are going to increase. Viable in a life threading situation, less so: “for prevention of infection for people who are being exposed.”

This paper has a good overview, they say the rate of adverse events is around 1/1700. So if it reduces your risk of death from respiratory failure in the next week by almost any positive amount, it's worth doing.

This is only going to be used in hospitalized patients who are already developing respiratory failure (low blood oxygen levels), not in random people off the street with a cough.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3356109/#S1titl...

I agree with you, but here is a direct quote from the article:

“it can be used for prevention of infection for people who are being exposed or it could be used for therapy for those who are sick.” This is not something to generally be handing out to people after simple exposure.

Researchers always talk about what could be but not necessarily what should be. Don't worry too much, in practice what you suggest will most likely happen.

I think your position is reasonable.

In the full perspective article [0], they advocate more for using this treatment to keep medical professionals from succumbing from the disease until a vaccine can be developed.

And they propose what seems like a pretty robust set of safety requirements

[0]: https://www.jci.org/articles/view/138003

Based on the HIV epidemic back in the 1980s, techniques have been developed to inactivate any pathogen in donated plasma. They can use detergents or heat.

Could something slip by? Sure, but it’s a pretty robust system.

What do those techniques do to antibodies?

Presumably nothing.

IV Ig is a very common plasma product. The therapeutic entity is the antibodies and they survive the sterilization process.

Can you please explain? On the surface this all sounds great, then again, on the surface a lot of things sound great.

Especially looking for clarity around this part:

Are there side-effects to using this?

Plasma is very safe. It is screened for bloodborne pathogens and blood typed so you don't have a transfusion reaction. Blood transfusion is one of the most regulated industries in the United States. It's one of the safest things available.

> Plasma is very safe. It is screened for bloodborne pathogens

For those we know. In some countries with centralized organizations handling transfusions, both HIV and hepatis were spread before they knew to test them -- then even after they learned. People sued for willful poisoning in Europe, as there was documented evidence the persons taking the decision were told about the risks yet decided to ignore them against experts advice. To the best of my knowledge, nobody was convicted, ever.

> Blood transfusion is one of the most regulated industries

Now, given that background, do you think regulations will protect you from unknown pathogens? Or from known ones if someone decides not to bother with the testing?

That was a huge failure on [1] the Canadian Red Cross. They knew the blood was tainted but wanted to use up existing supply. They were buying blood from prisoner populations, didn't bother to do testing that would have detected most of the Hepatitis C cases, and infected more then 2000 Canadians with HIV. This was a giant screw up I have heard many times because back just before it went public the doctors wanted to give my dad a transfusion for a massive cut he sustained at work. He refused saying no way he trusts the blood. It was just a gut feeling. The doctor said he was making a foolish decision. Two weeks later it was all over the paper. So of course my dad took the paper to his next doctors appointment to get his stitches out and asked the doctor what he thought of his decision now. [1]: https://www.cbc.ca/strombo/news/canadas-tainted-blood-scanda...

Or maybe it was Canada, I can't say for sure. I just wouldn't call that a screw up, but deliberate risk taking by managers ignoring experts.

Tell us, what was the doctor reply? That your dad was lucky?

But luck favors the prepared mind - or something like that.

The JHU team is waiting on FDA approval for a clinical trial...

That doesn't make sense at all. It will be limited though and probably only be available to the most ill and front line medical people, there's simply not enough people to provide the plasma especially if it's voluntary.

Dumb question: infusing someone with antibodies-containing plasma from a recovered patient will help the receiver develop their own antibodies ?

Thanks.

Why do they keep saying 'until vaccines are ready' as though it's a foregone conclusion that we can make a vaccine for this? Is this type of virus always a good one to make vaccines for?

There are tons of viruses we have failed to vaccinate for, despite trying for 30 or 40 years. People seem to be universally saying a vaccine is '12-18 months away'. Is this just misinformation?

I would love to hear from an expert about this.

Not an expert. It's not guaranteed but it seems like covid19 has a lowish mutation rate, similar or perhaps lower than the flu. So it would seem reasonable that this a vaccine-amenable virus. But there are no guarantees.

Because, there are multiple teams of companies and scientists around the globe, that all report that they'll have candidates ready in the very near future, i.e. 3-4 weeks. Which means they are convinced the vaccines work. But since vaccines are given to a large number of people, you have to make sure that there is a very low number of adverse effects. And that takes most of the time. But the vaccine candidates are almost ready.

This thread is quite encouraging.

Argues that reason why we don't have one for other coronaviruses is because of cost-benefit not high enough, rather than technical hurdles. 20% colds caused by 4 different Coronaviruses, so hard to justify making a vaccine that reduces cold risk by a few %.

Agree that there is uncertainty though.

"Covid is so technically doable we already have vaccines for dog & cow coronaviruses. We’ll definitely make one for covid, trials will be simple since we’ll be specifically trying to prevent Covid, which is only caused by SARS-CoV-2 (not by dozen different viruses)"

https://twitter.com/PeterKolchinsky/status/12404980379585454...

China sent 90 tons of plasma to Italy? I don't understand. A ton is 1000 liters. A single blood donation is usually 500ml , not sure how much plasma that would produce. But this means that they had at least 180K donations which seem implausible. Could someone please explain?

Perhaps the plasma is packaged? I'd expect there'd be a fair amount (20-50%?) of non-plasma in those 90 tons.

I’m going out on a limb here. One possibility would be mandatory blood donations at “re-education” camps and prisons.

> clinical trials could begin in 3–4 weeks provided that they clear all the regulatory steps. If that happens ...

Can someone break this down day by day as to why 3-4 weeks are necessary and proper to get through the very first regulatory hurdle?

>> You're making sure that there are antibodies in there and that they would be effective?

> Exactly. Exactly—that we have a potent unit. We think that one person can treat two people.

Does this work in an ongoing chain? For example if person A’s plasma is used to treat B, can we take from B and treat C as well?

Or does the quality of the anti-bodies depend purely on the immune system of the hose?

Once someone has been exposed and recovered, they should have the antibody concentration required to be become a donor themselves.

The required number of cells we’re taking about is high enough that you’re not transfusing A->B and then recovering A from B’s plasma and going on to give A->C.

But while B is infected they will make their own antibodies and after they recover they could then be a donor as in B->C.

As TFA mentions, China doesn’t even bother testing the level of antibodies, they just collect the plasma from anyone recovered. 90 tons to Italy... is a lot of plasma.

At least for IVIG the plasma is pooled from a large number of donors for each transfusion ultimately given to a patient. So it’s more a question of the average antibody load than needing to gauge each individual donor’s levels.

> Each IVIG preparation is made from the pooled plasma of 3,000-10,000 blood donors, which is then purified to contain more than 90% antibodies. [1]

I think we need to start collecting plasma from recovered positive cases today. I get that for a trial you do want to have a measured baseline of antibodies. But we can start stockpiling and pooling COVID antibody plasma even without the antibody testing.

[1] - https://www.rheumaderm-society.org/ivig/

China now has a lot of donors for plasma with antibodies. That's why they can stop the shutdown and start tracing outbreaks and treating patients.

Does someone know how much of this needs to be injected to be effective?

Not a real answer, but the article says one person can treat two people. So somewhere around 0.25 to 0.35 liters is a rough guess, assuming "one person" means "one typical blood product donation".

Got you. Thanks.

Vaccines should be the better idea rather go behind launching tons of ventilators. Even there were people not educated and still not care about the issues. For those people antivirals don't be the right choice, looks like vaccines are the best prevention - Early vaccines. How about trying the Ebola vaccines - I think that can be a preventive measure right.?

I don't see why people think we will hold out 18 months for a vaccine to be developed and tested, society would fall apart by then. I don't see it lasting longer than 2-3 months quarantine and then the common people will just go out anyway, especially in the USA where there's not much of a safety net.

There won't be a safety net anywhere if they require everyone to be quarantined for 18 months. The government can print money by changing a number in a computer, but they can't print sandwiches that way. Eventually dumping money into the economy where very little is being produced just leads to runaway inflation.

I don't think anyone is expecting an 18 month quarantine (and no country in the world has a safety net for people to sit home for 18 months). I expect 2-4 weeks at best in an attempt to 'flatten the curve', and then isolation of vulnerable population going forward. The spread will also slow as more and more people have the mild version and can no longer be a vector.

Why this article does not mention chloroquine at all, though?

Problem with vaccines is that there is as yet no evidence that humans develop immunity to COVID-19. No immunity, no vaccine.

Hopefully that changes soon.

https://twitter.com/NAChristakis/status/1240689935557865472

Details a study on a different Coronavirus in 1990. There is definitely some immunity, but its complicated.

Antivirals are ready. HCQ was mass produced for decades, and ramping it up is trivial, and already done.

The first vaccines, BGM, will be ready in summer. This was already applied en masse in the UK in the 60ies, and is in stage 3 testing.

What else: Vitamin C is ready.

Self made masks are better than no masks.

Ramping up tests kits are the most important part until summer. There's a new faster one in testing, which needs 20min, and will cost €15.

Contact-less thermometers can be imported en masse from China.

Creating antibodies from plasma is not really viable for billions. The rest is.

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