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Comment by studius | Hacker News Reader

Ebola was localized. COVID-19 is not.

I like your optimism, and what you said isn't incorrect about Ebola at the time, but I don't think it's correct about our current situation. How many locations globally have this level of refrigeration? Given that there would be high demand for it, wouldn't prices on any available refrigerators exceed what even the most altruistic companies and organizations could pay?

This still needs to be solved. We have a lot of entrepreneurs, investors, and engineers reading this, so let's not be hasty in hand-waving over something serious.

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On one hand you're right to be concerned:

* The largest chilled supply chains, for things like frozen food, don't get anywhere near -80°C

* The question of what to do in poor countries is very much unsolved

On the other hand:

* Developed countries have at least some cryogenic supply chain in place, for things like fertility medicine.

* You can get a surprisingly long way with couriers transporting insulated boxes full of dry ice (or liquid nitrogen).

* The prize on offer here is absolutely huge, because lockdown is so expensive. $10 billion a day buys a heck of a lot of couriers.

We manage to get $1M cruise missiles anywhere on the globe quite quickly. If the world can mobilize for WWII - the US alone built 1,200 warships in a four year period, 2,700 Liberty ships, 300k aircraft, etc. - we can mobilize for a global pandemic... if we choose to.

The world didn't mobilized for ww2. One country mobilized and started to threaten the existence of all.its neighboring states, and those who managed to leverage geographical and climate barriers managed to prepare themselves to intervene.

This is by far not the challenge covid19 poses to the world. It wasn't when it was China's local and regional problem, and it is not after it spread out of China and became a pandemic.

Objectively, at most Covid19 causes a slight increase in the global death rate, and this is only observed during the initial spread before herd immunity kicks in. Ww2 killed about 90 million people in 6 years, while covid is bound to have killed about 1.3 million in one year.

The analogy is imperfect, but it's imperfect in both directions - we don't have to make 300k planes and fight Nazis, we "just" have to produce a bunch of vaccine and some freezers.

It should be substantially less difficult than winning WWII, which again - we were capable of scaling up industrially to accomplish.

> this is only observed during the initial spread before herd immunity kicks in

When will that be? NYC's new spike is demonstrating even their enormous outbreak didn't generate enough of it.

The US has the manufacturing capacity for ships and planes before WW II. Do we have any factories left making refrigerators? Or are we just going to have to order them from China?

> Or are we just going to have to order them from China?

It's a global pandemic. Order them from anyone who can make them at scale. Coordinate with the WHO to avoid silly bidding wars.

I do not believe herd immunity is a thing when every 6 months the herd has to become re-immune

I dealing some on the distribution side of this. NYT has a pretty good article explaining all the infrastructure that is being rolled out. (1)

Even dry ice in coolers is low tech but gets you a lot of time considering storage for the second booster dose will be centralized.

The risk is real though. Breaks in cold chain storage have inactivated vaccines have been documented to leading to outbreaks in other disease states. Still, at this point, from my boots on the ground perspective -- so far, so good.

1. https://www.nytimes.com/2020/09/18/business/coronavirus-covi...

>Breaks in cold chain storage have inactivated vaccines have been documented to leading to outbreaks in other disease states.

Surely there's got to be some existing shipping indicator to track if a shipment has exceeded the temperature limits during transit. Even just a vial filled with a liquid that freezes at e.g. -70C would work just by tipping it upside down when frozen.

For what it's worth, one of the organizations that I've been following regarding COVID vaccine's in less developed economies is GAVI:

- https://www.gavi.org/vaccineswork/cold-supply-hot-demand

I don't have much more on that front, but it's worth a look to see what well developed agencies are aiming at.

> Ebola was localized. COVID-19 is not

You could easily localize COVID-19, just make a vaccination passport. No entry to a country if you're not vaccinated.

> How many locations globally have this level of refrigeration

Almost all developer countries, urban centres, where majority of people live anyway.

> Almost all developer countries, urban centres, where majority of people live anyway.

At -80C?

Edit: There are hardly storage places right now for these temperatures.

https://www.youtube.com/watch?v=byW1GExQB84

You can buy dry ice at your local grocery store. You can probably buy a cooler to put it in. And you get a week to use it after thawing, so if there is a break in the supply chain you only need to detect it and announce a vaccination clinic to that area. There might be some small town that gets 100% vaccination early on just because the truck broke down nearby and so local doctors were suddenly called upon to vaccinate their whole town just to use doses that couldn't be shipped any farther.

The linked video claims Pfizer has a similar solution and the currently tested parameters limit the cooler can only be opened 2x per day, and not more than 1 minute at a time, and the box only lasts 10 days, and carries doses in multiple of 1000s.

A breakdown scenario in a rural area could mean 1000s of wasted doses

> A breakdown scenario in a rural area could mean 1000s of wasted doses

Don't you think Western countries are ordering many thousands more doses than they actually need?

Breakdowns happen - places don't need to have perfect infrastructure in order to warrant treatment.

No. There isn't the ability to deliver more supplies than needed - at least not through the end of 2021. Until then every dose is urgently needed by several people only one of who can get it.

I'll happily wager the UK and US will over-order and then tacitly use the argument you have made to say that African countries are wasteful and don't deserve their supply.

US and UK may over order, but they will not get deliveries. Medical companies tend to have policies in place that will distribute to Africa ahead of richer countries if the richer countries are not seeing outbreaks. Obviously there is more money in the richer countries, so the early delivery will skew that way. However once enough are vaccinated (from all potentially passed vaccines) that a country can safely open they will start redirecting vaccines to poor countries.

Once the world is open the US and UK will be happy to say that they were able to cancel some unused vaccine supply if it turns out not needed. (which will be easy - between focusing on poor countries and moving production to something else (or winding down) as they recognize the need is gone they will be willing to end those contracts not completely filled. Politically it is a money saving move.

Of course the above assumes best (or at least) case. There are many ways things can go wrong. If all approved vaccines need a booster every 6 months things will be very different. (this is an unlikely but still possible very worst case)

I can't think of a rural area that is more than 2 hours drive from a city large enough to take thousands of doses.

They should be able to put out a general announcement and get thousands to get the vaccine if they need to. A lot of people who can get off work on short notice if there is an emergency. Obviously not everyone, but thousands can be redirected to someone else on short notice. Of course this requires emergency shipments to those who should have got the original, but the breakdown would require that anyway.

I don't know what the thawing protocol is though - this is a real concern that needs to be handled. I assume those who deal with the logistics have plans and backup plans that account for all of the above.

If you are on the Concordia Station you can just leave it at the windowsill and it will be just fine. One of the perks of living in Antarctica. :)

What if a freak heat wave comes and suddenly it is -55 overnight? :-)

Yeah, imagine that! You could like have just three layers of jackets or something! :)

Well, as long as the temperature is under zero, all is fine - otherwise the 4 kilometers of ice under your station might pose a problem.

> > Almost all developer countries, urban centres, where majority of people live anyway.

> At -80C?

Absolutely. This is a solved problem.

You can buy dry ice at your local supermarket. I buy meat from a ethical farming operation that ships their product in insulated packages packed with dry ice. There's almost always dry ice left over. I made a bottle bomb out of the remainder once.

Every major medicine manufacturing company will already have had supply chains in place to deal with this for other medicines.

Storage is a red herring. It won't last more than a day in any given medical facility.

There are warehouses extremely well equipped for this. I saw a recent documentary where they were preparing for such a vaccine.

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