> Although the magnitude of neutralizing antibody (nAb) responses correlated with disease severity, there was a rapid decline in nAb titres in most patients within 3 months after onset of symptoms. [...] However, the consequences on secondary immune responses and their ability to prevent reinfection remain to be determined.
I don't think it's possible to say a yes or no answer if somebody has immunity using a lab test today.
Though, the vaccine is only needed to last long enough to eradicate the virus. If mass application of vaccine can plunge the r-factor well below 1, it should be more than ok if its protection only lasts 3-4 months.
If the each contaminated person transmits it to two other people, you'll need to keep half of the people immune to each at any single time. If you are doing this by vaccines, you'll need to give it to half of the people on that immunity window.
And you must also syncronize it internationally.
[1] https://www.canada.ca/en/public-health/services/publications...
It's not impossible for countries with a small population, but AFAIK the flu is the largest scale vaccination in the world, and we are talking about something 4 times larger (than those countries that vaccinate the most - how are China and India numbers?).
But then, this seems to be the worst case with a reasonable likelihood. Things will probably be better.
COVID is much scarier than flu, which should encourage people.
Then you need to administer something like 300 doses per second globally, if you have 1B doses.
This is also assuming the virus doesn’t mutate during that time (it mutates very slowly but it could still happen).
The vaccine really needs to give multi-year protection otherwise it won’t be viable in the long run.
[1]: https://cen.acs.org/business/outsourcing/Moderna-picks-Lonza...
Source: Live in Lansing MI where the nutty politicization of this issue is out of hand and there are redneck “anti-mask” protests seemingly once a month.
https://www.fiercebiotech.com/biotech/moderna-finalizes-desi...
Moderna has plans to be able to manufacturer 1 billion doses a year. AstraZeneca has announced plans to manufacturer 2 billion doses a year, with plans to produce 300 million doses by the end of 2020. The Chinese firms Sinopharm and Sinovac are ramping up their production right now, and will produce 200-300 million doses by the end of 2020. With all the other firms developing a vaccine it seems highly likely we could produce enough vaccine to vaccinate the entire population of the Earth in a single year. Now distributing and administering that much vaccine is another story, but manufacturing will not likely be the bottle neck.
Also based on the results from the study, two doses are necessary because one dose didn’t elicit a strong enough result but two did.
But, as an alternative to synchronization, you could also require vaccinations for everyone who travels.
If a country gets it under control within its borders, it could require visitors to show proof they either (1) have tested positive for the disease and then recovered or (2) have been vaccinated recently enough (but not too recently) and also tested negative for the disease.
That way, you'd know they do not have it and have some degree of protection against picking it up while traveling to your country.
Anyway, the travel restrictions I mentioned would hardly be bulletproof. Vaccinations don't confer 100% immunity, and tests aren't 100% accurate. So countries could still reduce their risk by supporting worldwide vaccination.
Also, this might be a moot question if we can't produce enough vaccines to do it all at once.
Thankfully the R0 of SARS-COV-2 seem to be around 1.4–2.5 (meaning you need ~30% to ~60% recovered), so a vaccine would be actually very effective. I highly suspect "Travel to Europe" (i.e. international travel) may still be delayed for a long bit until we've gotten around to ~50-60% immunized, but it's tough to say.
https://academic.oup.com/cid/article/52/7/911/299077 https://en.wikipedia.org/wiki/Compartmental_models_in_epidem...
If it's really down to a single company not being able to manufacture enough then it's time to open up the vaccine to licensing and let other companies pile in.
The world is facing a few problems like this, where the structures of the economy are getting in the way of doing real work. Climate change is another one. If cost wasn't an issue, and everyone was paid by some infinite coffer, we'd have switched to green energy years ago and it wouldn't have been controversial at all. Only now that it's cost effective are we switching en masse to green energy, and we're having to drag economies kicking and screaming away from coal even still.
The community seems to be second to capitalism at every turn, and whilst I know it's not a new thought, it's becoming more and more prevalent that we've made societies devoid of the capacity for community effort.
Edit: Thought I'd clarify, my point is that our governments are meant to supply the community capacity through paying for work with our taxes, but often structures that benefit private businesses win out.
More specifically, you're hopeful that the company manufacturing the vaccine would actually open up to licensing, but they don't have to, and the US has consistently shown it's disdain for compulsory licensing. It would be an exception for them to force the company to license a vaccine, and it's not like pharmaceutical companies have an ethical track record in the US. If it came down to money vs community health, I would absolutely expect money to win out in the US. It already does. Worse yet, the US has bullied other countries into tightening their own compulsory licensing laws, in order to protect US pharmaceutical companies.
Either they were symptomless or with good discipline and PPE you can limit its spread quite successfully.
To be clear, higher than in other cruise ships and other meat packing plants.
There was also a swiss military study where one group only got infected after distancing implemented. Positive cases, but no symptoms. Earlier group’s cases had symptoms.
Is anyone optimistic about that?
He vaguely remembers the case as something from the 50's or the 60's and todya we have better technology all around. But yes, I understand that most labs working on vaccines do take into account the potential difficulties in production.
That will be a really interesting question for the modellers, because vaccinating those who pose the highest danger of spreading the disease might have a much greater impact. If side effects turn out big you might even end up wanting to vaccinate everybody but the elderly.
Governments essentially said "If you can demonstrate reasonable efficacy and safety, go ahead and start mass production. If your Phase III trials fail, we'll make you whole and dump the doses in a landfill."
Otherwise, you had to wait the entire Phase III duration before even starting production, whereas now you'll essentially have viable vaccine on Day 0 when the Phase III trail concludes.
I wonder will people comparison shop.
Governments have too much incentive to purchase and distribute all they can get their hands on.
https://www.mcclatchydc.com/news/coronavirus/article24377546...
https://www.reuters.com/article/us-health-coronavirus-fauci-...
The "r-factor" (also called R_0, or attack rate), described the rate at which people once exposed to the virus move from S->I. The proportion of patients in (R) should not fundamentally change the r-factor.
That said, I do think your fundamental assessment in that moving more people from (S) directly to (R) would decrease the rate at which the disease spreads.
https://en.wikipedia.org/wiki/Compartmental_models_in_epidem...
https://en.wikipedia.org/wiki/Basic_reproduction_number#Effe...
It being artificially reduction is kind of given as it a vaccine, but as the basic reproduction number is being used to measure the number of reproductions from each [known] infected person within population groups it seems like THE measure of a vaccine's impact.
You seem to be talking about something else entirely.
This was just a Phase I (healthy subjects) and most of drugs/vaccines are successful at this stage.
Drugs are not software, you cannot ship a broken product and then fix it. Even if it is safe, but not effective, it would do more harm than no vaccination, as vaccinated people would change their behaviour.
I still haven't wrapped my head around antivax...
I mean, isn't that the product of poor education and lack of mandatory vaccination programs?
Where I'm from, you can't even sign-up children in school if they don't have the proper mandatory vaccinations - and school is mandatory, which makes it impossible to evade.
If they don't get the parents because they didn't take their child for vaccines (which is almost impossible because you're assigned a family doctor and he would flag it), they will get them when they'll sign them up for school. If they don't sign them up, social services all over them by then.
I know there are antivax people here, but they basically just avoid taking flu shot, all the rest they had to have them at some point. Hell if they cut themselves and need stitches, they will get a tetanus shot.
This also affects recommended vaccinations, like HPV. In Denmark, media coverage of alleged side effects led to a substantial drop (or delay) in vaccination against HPV (Hansen et. al, 2018).
It's a tough one in some ways, but more gets down to how you define what an antivaxer is.
I have a friend who will never have another flu shot and be weary of this vaccine - WHY, well he had his first ever flu jab a few years back, which had bad side effects for him and he lost hearing due to it in one ear. Hence, he's very weary of such vaccines now and yet, some people would label him an antivaxer! I don't think he is as he is basing his opinion on self education and more so, experience as well as he don't push his choice decisions onto others.
See medicines and vaccines have side effects, most people won't get any, some will get a few and a very few will have adverse effects.
My worry is those who have had bad experiences and maybe more prone to side effects in some medicines due to genetics etc, get labeled as antivaxers and their very real personal experience is overlooked and they are viewed as crackpots when talking to medical advisers in the future, let alone society.
But then for me an antivaxer is somebody who actively promotes the non-use for everybody period and run with that. Now I don't know anybody like that, but can see how some may of come about via a few edge cases and propergating that onto the whole. That is a case of needing education.
If some people want to make an informed choice about individual vaccines based upon their medical concerns that are real and not anxieties - well, that's how it should work. Though if they actively promote their choice onto others, well, that's not right and what I would class as an antivaxer.
Me, I sent email to to the research folks offering to be a human lab rat if it helped speed up vaccine development, not that i'd call myself a provaxer - just case of the maths made sense and as spoke said - the lives of the many outway the lives of the few. Besides I'm still here :-). But I can respect an informed choice made by some, as long as they don't feel the right to impose that free choice of theirs onto others.
The media has totally blown antivaxers out of proportion. On top of that, there are many people who are very much for MMR, Polio and most of our standard vaccinations, but are weary of newer vaccines like HPV (and get thrown in with all antivaxers).
Some vaccines aren't very effective. I was turning in my vaccination records for school once and I was missing my 3rd Hep B shot. You have to have 3 of those in a few months, and if you miss one, you have to start over. A biologist I knew said it only had a 60% take rate, and was one of the most common vaccines that had to be taken again for hospital staff (who are given antibody tests to see which vaccines they need).
And on top of all of that, look at what happens when a vaccine is rushed. In the 1970s, 60 Minutes did a documentary on the rush to make a Swing Flu vaccine. Millions were vaccinated with no ill effects, but there were healthy adults that did have long term, permanent neurological damage:
https://www.youtube.com/watch?v=hMUeZ4vz6cU
I had to stop getting flu shots because they'd make the entire side of my body on the injection arm, hurt for days. I'd get extreme fatigue and soreness. It wasn't as bad as the flu of course, but it was painful enough I decided to stop getting them. I had an asshole friend tell me it was psychosomatic (all in my head). I get all my other shots (including Typhoid and Meningitis when travelling abroad) and had no adverse reaction.
So I make an active choice that I'm not going to do flu vaccines.
This entire situation is dangerous because we're talking about personal autonomy vs some ideological concept of communal good; and we're not discussing it with the delicate discussion and nuance it deserves. You can throw around terms like "antivax" and "antiscience" and it's a religious statement at that point, because you're not addressing the very real ethical concerns people have.
Hep B is effective and the effectiveness window is being extended as time goes on. When I took Hep A/B vaccine I was told that it would last for 10 years. Right now the estimate is at 30 years.
They were talking about long term protection. Realistically it only needs to last a year or so. After all the flu vaccine is only valid for a year because it evolves so quickly.
As for safety, that's the entire point of these three phases of trials. seeing if its effective is a nice bonus, but in reality to see if there are any problems like there were with the dengue fever jab.
I commented on that part. And yes, it seems to be safe in healthy subjects (Phase I). The OP wants to move from Phase I to production immediately. I take an exception to that approach and I agree with you that there is a point in doing the three phases. The later of which actually focus on effectiveness as well.
Shipping something that's not effective is counterproductive. Being vaccinated would affect people's behaviour, if you told them that they should not change their behaviour back to pre c19, you would be just faced with questions on what's the point of vaccination.
We can ship placebo right now.
If this turns out to work in the short run, we should deploy it. Not wait 2 years while the pandemic rages to produce the perfect science paper.
The death toll from COVID lockdown is so much higher - from excess suicides, poverty, crime and violence - that anything we can do to alleviate the panic and get back to normal life is worth it.
That's the same false dichotomy we've been hearing since the pandemic began.
I mean, in an ideal population set where people acted rationally, it might be. In the real world, where fear motivates counterproductive behavior, it’s hard to imagine a different scenario where you don’t slow the economy (associated harms) while trying to mitigate the virus.
Another topic on HN that showed up today was "any claim without a URI should be treated as suspicious," which I would broaden to, as the kids say: "bring receipts." If you're going to implicitly (or explicitly) claim that the harms of a lockdown in response to a pandemic are greater than the harms caused by the pandemic itself, you should at least put a little effort into explaining why, and include at least some links to studies or informed discussion that support your claim. Just backing it up with "the truth of my claim should be clearly obvious to even the most casual of observers" is rarely good enough.
I don't think anyone has seriously claimed you can mitigate the virus's spread without slowing the economy, or that slowing the economy doesn't come with associated harms. The question was and remains what the balance is. Is there any evidence to back up the claim in the thread above that "the death toll from COVID lockdown is so much higher?" Higher than what? The projected death toll from no lockdown at all? When someone makes a claim about the economic damage from the lockdown, are they taking into account studies that try to project the economic damage that no lockdown would have caused?
We know that many people do not have comorbidities.
The mean age of patients admitted to ICU is 60.6 years (white people), 55.4 years (non-white).
88% / 93% of people were able to live without assistance in daily activities before admission.
How much more can we expect if things simply “get back to normal”. Hard to say but obviously a gigantic loss. I’m also highly skeptical of claims that #1 suicide, crime, violence have increased significantly. Source? Poverty/economic disruption is obviously a massive damage that cannot be understated either.
But I’m highly highly skeptical that countries who try to ignore the problem like Brazil, USA will end up economically more successful than countries with strong countermeasures like South Korea, Taiwan, New Zealand, and many others. Beat the virus to fix the economy.
At some point there is an inflection point where it makes sense to “give up” and accept that countermeasures are more costly than the benefit they provide. Clearly every day we delay and have high rates of infection, and the longer the vaccine takes, we move closer to the “give up” side of the calculation. I’m not at all convinced we’ve reached that point yet and we certainly hadn’t reached it at the point the federal administration gave up.
https://mobile.twitter.com/erictopol/status/1276153119492186...
Except those people don't pay with money, they pay with blood.
You may have misunderstood my point.
I may not have articulated my point well.
We said that before, and we got Pandemrix.
Vaccination is safe. It's important we get as many people vaccinated as possible, and one of the ways we do that is by maintaining the safety.
https://en.wikipedia.org/wiki/Pandemrix
https://www.narcolepsy.org.uk/resources/pandemrix-narcolepsy
https://www.cdc.gov/vaccinesafety/concerns/history/narcoleps...
That is obviously much better than the current Covid situation.
Somewhere in the middle things would get iffy and ethically interesting. The front-line medical worker is probably well-compensated. The essential workers at the grocery stores and warehouses are not.
Hopefully the vaccines are safe and effective and all of this remains a hypothetical.
Because it’s only “eradicated” in New Zealand so long as they wish to remain shut off from the rest of the world.
Trade and communications are running normally. Outgoing international travel is allowed, but of course hardly anyone wants to until the overseas COVID situation settles down. Inbound international travel is bottlenecked on the quarantine system while NZers overseas keep returning here, but that won't last forever because there is a finite number of them, so at some point non-citizens/residents will be able to travel here with a 14-day quarantine requirement and an associated cost (about $4K each). That will work for students, immigrants and long-term visitors. Short-term international tourists are really the only group that will be effectively blocked long term if we don't get a vaccine.