OK, someone tell me why this isn't the good news it sounds like
> Without a strong mucosal response, injected vaccines may be less likely to produce so-called sterilizing immunity, a phenomenon in which a pathogen is purged from the body before it’s able to infect cells, Dr. Durbin said. Vaccinated people might be protected from severe disease, but could still be infected, experience mild symptoms and occasionally pass small quantities of the germ onto others.
https://www.nytimes.com/2020/07/14/health/coronavirus-nasal-...
If you're about repost right-wing canards about how it's less deadly for children, please review salient facts about infectious diseases, such as the fact that they are infectious. The goal of vaccinating younger people is to protect those whom they might infect.
That's extremely rare, if it happens at all.
> The goal of vaccinating younger people is to protect those whom they might infect.
You want to subject children to a medical procedure that they won't even benefit from?
Less than 80 people under age age of 15 have died from COVID. Child deaths from COVID are essentially zero.
In the same timeframe about 110 died from influenza. Immunizing children for influenza also seems unnecessary.
Though, sometimes people think vaccines just prevent someone getting a disease. Stop it completely in its tracks. That's true for some, but it's not that simple for others.
Unfortunately a measured immune response does not ensure:
- That the virus can't be transmitted to others
- That you are less likely to catch and replicate the virus
- That you can't get ill from the virus
- That you can't get "long covid" symptoms
- That you can't die from covid
- That the immune response lasts for more than a few months (this is why we keep getting some of the same cold viruses; our immunity to them doesn't last)
- That the R number goes down (if it doesn't prevent transmission)
- That the R number doesn't go up (if people change behaviour in response to knowing they or other are vaccinated)
- That the virus won't evolve a workaround in response, like the rapidly mutating flu viruses
An immune response certainly suggests those things. But we can't be certain from immune response alone. Consequences need to be measured as well. We'll have a real solution when those sorts of things can be demonstrated, but it will take much longer to find out unfortunately. Probably we have to deploy a vaccine on a large scale somewhere before we can even find out how effective it is in the ways that ultimately matter.
Still, if a vaccine combined with uptake and people's behaviour reduces R below 1.0 at scale, that's enough to be a breakthrough. The greater the reduction the better, but 1.0 is the magic number.
Even if there's one good vaccine, having multiple good vaccine types in the world will be better. The virus is less likely to evolve a defence against multiple vaccines than against a single type deployed everywhere.
The fact this vaccine targets the spike protein is also good news, because even if the virus evolves, there's evidence that the spike protein is key to its harmfulness, so any evolved strains that keep it will likely trigger an immune response, and evolved strains that change the spike protein seem likely to be less harmful too.
To make the virus for the vaccine you need to use a different virus that when it replicates it creates copies of the actual virus used in the vaccine.
Think about it as a self extracting archive that creates copies of an uncompressed file (the actual vaccine) the file that it outputs doesn't have the information to reconstruct the self extracting archive itself.
I guess the thought is that a really unlucky evolutionary accident would be when the other virus capable of replicating and the vaccine meet in a body, and by chance transfer some of those instructions across. I presume that's rare or never seen, but I don't know, and (with a safety-engineering mindset on) I'd automatically consider that a "chance" unless it is ruled out by something.
> In extremely rare cases, natural mutations can cause a reversion to virulence. In this case, the virus can revert to wild type or develop into an entirely new strain.
Now, the Oxford vaccine is not an attenuated virus as is usually meant by that term.
On the other hand, it's not the same as an "inactivated virus" vaccine type either, where a virus is broken apart.
It's a different sort which doesn't fall into either of those categories. It's described as a "weaken adenovirus" and "replication-deficient" because of replication genes being deleted, and spike protein coding added. (There's no coronavirus at all, just the spike protein. This is completely different from other vaccines.)
The replication-deficient adenovirus has been studied thoroughly, not just for Covid but earlier as well. There are good reasons they selected it.
I will certainly take that vaccine when it's available, if that counts as any sort of endorsement.
I have high confidence in the people engineering and studying it. (I'm in Oxford, btw ;-) But can you really generalise the observations of inactivated virus vaccines to this relatively new kind? I think no, it has to be studied and monitored with care. Thankfully, I think they are doing exactly that.
Looking good, but still months away from rolling out.
That's the part I'm referring to by "not caring" - just ignoring the close orders, especially since "two weeks to slow the spread" has been so completely abandoned.
I encourage you to visit one of the no-lockdown states like Florida or South Dakota sometime and see how much of a complete falsehood this is.
* What law? In the US, the lockdowns were under emergency powers of the executive branch, which are supposed to only last a limited time (30 days where I am, for example). Several of these were challenged and found to be unlawful.
* The US lockdowns were originally only mean to prevent hospitals from being overloaded. We are way way past that point where that was an issue - all the emergency capacity has been dismantled for months.
* As sibling comment implies, something like half the states in the US aren't under any lockdown now, businesses there aren't having issues staying open, and their stats are no worse than the locked-down states.
* Speaking of preventable deaths, suicide and overdose are climbing where lockdowns are still in place.
In some cases there have been legal challenges to those laws so there aren't givens but even if those are successful, my point was that even if you do re-open you can't force customers to come back when they feel unsafe. Even in the states where restrictions have been relaxed, a large number of people are not comfortable hanging out at a bar or restaurant — the problem being the risk of a serious disease, not the countermeasures deployed against it.
> The US lockdowns were originally only mean to prevent hospitals from being overloaded. We are way way past that point where that was an issue - all the emergency capacity has been dismantled for months.
The lockdowns were, as clearly communicated at the time, intended to slow community spread. Avoiding hospital overload was part of that but so was avoiding large numbers of people getting a serious disease with potentially life-changing impact when they don't need to.
> As sibling comment implies, something like half the states in the US aren't under any lockdown now, businesses there aren't having issues staying open, and their stats are no worse than the locked-down states.
And that commenter was wrong just like you are wrong. Anyone who follows this issue knows that the cases have been rising recently (~35%) and there's a noticeable correlation with the states which re-opened high risk activities and those who did not.
For example, they mentioned South Dakota which is at an all-time peak:
https://www.nytimes.com/interactive/2020/us/south-dakota-cor...
Compare with, say, New York which is roughly 20 times larger even before you account for density differences:
https://www.nytimes.com/interactive/2020/us/new-york-coronav...
A common cause of error here are people looking at the all-time cumulative stats rather than the last week or two and missing that while, say, NYC was hit early with quick community spread in a dense environment and thus had a brutal spring but the increased lockdown have kept levels low since then.
This is demonstrably false. Some places are already back to life as normal, like Florida and Sweden, with no business closures. And in spite of this they still have lower deaths per capita than some places with heavy lockdowns like New York, Peru, Belgium and Spain.
Even if we had a vaccine ready for the roll-out today, I don't see us going back to normalish until late 2021 at earliest.
As with any vaccine, you'd need about 80% of the population to vaccinate in order for herd immunity to kick in. I feel like we're gonna have trouble reaching that amount for years to come.
Getting a working vaccine is only step 1 towards eradication path, not the end goal.
We're not going to eliminate the virus completely. That's a given, we should stop aiming for that.
If we get to a point where there's a stable number of daily deaths then we're good. (like we have for literally every single fatal illness.)
Smallpox. And if you consider within the borders of a given country, a dozen others (polio, measles, mumps, rubella, chickenpox).
Fair enough. I would consider a virus eradicated when the general population gives zero thought to it, and effectively no one dies from it. Doesn't meet the strict medical definition, but I thought the description of "If we get to a point where there's a stable number of daily deaths then we're good" was overly pessimistic.
That's not how it works. Just because you don't see an outbreak for a while, that is never a reason to stop immunizing children. Pathogens can and do have natural reservoirs. This is why when some idiots stopped taking the Measles vaccines we had an outbreak here in the US.
Deaths is the only relevant measure.
You can also corroborate this by comparing it to new hospitalizations, which are also up.
“Deaths is the only relevant measure” - not sure where to start with this except to say that this is not at all what epidemiologists seem to think and I won’t address it further without some very dramatic reasoning and evidence.
No, it suggests that you’re doing more testing, and finding more cases. Which, exactly as the OP said, is a metric that can be manipulated by doing more testing.
The whole reason we emphasize positivity rate is to try to compensate for the inherent bias in reporting raw case counts.
There have been far more cases than we have ever formally detected with testing. There’s plenty of room to increase that number by testing more people, but it will not affect hospitalizations or deaths - which is exactly what we’re seeing.
Positive test rates measure what was happening about a week ago. Hospital admissions reflect activity a week or two before that, and deaths often get reported a month or more after the events that caused people to get infected.
You have to look at all the data to get an idea of what is happening.
"If it bleeds, it leads"
I don't know about you but I'm feeling like simply "getting to a stable number of daily deaths" doesn't cut it. Also, that statement alone doesn't make sense to me - a fatality rate of 50% could potentially maintain a stable rate of daily deaths... Of thousands.
https://covid19.healthdata.org/global?view=infections-testin...
https://covid19.healthdata.org/united-states-of-america?view...
But notice, in the latter chart, that in the US the number of infections is predicted to peak in January and then start going down. It seems plausible that by March, we'll achieve some level of herd immunity, relative to the precautions that are currently being taken. We might have a situation like Europe over this pas summer, with small numbers of cases until a second spike in Fall/Winter 2021. That would buy us the spring and summer to roll out a vaccine.
Of course, I'm far from sure that this is what will happen -- but it certainly seems plausible to me.
For example, I'm a professor at the University of South Carolina. Here we've had around 2,500 confirmed Covid cases, and perhaps around 10,000 cases in actuality. Nearly all of them happened in the first few weeks of the semester, and now the positive test rate is extremely low.
Looking around town, it's pretty clear what happened. There are some students that have acted like nothing is happening, partying and drinking constantly. That population has presumably hit herd immunity already. Meanwhile, there are many students (and staff) that are exercising precautions, and not venturing out a lot, and probably few of them have contracted the disease.
Now, we can't just go back to normal, or else cases would spike among this second group -- but locally it seems that we can afford to relax a bit.
And, also, we're at 8.8 million confirmed infected -- the actual numbers are presumably much higher.
Literally, right now we are seeing case rates explode, but the number of casualties is paradoxically very low because it's mostly the younger cohorts getting sick - which is probably a social function of things like 'back school' and 'risky behaviours' among younger groups.
If we could get everyone 50+ vaccinated, we may be largely safe - maybe not 'back to normal safe' - but the combination of 'partial herd immunity', 'much lower rates of hospitalization' etc. may mean we can 'kind of get back to normal'.
At minimum younger people who have had covid are looking at a lot more regular check-ups for the rest of there life.
There's not a single peer-reviewed study showing a significantly higher frequency of long-term adverse effects in healthy individuals compared to other respiratory illnesses.
You don't need to eradicate the virus, just stop it affecting the most vulnerable. Everybody else can then carry on as normal (albeit with a slight chance of getting a nasty flu-like illness).
Not to mention that we already know about long term side effects that have nothing to do with a specific age group, and that there's a chance of re-infection.
If we just vaccinated 65+ year olds, we'd cut deaths by 80X%, where X is the effectivelness of the vaccine. Even if the vaccine was only 80% effective, that's still 65% reduction.
Add in people with dangerous conditions, heart conditions, cancer, morbidly obese, etc., and you could probably knock it down further.
And as the percent of the population with immunity rises, the spread will slow quite a bit.
We don't need heard immunity to open back up.
Because of this high dispersion rate, it may make sense to earmark a certain amount of vaccine doses for people who are not themselves at risk of complications when contracting Covid, but who are at risk of becoming a superspreader.
(Disclaimer: I'm not an epidemiologist.)
At least then we stand a chance of getting the economy back on its feet.
For instance, I'm a vulnerable person because of preexisting conditions, so I'll likely be offered a vaccine relatively soon after approval. But that won't have a large impact on economic recovery: I'm in the home office in a single-person household and don't have any care obligations, so I'm at a comparatively low risk anyway. And I won't change my current behavior until the disease is fully gone anyway.
The US has five million people who tested positive and have recovered. Likely also another 30-50 million who were never tested because their symptoms were to minor. And another 66-165 million who have cross reactive T-cells.
Some researchers have concluded that the herd immunity threshold for sars-cov-2 could be as low as 10% or as high as 50%. I don’t think anyone sees it as high as 80%.
The mayo clinic suggests it could be 70%, and I have seen others suggest 80%. I have not seen anyone suggest as low as 10/20% so I think that suggestion is a huge outlier and even the paper you link says as much.
One of the papers hypothesized that this demonstrates why areas like NYC got hit so hard initially and have remained stable since. Seroprevalence surveys back in the early summer indicated that between 20-30% of NYC residents had contracted Covid already. The lockdowns obviously blunted the surge, but unlike other areas of the country, as NYC has opened back up, there hasn't been much of a second wave at all. With more than 2/3rds of the population still without any kind of exposure to the virus, you would expect a dense city like NYC to see a large increase. The paper concluded that this is evidence that might suggest that the herd immunity barrier is far lower than initially estimated. I've seen some papers suggest something closer to 20-50%, but nothing so low as 10%. I'll see if I can dig up some of the preprints to post here.
Wrong. The herd immunity threshold (HIT) for influenza is 33%-44%. HITs are different for every infectious disease. Current estimates for COVID-19 are 60-75%.
Furthermore, I know of at least 3 leading statisticians that hypothesized (very early on) that the variance of infection trends pointed to pre-existing immunity in various populations. The evidence supporting this is mounting.
"I think the first thing we to review is who is Peter Doshi? And why is he so insistent on getting this data?
Peter Doshi received his BA in anthropology from Brown University, MA in East Asian studies from Harvard University, and Ph.D. in history, anthropology, and science, technology and society from the Massachusetts Institute of Technology. Those would be fine credentials for someone who is going to teach history or anthropology."
https://www.skepticalraptor.com/skepticalraptorblog.php/pete...
What's there to deal with? Let people make that personal choice and leave them alone.
The most we're going to get out of a vaccine is a tool that can be used in conjunction with physical distancing, and masks, to keep the infection rate and hospitalization rate sustainable.
Even with a vaccine, COVID-19 will remain one of the leading causes of death among the sick and elderly. The percentage of chronically ill people who live, and the percentage of people who make it past age 65, will plummet.
Everyone who's alive now will almost certainly need to socially distance (and should wear an N95/KN95 mask in public indoor spaces) for the rest of their lives.
What's happening now is humanity's normal.
Is it? Current studies, AFAIK, give very variable attack rates, from low zeros to around 30%. Only higher if due to close contacts for longer periods of time (carriers, fishing boats, meat packing plants). This preprint on trasmission dynamics and evidence from September[1] has lower figures.
> Everyone who's alive now will almost certainly need to socially distance (and should wear an N95/KN95 mask in public indoor spaces) for the rest of their lives.
I wonder how we're even supposed to build a society that can live without any or very reduced form of contact. I think it's socially unsustainable.
[1] https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3692807
By then it will kill at least a million people at the current trajectory. So US needs to start acting more aggressively now.
Can you also share some of those sources you mention? Thanks!
> Two of those companies, Moderna and Pfizer, are now in Phase 3, large-scale clinical trials. The 30,000 volunteers in each of the trials are getting two doses, with Moderna spacing their shots out 28 days apart and Pfizer spacing theirs out by 21 days.
> AstraZeneca is expected to start Phase 3 trials this month. Their Phase 1 and Phase 2 trials used two doses given 28 days apart.
Okay good so just lets get it shipped!
A: Quite data driven (and frustrated when data's not there)
B: Former work history in monetary policy a fan of fan-charts (i.e. central projection isn't the only thing, there is a spread from the central projection).
C: Not willing to over-speculate on either side.
D: Perhaps not a super people person, but not negative either, see A. Quite nuanced if others listen, and would listen to those advising him keenly. And starkly aware of causes of death that are not Covid-19, but linked and accelerated due to it - avoiding hospitals, mental distress, etc.
All in all, not a bad choice for a health secretary. Reading between the lines, I'd give it 2-3 months until this is rolled out.
The AstraZeneca vaccine is based on an adenovirus vector, which has never been approved for use in humans. It uses a weakened live virus that can (and apparently has, in the case of the J&J vaccine, which is using very similar tech) cause serious adverse systemic reactions. From what we've seen so far, the safety profile for these vaccines is far worse than the mRNA/lipid nanoparticle based vaccines coming from Moderna and Pfizer/Biontech.
It's also not really news. We know that a vaccine will prompt an immune response. Dozens of others in progress have already shown this with phase 1 and phase 2 data. The question is how strong, how long lasting, and how safe is it, along with the question of real world efficacy data from placebo controlled trials.
The worrying trend is the ,,signed contracts with governments'' part even though the clinical trial results are not out yet. It seems that vaccination gets highly political, just like how EU made a mistake of paying for Remdesivir even though we knew that it's not worth it at that point.
There is no evidence to prove the vaccine has caused any serious adverse effects so far. If that were the case, it is unlikely the Data Safety and Monitoring Board (DSMB) and U.S. Food and Drug Administration (FDA) would recommend resuming the trial.
> After a thorough evaluation of a serious medical event experienced by one study participant, no clear cause has been identified. There are many possible factors that could have caused the event. Based on the information gathered to date and the input of independent experts, the Company has found no evidence that the vaccine candidate caused the event.
https://www.jnj.com/our-company/johnson-johnson-prepares-to-...
There's also no evidence to prove that it wasn't. Furthermore, the AstraZeneca vaccine was halted for a case of transverse myelitis, a very common (and serious) adverse reaction seen in DNA/adenovirus based vaccines like ChAdOx1 [0]. These complications have not been seen at all in the mRNA based vaccines, since they do not involve a live virus.
[0] https://medcitynews.com/2020/10/report-fda-takes-closer-look....
Also, the AZ trial was given the go-ahead along with the J&J trial.
https://www.reuters.com/article/us-health-coronavirus-astraz...
Glass half empty: We don't know how the immune response measured relates to protection from or lessening of the infection. This is what the ongoing trial is trying to find out.
This is, IIRC, the second report of successful immunogenicity in older people. There was a (small) cohort of > 65 year old people tested with Pfizer / BioNTech's vaccine in the Phase 1 trial, and even there immune responses were found and measured.
There are tests that can be run to show an immune response.
One thing I’ve learned is it’s extremely hard to get doctors to run the tests. AND there are a whole lot of them. AND I’ve run into many doctors that are 10-20 years out of date with treatment and diagnosis protocols.
As in, current recommendations are that test X isn’t reliable. Use test Y. Doctor refuses to run any test because you’re the wrong gender. AND The moment you see someone in a practice your banned from seeing anyone else in the practice. So second opinion means going to 20 miles to another center.
Oh, and it’s 3 months+ to get a single appointment. You may need two dozen appointments until they narrow in on the issue.
That something is possible still leaves a massive gap of getting it done.
[nature.com] https://www.nature.com/articles/d41586-020-02633-6
On a separate note - the voting on this thread at the moment seems pretty wild with some seemingly innocuous comments being downvoted. I don't get it.
They shouldn't be off the hook completely. They should still have to show they have conducted a responsible level of testing and checking for the circumstances, that they are continuing to refine that verification even after widespread deployment, and to motivate that to be done all levels requires some degree of moral hazard remains in place for them. In other words there should be some sharing of risk. Imho.
If there is some sharing of risk, but no profit to be had (and ultimately profit is what buffers you against risk) then why would you be involved at all? Let some other company take the risk?
So this isn't like we are relying on AZ to create it, test it and sign it off. National agencies will ultimately sign off on whether it can be used or not. Given the high profile nature of this vaccine you can be sure that results will be widely studied, and the opportunity to hide results they don't like will be limited given we all know the trials are occurring.
Now (soon, hopefully) people can acquire immunity through a vaccine, instead of through a virus that leaves long-lasting damage to the body (in particular, but not limited to, the brain).
However, the efficacy of this vaccine (and all the other candidates) still needs to be clarified - ie is it like a measles vaccination (~90% efficacy) or the flu vaccines (~ 25% - 50% I believe).
- Efficacy of at least 60%
- Lower bound of efficacy (confidence interval) >= 30%
- Minimum safety data for at least one or two months post vaccination (I don't remember if it's one or two)
- At least five severe cases in the control arm
- Requirements for the trials to go on even if efficacy is found for an additional year after the trial end (for most of the trials, this means two years in total)
> One in 20 people with coronavirus are likely to have symptoms for eight weeks or more, according to a new study by King's College London.
> The research, which uses data from the COVID Symptom Study App, suggested so-called "long COVID" affects around 10% of 18 to 49-year-olds who become unwell with coronavirus.
Whole study is here: https://www.kcl.ac.uk/news/study-identifies-those-most-risk-...
The actual study seems to say 1 in 20 have symptoms for eight weeks, which might be closer to what you could fairly describe as “long-term”, but says nothing about the severity (though I haven’t waded through the whole article).
Anyway, the drop-off from 10% having symptoms at 4 weeks to 5% at 8 weeks is encouraging - it intuitively suggests that the negative symptoms aren’t permanent, even if they take a long time to go away.
Long term health effect claims are being made all over the show - if this is the measure that is outrageous reporting.
Most people would worry about 'long term health effects' as they'd usually assume that it's going to go on for years.
I feel a lot of Covid effects are being massively overblown because people aren't aware that other more common viruses that we don't worry about can have these "long term" effects as well.
Those 4 week and 8 week statistics are part of an attempt to understand what's going on. It doesn't mean 8 weeks is considered long covid.
They are worried about effects where people got it months ago and are still disabled from it. Things like still struggling to walk upstairs 6 months after getting covid.
And that young, fit people are reporting it, not just "old".
The worry is that it doesn't appear to be getting better for them yet. The greatest worry is that people who get it might never recover, or might take years to recover. We can't know yet.
Flu and other viruses affect some people that way, but it's a small number of unlucky people. The worry is that the number affected by long covid in this way are a much larger number of people.
My fear is that this is super, super, super rare, but figures are including long term as low as 8 weeks, so we have absolutely no idea how small / large the number of people having this critical level of long term effect actually is.
There are plenty of anecdotes to be found of people reporting debilitating long-covid symptoms for 6 months so far. That's "still sick since I had it back in March/April".
(It hasn't been around for a year so nothing can be said about that timescale yet.)
That's significant enough that public health officials are talking openly about it as a concern, so it's not just a few isolated anecdata.
There are some reports suggesting neurological impairment. Along with observed blood changes (thickening), which is concerning regarding long term damage for rational reasons. If that turns out to be true, that sort of damage tends to never completely recover. Rather you learn to adapt and live with it.
However, they stating they're also counting 8-10 weeks as long term, so the stats are obviously way inflated. I'd really like to know the number of people having the extreme effects, without the media trying to inflate the figure.
Judging from our response to Covid-19, if this had actually been the collectively-feared zombie virus, the pandemic would have been far worse than any fictional account has manage to capture so far.
World War Z
Walking Dead
Shawn of the Dead *
28 Days Later
The Last of Us
What's worse than the above?
* (ok maybe not this one)
In what percentage of people who get COVID-19 is there long-lasting damage to the body? What other conditions did the people who get long-lasting damage to the body have? How does these numbers compare with other diseases?
Would appreciate citations.
And this is one kind of neurological effect. This is a more global view of how the virus could affect the brain:
https://www.scientificamerican.com/article/what-we-know-so-f...
And I'm not even touching the subjects of damage to the heart, clotting problems, etc.
However, those covid-induced strokes definitely affect the brain.
https://www.thestar.com/life/health_wellness/2010/09/02/sars...
This is still good news. But it should be put in perspective, this does not automatically translate to "this vaccine will work fine in both young and old". It just means we can have some higher hopes that it will.
Only RCT results of the real infections will show if it really works. (RCT for the vaccine is running and first results are expected soon.)
Injecting a disease into volunteers is called a human challenge trial. It is a type of RCT, but it is not what is being discussed here.
What you're referring to (voluntarily infecting people) are challenge trials, which are also being discussed, but are still somewhat ethically dubious.
There are already a bunch of vaccines going through this process.
Challenge trials is where you purposefully infect subjects. TheY are highlY controversial but according to Oxford, would speed up the research and they are planning to do one.
Personally I would argue that the standards should be kept to even when the world is on fire, I mean they do exist for a reason.
I mean, its better news than the alternative, but I think "Oxford vaccine produces zero immune response" would be a far less likely outcome.
s/year/month/g