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Comment by vimy | Hacker News Reader

Monoclonal antibodies are already successfully being used. This is just a press release from another company wanting in on the action.

Honestly surprising why so few people know about the antibody therapy we already have, reduces death by 80 to 90 %. Also unclear why we still need vaccine mandates when we have a cure.

https://floridahealthcovid19.gov/monoclonal-antibody-therapy...

https://www.washingtonpost.com/health/covid-monoclonal-abbot...

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Two reasons. Vaccines are waaaay cheaper, and second, covid patients are tying up limited medical resources (ICU beds, ventilators etc).

Also that vimy’s question seems to imply that vaccination blocks getting treated in the hospital with antibody therapy later. That seems obviously false, no? I assume that the effects are likely multiplicative, and not subtractive as vimy seems to be suggesting.

Also perhaps too because the MAB treatment may reduce your ‘natural immunity’ benefit that vaccination-hesitant people seem to be so hyped about getting from being very ill. Versus giving the vaccines that actually do give ‘natural immunity’ to you.

That’s not what I implied. And also not true, vaccinated people can also get treated if they have a breakthrough infection.

What’s unclear then? We don’t have a magic 100% cure, we have a pretty good drug that works much better in combination with vaccination.

>Honestly surprising why so few people know about the antibody therapy we already have, reduces death by 80 to 90 %. Also unclear why we still need vaccine mandates when we have a cure.

Do promptly delivered monoclonals blunt your body's natural immune response and prevent natural immunity, as your body doesn't need to make its own antibodies?

If so, all the more reason to get vaccinated as soon as the engineered antibodies fade. Or before treatment, I don't see why having both wouldn't be extra effective?

An ounce of prevention is worth a pound of cure Also, since vaccines reduce death to almost 0, and a 'cure' on top of that reduces death by 80-90% (as you claim), if everyone is vaccinated that can be, and there is a treatment, there is no more disease, but thousands are still dying every day. So we need the vaccine mandates.

Additionally, death is only one of many of the devastating outcomes of Covid. In many cases there are profound and longterm effects. So we need the goddamn vaccine mandates.

We still seem to have >1500 deaths/day in the US. Is treatment effective but not available? Or is it just not effective?

worth remembering that we have > 8000 deaths a day under normal circumstances and with covid does not necessarily mean because of covid.

We're still getting ~15,000 excess deaths every week, compared to recent similar years and given our population size. [1]

I'd like to see how to explain all 15,000 deaths per week as being simply "with Covid" instead of caused by Covid. Is it all still lockdown-related stress causing the deaths? And all of them happened to die "with Covid?"

1. https://www.economist.com/graphic-detail/coronavirus-excess-...

This line of reasoning from the parent comment is tedious, I don't know where it originates from but I had to debunk the same statement made by Brazilians and used the same metric as you: excess deaths are still high as a kite.

It's exhausting to be facing this misinformation spread in different languages and cultures. Even here in Sweden I have had to put up with people using flawed statistics to make a point without considering the nuances of the metrics they choose to parade around.

I'm tired.

The link you posted is just raw excess deaths. Whether they had COVID or not is unknown, so the "with COVID" vs" "from COVID" argument is irrelevant here.

While I agree with you that a significant part of those deaths are in fact from COVID, there's other explanations other than "lockdown stress" that could cause increased excess deaths - people avoiding medical treatment due to fear of catching COVID in healthcare settings, hospitals being overloaded in the first place and surgeries being delayed, or poorer health outcomes due to financial impact, which in extreme cases could cause food insecurity or homelessness.

Come on, it's been a year and a half now. Why are people still making these tired points which have been discounted all over

We all know with covid doesn't always mean because of covid, but it's statistically significant enough that dying shortly after covid gives a pretty damn good representation of the infection rate. It's statistically unlikely that you die from unrelated causes within 28 days of a positive covid test

It's 100x more expensive than a vaccine.

I don't think it's fully available, so it's rationed for high risk cases. And it's expensive (much more so than a vaccine, you need an IV and to go sit in a hospital room for awhile)

Rationed for high risk? I’ve read about multiple politicians receiving it. I suspect it must be rationed for other reasons

Rationed for the usual reason because it's hard to make and there isn't enough to go around. That's a usual problem with monoclonal antibodies. That's also the reason they tend to be so expensive. Also if they aren't administered soon enough they generally don't work very well.

> Rationed for the usual reason because it's hard to make and there isn't enough to go around.

The technology to make monoclonal antibodies is simpler than that for mRNA vaccines.

> That's also the reason they tend to be so expensive

Economies of scale play a big role. At similar scale mab should be cheaper than mRNA.

You need about 30 ug of MRNA vaccine. For Regeneron the dosage is an initial dose of 600 mg followed by 300 mg every other week. Pfizer is $19.50/dose. Moderna is $15/dose. Regeneron is $2100/dose. And that's with the US govt having bought millions of doses of Regeneron.

> The technology to make monoclonal antibodies is simpler than that for mRNA vaccines.

It’s more mature technology, but unlike the mRNA vaccines it’s not cell free and as a result is harder to scale up. At similar scale mRNA will still be cheaper; that’s one if mRNA’s biggest selling points.

> This is just a press release from another company wanting in on the action.

Was the URL changed? This is a press release from Swiss Federal Institute of Technology Lausanne and Lausanne University Hospital, both public institutions.

No, I was sleep deprived and made a mistake. :p

It says in the article they are spinning off a startup company based on the research. Also that this is funded by a public-private partnership that "reduces bottlenecks"

> Also unclear why we still need vaccine mandates when we have a cure.

Corruption. It always have been the alpha and omega of this whole vaccine story, minus the part where governments went on-board as a way to restrict citizens right.

Because a course of monoclonal antibody treatment costs $5000, whereas a vaccine could be had for dollars

The price is not relevant. The idea behind vaccine mandates is that it’s the only way to protect people so therefore it’s ethical to force people to take the vaccine. But this treatment has been available for almost a year… No one should be forced to take something if there are alternatives.

Instead we should have ramped up production of these game changing drugs. Why didn’t we?

...because MCA is a treatment, while the vaccine is a prophylactic. Every person who refuses the vaccine and winds up needing ICU treatment means resources unavailable for breakout cases and non-covid emergency conditions. It's absolutely ethical to compel vaccination in order to safeguard the health and safety of the overwhelming majority of Americans who are being individually and socially responsible by getting vaccinated; and the healthcare system and workers, which are under tremendous strain.

Also, prior to COVID, monoclonal antibodies were being tested in single digit numbers of patients with highly aggressive cancers at a cost of $500K per treatment. The cost has come down 100x, so it's inaccurate to claim production hasn't ramped up. It has, it's just still way more cost effective to get a vaccine.

> It's absolutely ethical to compel vaccination

It's never ethical to compel the innocent to do anything.

A shifting of the incentives would be far more ethical, but difficult politically - perhaps make people who are unvaccinated pay a greater percentage of their treatment, or need to take special insurance. I'd advocate that kind of thing for most things relating to personal/lifestyle choice, obesity being a good example, giving better premiums to non-smokers, vegetarians etc but when the numbers of (possible) patients becomes big then it's unlikely to be taken up either by an electorate nor by a politician.

That's ignoring how many health systems seem fundamentally broken for other reasons (e.g. US and UK).

> It's never ethical to compel the innocent to do anything.

What does that even mean? Innocent of what, having an immune system?

Financial incentives, such as being fired if you create a hazardous workplace by refusing vaccination, are a form of compulsion on an escalating ladder of methods to convince people. The government absolutely leaned on business to make that happen in order to avoid a direct mandate.

> What does that even mean? Innocent of what, having an immune system?

Innocent of a crime. That's it's usual meaning, and we compel those guilty of crimes to do things they don't want to.

> Financial incentives, such as being fired if you create a hazardous workplace by refusing vaccination, are a form of compulsion on an escalating ladder of methods to convince people.

That's not an incentive, that's a punishment. I do agree, however, that it is a form of compulsion (a compulsion is never also an incentive).

What a strange way of looking at the world. When did you choose to have that perspective and why?

You need to be more specific, especially to keep within the commenting guidelines https://news.ycombinator.com/newsguidelines.html#comments

I'm not sure what you are referring to with terms like "innocent", "crime", "compulsion" etc when the topic is a covid vaccine.

I don't know why everyone's up in arms about this particular vaccine. Kids around the world are given vaccines for polio, diphtheria, pertussis, tetanus, measles, tuberculosis, hepatitis B, hiaemophilus influenza type b (Hib), diarrhea, smallpox etc.

Why is everyone up in arms about this particular vaccine, esp. when the mRNA based ones don't even have any part of the virus? I can't think of any reason other than stupid/criminal politicians on the right using whatever slogans they can to influence their sheeple to maintain their foothold. Jeez.

> I'm not sure what you are referring to with terms like "innocent", "crime", "compulsion" etc when the topic is a covid vaccine.

Why I'm referring to them is because the only members of society we usually compel to do anything are:

- children - those in the military - those guilty of a crime - those who have lost their mind

Adults innocent of a crime, not in the military, and who are compos mentis are not subject to compulsion - to compel them would likely be a crime.

> I don't know why everyone's up in arms about this particular vaccine.

I am not everyone and I am not up in arms about the vaccine, I am responding to the element of compulsion and violation of the normal situation of legal standing between an individual and the government (who would be the ones doing the compelling). If you compel someone to get any of the other vaccines listed, then I would be "up in arms" about that too.

All laws and rules of a society are compulsions if you want to read it that way. Stopping at a red light, removing ones shoes at the airport, not going the other way on a one-way street, headlights turned on in the dark, stopping for pedestrians .... these are all compulsions and public safety measures. I see the covid vaccines (now that they have been so extraordinarily tested) as benignly ... I don't see why words such as 'compulsion' and 'crime' even enter the picture.

I find that when people need to expand the definitions of common words to render them virtually meaningless and, more importantly, strangely convenient to their point of view and the argument they are presenting, that is the point I realise that they’re not interested in a proper discussion and leave, entirely unpersuaded.

Everyone is compelled to do many things they don't want to do every day.

Are they compelled by law to undertake invasive medical procedures?

From [1]:

> An invasive procedure is one where purposeful/deliberate access to the body is gained via an incision, percutaneous puncture, where instrumentation is used in addition to the puncture needle, or instrumentation via a natural orifice. It begins when entry to the body is gained and ends when the instrument is removed, and/or the skin is closed. Invasive procedures are performed by trained healthcare professionals using instruments, which include, but are not limited to, endoscopes, catheters, scalpels, scissors, devices and tubes.

Without the consent of the person it would constitute a serious form of assault and battery, a common law crime that stretches back at least 1000 years. I do hope that you or anyone else is not subject to such things on a daily basis.

Are you?

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6678000/

MCA can also be a prophylactic.

The assumption that vaccines would end the pandemic was also based on the idea they would stop transmission. This turned out to be wrong. Vaccines are excellent at preventing hospitalization but do a crappy job stopping transmission.

So when we have vaccines who are only excellent at self-protection and we also have a cure, I don’t see why we would compel anyone to take something they don’t want to.

That is simply nonsense. The current vaccines are not completely effective at reducing transmission in a rapidly mutating virus when a significant minority is refusing to take it. If the vaccine was deployed to 95% of the population the virus would not have enough hosts to continue propagating and would reduce to background noise that can be easily handled by the medical systems with treatments like MCAs.

I'm also curious what is acceptable about monoclonal antibodies, but not the vaccine? They've been developed by the same types of scientists, on a similar timeline to the mRNA vaccine technology, and they work on similar fundamentals, but the MCAs are a less effective solution in terms of cost, production, deployment, and long term protection. The whole thing just seems like a temper tantrum with no rational basis.

> I'm also curious what is acceptable about monoclonal antibodies, but not the vaccine?

I don’t know since I’m vaccinated. I just think people should have a choice.

What really protects people is herd immunity. Ethically malingers that don't voluntarily contribute to that need to be forced. You might not like that for ideological reasons, but really who cares.

The people at most risk are the "Ethical malingers". The people at least risk are those who already have a low risk profile and/or those who take the vaccine.

I wonder what other populations you might compel to do things - or not - for the "herd" and their health. My guess is it would look cruel and capricious very quickly, much like any other tyranny.

What's wrong with letting them go out and get sick, if that's what they're comfortable with? You're telling them they need to either stay home or get a shot? Why not let them go out, and take the risk of getting sick? We already know, at a population level that complications from Covid happen in a very small percentage of people. At this point we have the knowledge and tools to manage things. Let everyone out, some get sick, many recover, and we get over this in 6 months. Really it seems the lockdowns are the problem since it's letting this disease meander and figure out the best way to keep transmitting.

Monoclonal antibodies are expensive and hard to make and the manufacturing processes don't scale all that well.

Ok. So let's flatten the curve with mass produced MCA. You can't wait giving MCA until people are hospitalised, they're not effective anymore at that late stage.

So do we test everyone all the time to determine whether they need the stuff? If they test positive, how do we encourage them to take the MCA? Or we could give them to everyone all the time, continually, as a prophylaxis. I'm sure that would to over well.

You could also limit the prophylaxis to particularly endangered folks, but you'd still fill the hospitals with not particularly endangered people who drew the short straw.

That's essentially what we are doing, except the not particularly endangered people can just get the vaccination.

This is the wrong way to do the math (setting aside that your numbers are wrong and other arguments).

The right way would be to compare number of people vaccinated to prevent one person falling so ill they require monoclonals. Since this >> 1, the financial calculations aren't so straightforward.

That's also the wrong way to do the math which is even more complex - price is broadly based on supply and demand, so should vaccinations go down and demand for monoclonals raise, assuming supply cannot meet the demand, which will also raise price and change the economic modelling.

MCA therapy also needs to be started early after exposition (even prophylactically). It doesn't do much good for patients that are hospitalised because they have a bad case, that's too late.

It costs 1-2000€ in Europe. A day in the ICU costs 7-8000€.

I would guess because covd patients are already taking up hospital resources (beds, vents, care staff) even with restrictions and vaccines. If the solution was cure rather than prevention, then the hospitals would become overwhelmed while they provide care until the antibody therapy kicks in

Also, it causes the spread to go exponential as there's no restriction to the spread, so the hospital admissions go exponential too

Plus, there's the whole US treatment costs thing too

The vaccination centers can double as infusion centers. The therapy kicks in immediately, you’re back to normal the next day. It’s really a wonderdrug and weird we haven’t heard more about it.

Having a building is the least of the concerns, there's tons of buildings around. You need beds, medical staff, and vents/cpap.

And if you don't prevent the spread then your infection rate is exponential and collapse the healthcare system. Ignoring vaccines in favour of treating the critically ill is absolutely the wrong way to go about it

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