Could One Shot Kill the Flu? | Hacker News Reader

Could One Shot Kill the Flu?

newyorker.com

48 pointsbpierre108 comments

"No", I suppose. From the last paragraph:

> For now, we remain on the cusp of a breakthrough that could neutralize our foe. A few months after my tour, BiondVax announced the results of its Phase III trial. The researchers found that, in a randomized, double-blind test involving more than twelve thousand people, M-001 did not significantly reduce the incidence or severity of the flu. “For now, the M-001 vaccine candidate remains on the shelf, and we may return to it in the future,” Joshua Phillipson, the company’s director of business development and investor relations, told me.

https://en.wikipedia.org/wiki/Betteridge's_law_of_headlines

There's a lot more going on than this pull quote suggests. Mosaic vaccines sounds like they're still in the running, and the discovery of people with universal immunity suggests the problem may be solvable.

> Your scientists were so preoccupied with whether or not they could, they didn’t stop to think if they should.

I'm curious what (if anything) the unintended consequences of this would be.

You evolved to get sick. Autoimmune diseases (your immune system gets bored and starts attacking you) can be caused by living in a too sterile environment.

Is this no longer an unproven hypothesis? My impression was there’s just a lot of correlation evidence.

Having just recently watched the OME videos on Immunology, at least they still think this is an unproven hypothesis.

What the consensus seems to be is that autoimmune diseases are a combination of genetic and environmental factors.

Wikipedia claims there is "significant evidence" for the Hygiene hypothesis, but says disagreement still exists, no definitive proof.

My brother has served for around 9 years on a warship. Modern warships are using pressurized cabins to keep chemical weapons and alike out. He has developed allergies against cat hairs, dust and other stuff in these times. Prolonged times out on the sea with high levels of cleanliness (is that a word? non-native speaker here) might have played their fair share in this.

edit: Maybe another point or just a corelation for this thesis.

Adult onset allergies typically appear in peoples' 20s. No one knows why but nasal allergies effect ~6% of US adults, many developing them as adults, almost none of whom live on US war ships.

Anecdotal evidence is a scam

Nah, it's anecdotal at best. ;-)

My sibling hasn't served on a warship and still developed several allergies after age 35.

A vaccinated immune system is neither "bored" nor "sterile". People get vaccines before traveling to exceptionally insterile places, to give their immune systems more training so they are prepared to fight pathogens when they are exposed to them. Nothing boring about it.

Not if your goal is to extinct the flu virus.

Are you implying that catching a flu virus every couple of years is "good for you" beyond confering immunity to other flu viruses?

More or less.

You are built up of many feedback systems trying to achieve some stable or metastable state.

Without knowing the exact mechanism, the hypothesis goes something like this: your immune system has an internal variable "activity", and given long periods of nothing to do, it will ramp up its sensitivity until it finds something to do -- and you develop an autoimmune disease ranging from environmental allergies (reacting to things which aren't threats) to one of many where the immune system attacks your own tissues. The actual mechanism likely more complex than a single variable thermostat, but that's the general idea.

So yes, challenging your immune system from time to time by giving it a disease or two to fight off might indeed be "good for you".

Sure, but why does that challenge need to be the flu, and not the billions of other microbes we encounter on a daily basis, or even a yearly vaccine?

Even if you were right about that, we're not talking about a common cold. Flu is a serious disease that makes healthy people stay in bed for almost a week. Surely we can "train" with something else.

We harbor more bacterial cells in our body than human cells..

I am really going to ask you to cite your sources on the fact that autoimmune diseases are caused by sterile environment. I remember reading that people of european descent have increased odds of certain autoimmune afflictions because of the black plague [1] and also on the wikipedia page it mentions that autoimmune diseases are triggered by infection [2], not LACK of it.

[1] I failed to find a source for this though, so if someone can point me out if I'm right or wrong, please do so.

[2] https://en.wikipedia.org/wiki/Autoimmune_disease#Causes

If it could the title wouldn't have a question mark on the end, you'd get more clicks with a definitive title and newspapers wouldn't waste that

> you'd get more clicks with a definitive title

Unfortunately, demonstrably not true.

From context clearly a mistake when writing.

By definitive, he meant if it were truthful. But since it isn't, they get more clicks with the false headline, since the truthful one would simply say that the flu isn't stopped, which isn't a substantive story.

As we know, a question mark in a headline indicates that it's false, since if it were true, they'd just write the headline without the question mark.

> if it were truthful

Aye exactly. The priority is legally covered, clicks. This is also why you see "allegedly" even when something isn't actually alleged haha

"The man was allegedly murdered blah blah".. no, the man was murdered, we know this for fact. There is a body with 20 knives in it.

The suspect allegedly did it, though. Journalism lmao

Probably not. Even if you got a "universal" influenza A vaccine, enough is known about the type of immune response required that there's no way it could remain protective for more than a few months. If your hemagglutination inhibition titer gets too low (and it does, within months), you are no longer protected against infection and disease. Sure, you still have T-cells, but getting an actual influenza A infection is the only real way of getting enough of those. The live attenuated vaccine works somewhat for that in children, but it's not optimal.

Not an epidemiologist. But I also find myself saying this sometimes in context of covid. An actual infection is the only way to get any kind of long term immunity (the next best alternative being booster shots every year). If youre young, healthy, have access to high quality care and without any preconditions this could be a viable strategy for you. (Serious disclaimer - Please get vaccinated first before going down this road). Alas i find myself to be the minority in this argument.

Edit. Reference https://www.medrxiv.org/content/10.1101/2021.08.24.21262415v...

Edit. I agree its not a safe strategy. Kids please dont do this at home. Consult a doctor, epidemiologist etc.

Serious question: if you're not an epidemiologist, why do you tell people this? Do you have some research you can link to that actually supports your assertion?

Epidemiologists are mainly social scientists and policy analysts, and not biologists or MD's anyway, as then they would be infectious disease specialists.

From what I've seen, most data scientists could provide equal or better analysis.

Many epidemiologists are effectively specialized data scientists, and I don't think a random data scientist could provide equal analysis. Sure, they can both run a regression, but you benefit from understanding particular study designs, as well as biology/chemistry/toxicology.

I don't know much about infectious disease epidemiology, but I'll use glyphosate toxicity as an example from environmental epidemiology. Glyphosate was found to be non-carcinogenic by the EPA, but if you review the literature on glyphosate toxicity, industry-affiliated researchers tended to study pure glyphosate, and these studies were the majority of those considered by EPA. Researchers without industry affiliation tended to study glyphosate in the formulations actually sold in products such as RoundUp, and found much stronger evidence of carcinogenic toxicity.

I don't think a generic data scientist would think to ask the question about glyphosate formulations, as many people at EPA did not.

I agree, though my impression is epi's use policy driven hypothesis' to construct data driven stories around, which is great for directing their attention to things like your example, as ultimately it was an activist narrative backed by epi data that made people aware of how bad some of those carcinogens were.

However, there are many epis who are just political scientists, and calling them epidemiologists and conflating them with bio or medical experts is sort of like the way we talk about devs as engineers and architects. Covid has really put them in the spotlight, as they're the ones driving policy, which becomes a big deal when we start using their work as justification for internal passports and mandates. I'm saying the epis working on covid aren't held to the standards of other scientists or even data science hackers, and they are being used to launder radical policies through "expert" models data. I've got massively controversial opinions on these topics because of my health information privacy and security work, so YMMV.

I'd posit that a data scientist with working professional competence in say, R and Pandas has as much or more modelling experience for empirical discovery than most epi's where I'd suggest the epi's are a kind of policy profession, and that someone with those basic quantitative skills is equipped to question policies and assertions produced by said epis.

Yes, there are policy-focused epidemiologists and informatics-focused epidemiologists. My partner is the latter, so I'm much more familiar with that world, and that's what I associate with "epidemiology". There is overlap, of course, but I take your point that you can't necessarily know someone's quantitative analysis skills from knowing they are an epidemiologist.

I would just note that "a data scientist with working professional competence in say, R and Pandas" describes a good number of epidemiologists, who also have infectious disease, toxicology, and study design knowledge on top of this.

Yes you’re rite i shouldn't express my opinion too much in this matter as I am not a specialist. I usually say this to very close friends when they ask my opinion.

Added some actual research to the original comment.

Thanks for adding the original research.

I'm also not an epidemiologist, but I can think of at least one disease where the advice "catch it when you're young and you'll have stronger immunity" has a serious downside: chickenpox. A subsequent case of chickenpox itself is rare, but the herpes zoster virus remains dormant in the body and can re-appear as shingles in adulthood. I don't know the probability of that vs catching chickenpox following vaccination.

> An actual infection is the only way to get any kind of long term immunity

I can understand this intuition, that only "the real thing" can make you immune to it. But do you have any data to back up this claim? And what, then, is your conclusion? That we should get vaccinated, and then catch COVID afterward to make sure that we have real, lasting immunity? Or that we should skip vaccination altogether, and just accept the 3-4% risk of dying?

Just to be That Guy, the risk isn't evenly distributed. Nobody has a 3% chance of dying; you either have much more or much less.

No, but the chance of getting serious but non-lethal secondary effects from COVID may be more evenly distributed. Young people are less likely to die but they still get blood clots, brain fog, myocarditis, and other loving term effects.

That's still the population's chance. Your chance may very well be 100% - you just don't know until you contract the disease.

I added a reference to my original comment. Maybe its what youre looking for.

But otherwise i dont really know honestly what the risks are but i wouldnt say for a young healthy person its at 3-4 percent of dying. For context I have had covid and a high fever and mild pneumonia during it so I have some idea.

FWIW I would definitely recommend the get vaccinated (two shots maybe even a booster) and then getting covid as its a safer strategy. But yeah youre not going to get immunity otherwise is all I am saying.

A shot that needs to be refreshed every few months until you die? That sounds like the optimal solution for pharma companies, a consistent and never ending stream of income.

Having to wash your hands every day until you die? Sounds like the optimal solution for pharma companies, a consistent and never ending stream of income from handwash.

Probably not, unless you go back and forth between hemispheres so you are almost always in the colder season. Current flu vaccines only last a few months already, but flu is seasonal.

Wait until you hear about food and water.

Food and water aren't as easy to restrict as medicine of any kind. Just think of the patents, with the right tricks they could even half ass the first version and patent every individual improvement over decades.

> After the swine flu’s relatively harmless nature became apparent, many people asked if the alarm it provoked had been warranted. A Swiss survey found that trust in institutions had decreased. Some scientists and officials accused the World Health Organization of stirring up a “faked” pandemic to justify its budget.

Damned if you do, damned if you don't.

Even if such a vaccine was developed, our current reality shows that not enough people would take it.

The good ol hypothetical shot. If only people would take this shot that doesn't exist yet.

We don't have a vaccine that reliably kills coronavirus in "one shot", so we don't really know. For the vaccines that work, uptake is much higher than that for the covid jab.

Well yes. We don't have a vaccine that kills coronavirus, because vaccines don't "kill" anything.

Obviously. I'm using "kill" colloquially, in the same way the article title does. No need to be pedantic.

Neither do forks put food in your mouth, yet no one would quibble with saying they do.

What's with the purposefully uncharitable reading of people's points on Hacker News lately? Is the last bastion of rational polite discussion on the internet going away?

That uptake is high in large part because we require them to go to public school. And, let's not forget, the vast majority of childhood vaccines are multidose: https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolesc...

This is extremely impressive research. I think if COVID has taught us anything though, even an array of available, safe, preventative medicine is not convincing for some people.

If only it worked for more than a few months at a time it might be worth it for more people. As of right now natural immunity is still much much better protection for those who have already recovered from COVID.

This is not the case. The protection from vaccination is both higher and more consistent than natural infection with Covid-19. The very best immunity observed is in people who have been naturally infected and subsequently vaccinated (I don't think any studies yet out that have tested the other way around). Those people produced antibodies which showed strong in vitro activity against even highly mutated and apparently immuno-evasive mutants and against other known coronaviruses.

https://www.nature.com/articles/s41586-021-04005-0

I am impressed at the amount and spread of disinformation. Absolutely amazing that world wide we have zero critical thinking skills at the population level. We allow ourselves to be controlled by a minority of very loud idiots.

No, it most certainly can't.

The flu, like all viruses like it, mutates quite rapidly.

It'll just mutate in response to the "one shot" to get around it.

So, "one shot" will turn into multiple... oh wait... we do that every flu season, and it's a never-ending game of cat and mouse.

It's not outrageous to think that mRNA vaccines may allow for more specific targeting in a way that may be less subject to immune escape than previous approaches.

The specific targeting makes it easier to allude the vaccine as only a small part of it has to mutate.

For example, natural immunity recognizes the entire coronavirus, not just the spike as the covid vaccine does. There was a study that natural immunity was more effective against the virus and variants because of this.

You could however have yearly subscription shots like we do now, just mRNA flavored that target the new strains, but there are hundreds.

I don't see the advantage mRNA would have over traditional vaccines for the flu, but for something like cancer or HIV it seems promising. Doing something your immune system can't do by itself.

> The specific targeting makes it easier to allude the vaccine as only a small part of it has to mutate.

Nothing says an mRNA vaccine can't express more than one protein.

That said, I'm talking more about being able to target a portion of the virus that's more fragile than others - somewhere a mutation is likely to make the virus useless if a mutation occurs there.

(The ability to rapidly adjust for mutations is a bonus, too. I'm hoping we get to a regulatory regime eventually where they can tweak overnight and produce fairly locally.)

> There was a study that natural immunity was more effective against the virus and variants because of this.

There's information in the other direction now. https://news.yahoo.com/vaccine-confers-better-protection-tha...

> I'm hoping we get to a regulatory regime eventually where they can tweak overnight and produce fairly locally.

I don't think that's likely. Even if a scientist was able to adjust a vaccine overnight, you'd still need to do a clinical trial to verify that the vaccine doesn't accidentally target something that it shouldn't.

> There's information in the other direction now. https://news.yahoo.com/vaccine-confers-better-protection-tha...

The way they conducted that study was terrible, read the qualifications and the limitations in the discussion at the bottom.

Personally the Israeli study looks a lot more sound.

Here's an analysis going over the two: https://brownstone.org/articles/a-review-and-autopsy-of-two-...

That's a heavily biased think tank. https://en.wikipedia.org/wiki/Jeffrey_Tucker#COVID-19_pandem...

> Please don't post shallow dismissals, especially of other people's work. A good critical comment teaches us something.

You may want to refute the points instead of attacking the source.

What did you take issue with in their analysis?

Sigh, what isn't biased these days? No need to poison the well, the article is clear and sound (to me at least) regardless of who wrote it and why. Do you have any arguments against it? Or your own better analysis of the two studies?

It really annoys me how people disregard what "the other side" is saying just because it's them saying it. Just adds to the polarization. And it annoys me because I used to do the same.

Maybe this is a less biased source? Dr John Campbell: https://www.youtube.com/watch?v=9bamaEMftg4

The studies I saw said the opposite. The vaccine is far more robust. Which is it?

There's the CDC study and the Israeli one AFAIK, here's an analysis of the methodologies: https://brownstone.org/articles/a-review-and-autopsy-of-two-...

>I don't see the advantage mRNA would have over traditional vaccines for the flu,

The current flu vaccine targeting isn't 100% reliable. If they can get better targeting for the mRNA vaccine it could be a win.

Eggs are used in the process for the traditional vaccine. Some people are allergic to eggs, so they can't take the traditional flu vaccine. For those people the mRNA version would be an option.

I would agree that it isn't an emergency, but there are benefits to it.

The entire article is about how they're addressing (or at least trying to address) this exact problem.

I think this is the right answer. Like Corona it mutates too fast. So you need to vaccinate all living creatures that can transmit the virus all at the same time.

Another way to get rid of it is to go into a global 100% lockdown for two weeks at the same time. Again animals that can transmit it included.

Coronaviruses spread easily indoors, people need necessities eventually and will spread it in some form.

Lockdowns don't work and never worked for this virus, they cause worse damage than the disease, lowers immune systems, destroys the economy and livelihoods, and they are authoritarian.

Sunlight and open air is a better baseline.

>> The flu, like all viruses like it, mutates quite rapidly. >> It'll just mutate in response to the "one shot" to get around it.

Curious how we manage to so effectively vaccinate against Measles, Mumps, Rubella, Smallpox, Chickenpox but cannot seem to do so against the Flu? Why dont those other viruses mutate rapidly to get around vaccines?

Measles can't create an escape mutant, or at least it's so hard that centuries of immunity exerting pressure and gain of function experiments can't produce one. Flu recombines and reassorts like crazy. It has RNA segments (the media likes to call them "chromosomes", but they are not) that are pretty much interchangeable, so if you or a non-human animal gets infected with multiple strains, you can get a virus with a hybrid of those segments quite often. I think rubella actually can escape. The chickenpox vaccine mostly just suppresses symptoms. The smallpox vaccine is just another orthopoxvirus, so you get pretty good cross reactive immunity.

https://discoverysedge.mayo.edu/2021/03/30/researchers-clari...

> The data presented in the manuscript show that, to escape immunity, a disease-causing, or pathogenic, measles virus would need to generate a large set of mutations — simultaneously — affecting multiple parts of the surface proteins. Simultaneous disruption of at least five antibody targets is required before the virus starts developing resistance to the diversity of neutralizing antibodies in the bloodstream.

I suspect we're going to find in the future that Influenza will have been replaced by a variant of SARS-CoV-2 (COVID-19), the disease spreads the same way, and outcompetes the flu in every way, furthermore, our public health response for CoV-2 (Masking, Quarantine, Isolation, etc) also impacts flu (probably disproportionately), and flu unlike CoV-2 is truly seasonal.

So we may have eradicated flu, by simply replacing it with a much more fearsome illness.

I can tell you right now from having gone through 2 colds in the last month due to kids, that competition in the marketplace of cold viruses is working. lots of competing products to acquire.

Same here.

This is our 5th endemic coronavirus. They tends to mutate into less lethal more viral over time. Check out the newest varient out of South Africa which looks promising for a healthy future.

Prior coronavirus species tend to evolve toward non-lethality because their peak transmission coincides with peak symptoms. Covid-19 is not like that and so has no evolutionary push towards non-lethality.

A variant of COVID as lethal as MERS would spread just as well since carriers are asymptomatic most of the time they are infecting others.

I agree that asymptomatic transmission reduces this pressure, but symptomatic SARS-CoV-2 carriers are often still contagious, and there is more public will to enact extreme precautions for more lethal illnesses.

So there is still some evolutionary benefit for lower lethality.

I'm trying not to read too much into the new variant yet, there isnt enough data to form a meaningful conclusion. But hope springs eternal. ;-)

Coronaviruses won't outcompete the flu for the same reason ants don't outcompete shrimps.

> Coronaviruses won't outcompete the flu for the same reason ants don't outcompete shrimps.

So, coronaviruses and influenza viruses have nonoverlapping habitats?

That's not the reason why ants don't outcompete shrimps. Does it help if I say shrimps and whales?

> That's not the reason why ants don't outcompete shrimps

Yes, it is.

> Does it help if I say shrimps and whales?

No, because shrimp and whales also mostly don't compete because they have largely non overlapping habitat within the ocean (and actually are otherwise more “potentially competitive”, if you pick the right ones of each, since both many shrimp and some whales eat krill, for instance.)

This is a case where it is probably better to just make your argument directly than to rely on analogy, I suspect.

Since COVID doesn't cause immunity to the flu, it can't outcompete the flu. You can, in fact, get both at the same time. Flu cases may be down due to anti-COVID measures, but it hasn't been eradicated. There is plenty of flu still circulating.

Edit: Source: https://www.cdc.gov/flu/weekly/weeklyarchives2021-2022/image...

There was effectively zero flu in Winter of 2020, it remains to be seen how much flu there will be in Winter of 2021, but since the same precautions one would take for COVID also stop flu. Beyond that, anytime anyone shows flu like symptoms they're almost automatically sent home for 5 days, until they get a clean COVID test, which basically stops flu cold in its tracks, this is how you end up irradiating something.

> this is how you end up irradiating something.

“eradicating”, and that's still wrong because influenza A has nonhuman reservoir populations, and anti-COVID measure may reduce spread in the human population but they aren't going to eliminate the reservoirs.

Flu is increasing again this winter. https://www.cdc.gov/flu/weekly/weeklyarchives2021-2022/image...

It will be interesting to see if CoV-2 has significant seasonality in the long term. We see numbers going up as parts of the US tend to spend more time inside (in the summer for southern states, or like around now, in winter for northern states), but once it becomes just an ordinary part of life, maybe the reduction of precautions will make cases more evenly distributed.

Yeah, I'm curious about that myself, I've been watching it very carefully.

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