Cont: The One Covid-19 Science and Medicine Thread Part 2

[Steve]

I'm going to say the opposite. All the news on vaccines to date has been very positive, the stability of the virus says it should work well, and I reckon we're six months from the first vaccine being available.

The science looks pretty good, the production facilities are past ready to go, with some in production in hope, and I think quite a lot of countries* will keep the foot on M. Covid's throat until vaccination can be achieved.

This is probably why we should keep trying. We're already ~$15T in the hole, be a bit silly to waste it all.

*Not including every country other than Canada from the entire Americas.

I wish I could be as optimistic as you. I doubt that a truly effective vaccine is going to be developed, distributed, and administered in sufficient quantities, to have any serious effect on the pandemic. If a vaccine is developed it will be the first one ever that is effective against any type of coronavirus. There are of course first times for everything but history does not show promise. Secondly there is recent evidence that antibodies developed in those recently infected fade away significantly over several months. If this proves to be true then vaccinating significant portions of the world population on a continuing cycle two or 3 times a year is a logistics nightmare. I really do hope I am wrong about this but it does seem be to be reality. The optimistic reports from labs need to be backed up by evidence that the vaccines they are working on will be truly effective in the long term.

 

[TellyKNeasuss]

I wish I could be as optimistic as you. I doubt that a truly effective vaccine is going to be developed, distributed, and administered in sufficient quantities, to have any serious effect on the pandemic. If a vaccine is developed it will be the first one ever that is effective against any type of coronavirus. There are of course first times for everything but history does not show promise. Secondly there is recent evidence that antibodies developed in those recently infected fade away significantly over several months. If this proves to be true then vaccinating significant portions of the world population on a continuing cycle two or 3 times a year is a logistics nightmare. I really do hope I am wrong about this but it does seem be to be reality. The optimistic reports from labs need to be backed up by evidence that the vaccines they are working on will be truly effective in the long term.

If a sufficient percentage of people are vaccinated, the virus will eventually die out as it becomes too difficult to find new hosts to infect. I would think that it would take at most 2 vaccination cycles. Unless there is a non-human reservoir for the virus that can transmit it back to us.

 

[Steve]

If a sufficient percentage of people are vaccinated, the virus will eventually die out as it becomes too difficult to find new hosts to infect. I would think that it would take at most 2 vaccination cycles. Unless there is a non-human reservoir for the virus that can transmit it back to us.

Consider influenza. Different mutated virus every year. Annual vaccinations required. COVID-19 could be similar except on a shorter time scale. Too early to know for sure even if an effective vaccine is developed, and that is not a given at this point.

Don’t get me wrong. I really do hope that an effective vaccine is developed. I expect one eventually will. I just think people who are expecting it it time to resolve the first, or even second, wave are overly optimistic.

 

[Arcade22]

You don't know the role kids play because the pandemic did not run the usual course. This virus spread out from China, probably starting in late 2019. It was spotted so to speak, and at that point a lot of people went into lockdown. Kids have been home from school.

Except in Sweden where schools for people under the age of 16 never closed and have remained open with only a few exceptions.

I hope you realize that they are not going to use Swedish kids as guinea pigs to satisfy either peoples curiosity or to produce scientific data that others can use to convince themselves that it's safe to open schools ever again.

 

[The Atheist]

I wish I could be as optimistic as you. I doubt that a truly effective vaccine is going to be developed, distributed, and administered in sufficient quantities, to have any serious effect on the pandemic.

Without one, it's going to become endemic, so we certainly need one.

The alternative is to get used to three-score years and ten as your lot all over again.

If a vaccine is developed it will be the first one ever that is effective against any type of coronavirus.

I see this said a lot, and it's mostly misinformation.

First off, until SARS, nobody tried very hard to find a vaccine for coronaviruses, because there was no financial incentive for it. Who would bother getting a vaccine for one type of a harmless cold when there are still 400 other kinds you might get?

Then, with SARS, we got as far as making a vaccine, but it never made the market because SARS died out.

The main impediment to making a vaccine would be an unstable virus, and Covid is very stable, so it should be fairly straightforward - we have vaccines for other RNA viruses.

 

[JeanTate]

Quite a lot of merino thinking* here ...

I don't think that's too hard, actually and I've tried so hard to be objective that some people accused me of wanting a pandemic at the start.

There's enough evidence now that we can be fairly sure that age, morbid obesity and hypertension are the big dangers.

FTFY.

Others might be poor infection control, lack of contact tracing, insufficient vents and ICU beds, ...

We can be fairly sure the IFR will be within margin of error of 0.5%.

Really?

Doesn’t the IFR depend on things like age structure of a population? Availability of appropriate medical facilities and capabilities (care, testing, etc)?

We are very sure that 90% of cases are never counted, which means that it's not 80% of disease that's mild, it's 98% are asymptomatic or very mildly symptomatic.

Nonsense.

Take Iceland: per WHO, 1836 “confirmed cases”, 10 deaths. If “90% of cases” were not counted, but 100% of the deaths were, then the IFR would be 0.05% (10/18360).

The rest of your post keeps getting deeper into the land where Bunyips roam (and bong trees grow) ...

Given that 98% of Americans are obese, it shows that it's not that deadly, because they're holding to the 0.5%.

Within that 25 of severe illness, an unknown - but very small - number of younger people end up with a debilitating and long-lasting disease, for reasons also unknown. Or die.

All those numbers are small, but the problem is that when everyone gets it at the same time, it screws health systems big time, leading to the unenviable situation of triaging for death. We can increase the size of ICUs all we like, but ya gotta have people to staff them.
<snip>

To be continued, maybe.

*you know, what the sheep grow

 

[JeanTate]

More merino thinking ...

Without one, it's going to become endemic, so we certainly need one.

The alternative is to get used to three-score years and ten as your lot all over again.

A recent Kaiser Health News article (“Fearing The Deadly Combo Of COVID-19 And Cancer”, link later) referenced a study “which reviewed records of more than 1,000 adult cancer patients who had tested positive for COVID-19, found that 13% had died. That’s compared with the overall U.S. mortality rate of 5.9%, according to Johns Hopkins. I do not know what the age distribution of those 1k was, but surely a lot of the 87% who didn’t die were in their 70+s.

<snip>

If wishes were horses, beggars would ride.

 

[Skeptic Ginger]

.... I agree, and I wouldn't say kids aren't spreading it, but the evidence appears pretty solid that they're an insignificant vector.

"At the moment, early data suggests" is quite different from "pretty solid".


This is older and may have been posted already but the points I've bolded are examples of things to keep in mind when drawing conclusions: New coronavirus studies say sending kids back to school would be a major risk

... One study even showed that asymptomatic children may have viral loads as high as kids or adults showing symptoms, which could mean they’re just as contagious. ...

... The first study involved research from China and Italy and was published in Science. The scientists found that children were a third as susceptible to coronavirus infections as adults, but they had three times as many contacts as adults when the schools were opened. The study looked at two different cities: Wuhan and Shanghai. ...

The Times also mentions a third study from the Dutch government that says “patients under 20 years play a much smaller role in the spread than adults and the elderly.” But researchers have pointed out that the study has a serious flaw. It looked at household transmission, and the researchers may have tested only those people experiencing more severe cases, which would be overwhelmingly adults.

 

[Lennart Hyland]

Sorry if this has been posted earlier:
Clear signs of brain damage in patients diagnosed with Covid-19 based on a study from the University of Gothenburg. (Swedish source: https://sahlgrenska.gu.se/forskning...en-pa-hjarnskada-vid-svar-covid-19.cid1689236)

Researchers analyzed blood samples from 47 patient with Covid-19 and found clear signs of brain damage, though if its the virus or the immune system causing this isnt yet determined.

 

[Skeptic Ginger]

If a sufficient percentage of people are vaccinated, the virus will eventually die out as it becomes too difficult to find new hosts to infect. I would think that it would take at most 2 vaccination cycles. Unless there is a non-human reservoir for the virus that can transmit it back to us.

When pathogens have a worldwide reservoir of humans (not even looking at if any animal reservoirs exist), you're not going to wipe it out unless you can track down and eliminate the spread everywhere in the world.

We're trying very hard to do that with polio which we know only has a human reservoir and we've yet to achieve success.

With good vaccine coverage in the US, Canada, the UK and the EU we might be able to eliminate it in those countries but we'd still have to monitor for cases introduced and do extensive contact tracing should that occur.

From experience with other highly contagious pathogens we probably need about 90-95% vaccine coverage (provided the vaccine is highly effective). Anti-vaxxers are preventing that level of coverage for measles allowing cases to be introduced and spread on a regular basis.

 

[Skeptic Ginger]

Consider influenza. Different mutated virus every year. Annual vaccinations required. COVID-19 could be similar except on a shorter time scale. Too early to know for sure even if an effective vaccine is developed, and that is not a given at this point.

Don’t get me wrong. I really do hope that an effective vaccine is developed. I expect one eventually will. I just think people who are expecting it it time to resolve the first, or even second, wave are overly optimistic.

I wish people would quit comparing this virus to influenza when it comes to continually needing annual vaccinations.

Vaccines may only provide time limited protection, but it won't be because the virus mutates to become immune to the vaccine. It's not likely.

 

[Skeptic Ginger]

Except in Sweden where schools for people under the age of 16 never closed and have remained open with only a few exceptions.

I hope you realize that they are not going to use Swedish kids as guinea pigs to satisfy either peoples curiosity or to produce scientific data that others can use to convince themselves that it's safe to open schools ever again.

No one suggested anything of the kind. There are hundreds of countries that aren't shutting down schools and aren't mandating social distancing besides Sweden.

But that's not the only way to study the role kids might play in spreading the virus. We need to start by looking at viral shedding in asymptomatic infections in children.

And I'm well aware of your defense of Sweden's policies re the virus. You need not drag that into this thread from the one it is being discussed in.

A Swedish study is legit discussion in this thread. I've already addressed two such pieces of evidence coming from the Swedish data. Swedish politics is not.

 

[Steve]

I wish people would quit comparing this virus to influenza when it comes to continually needing annual vaccinations.

Vaccines may only provide time limited protection, but it won't be because the virus mutates to become immune to the vaccine. It's not likely.

Well, it’s kinda hard to compare it to other coronavirus vaccines, isn’t it? And the current evidence of a limited time frame for the life of the antibodies makes it unreasonable to compare it to any long lasting vaccine. Influenza vaccines do seem to be the most similar to what can be expected from a COVID-19 vaccine.

And if I was mistaken about mutations then I rescind that comment. It was not important to my main point.

 

[The Atheist]

Others might be poor infection control, lack of contact tracing, insufficient vents and ICU beds, ...

Sure they do, and poverty might be a factor as well.

Doesn’t the IFR depend on things like age structure of a population? Availability of appropriate medical facilities and capabilities (care, testing, etc)?

Not when you're looking at an overall rate, no.

Obviously some groups will do better than others, but the world IFR at the end of Covid looks like 0.5%. That could change, depending what happens next, but if things continue as they are, without major shift in the virus, the range is fairly well agreed to be in the 0.2-1.0%.

Nonsense.

Except it's not nonsense at all, but established by various studies.

USA - the CDC estimates ten times more infections than positive tests.

Germany - Bonn University conducted a rigorous study and found the same.

There are other studies going right back to February, so let me know if you need more convincing.

The rest is simple maths - if 20% of x = y, then 2% of 10x = y as well.

Take Iceland:

Nope. Iceland, NZ, Taiwan & a few other islands are outliers and don't conform.

You accuse me of posting nonsense, then try to use an example making up 0.001% of total infections when we have the other 99.999% to work with.

The rest of your post keeps getting deeper into the land where Bunyips roam (and bong trees grow) ...

Going by your efforts so far, I'm not even going to bother to ask what you think's wrong with it.

*you know, what the sheep grow

And wrong again - sheep don't grow merino, they grow wool. Merino sheep grow merino wool.

Sensible option to raise sheep incorrectly when the other bloke's a Kiwi.

...New coronavirus studies say sending kids back to school would be a major risk...

Seriously?

Hey, I'm happy for you to produce evidence to the contrary, because the rate kids are dying at is so low I really don't have any strong opinions on it, but your link - which is almost two months old - clearly states:

The researchers indicate that children can transmit the virus, although neither study was able to prove the actual spread of the virus.

Two things out of that:

1 - A headline screaming "New coronavirus studies say sending kids back to school would be a major risk" and then immediately saying you don't have evidence to back it up is very poor work, and exactly the type of thing media need to avoid being labelled scaremongers.

2 - They've had almost two months to back it up and haven't. I call BS on it.

It's yet another case of having the option of believing real-world, mathematical evidence, or going with a gut feeling.

Hey, you can check, but way back in the thread, I said keeping schools open was a shocking idea, because kids are enormous vectors of everything from head lice to norovirus to the bleeding Black death.

But when the evidence shows me to be wrong, I'm happy to take that and say I was wrong.

Sorry if this has been posted earlier:
Clear signs of brain damage in patients diagnosed with Covid-19 based on a study from the University of Gothenburg. (Swedish source: https://sahlgrenska.gu.se/forskning...en-pa-hjarnskada-vid-svar-covid-19.cid1689236)

Researchers analyzed blood samples from 47 patient with Covid-19 and found clear signs of brain damage, though if its the virus or the immune system causing this isnt yet determined.

Given it attacks multiple other organs, it wouldn't be too strange for it to be attacking the brain.

More importantly, it again emphasises the need for a vaccine, because moderately severe cases cause so much damage, and even small percentages add up with no immunity.

I'll also note it's another mistake I made early on - I was only concentrating on deaths - and I even said at one stage than hospitalisations didn't matter too much - because if people didn't die, they were well again.

I was wrong, it's causing a wide range of serious and ongoing illness in a small number of people.

 

[The Atheist]

Just to reiterate on vaccines, Dr Fauci - whom I think everyone in this thread would defer to - is confident we will see a vaccine by the end of this year: https://www.vox.com/2020/6/23/21300563/coronavirus-vaccine-fauci-trump-testimony-house

 

[Skeptic Ginger]

Well, it’s kinda hard to compare it to other coronavirus vaccines, isn’t it? And the current evidence of a limited time frame for the life of the antibodies makes it unreasonable to compare it to any long lasting vaccine. Influenza vaccines do seem to be the most similar to what can be expected from a COVID-19 vaccine.

And if I was mistaken about mutations then I rescind that comment. It was not important to my main point.

Why compare it to any vaccines we do have?

This may not interest anybody outside of a small circle of friends...

1) Genetic drift: the flu virus evolved to change it's outer proteins by frequent mutations to enable it to defeat the immune system and continually reinfect the same populations.

2) Genetic shift: flu virus has a unique ability to recombine with other flu viruses:

When the virus enters a cell, it splits into 9 segments. If two flu viruses enter the same cell, they shuffle the deck before recombining into whole viruses that go back together as the virus emerges from the cell​

Measles and hepatitis B viruses are stable enough the vaccines for them have worked for decades.

We've yet to develop an HIV vaccine because the virus mutates continually defeating the immune response.

The point of all this is, COVID 19 vaccine will be what it will be. We don't know yet how long the immune response will be effective the same way we don't know how long antibodies will protect a person after natural infection.

There is no point in speculating. Wait for the data.

 

[Steve]

Why compare it to any vaccines we do have?

This may not interest anybody outside of a small circle of friends...

1) Genetic drift: the flu virus evolved to change it's outer proteins by frequent mutations to enable it to defeat the immune system and continually reinfect the same populations.

2) Genetic shift: flu virus has a unique ability to recombine with other flu viruses:

When the virus enters a cell, it splits into 9 segments. If two flu viruses enter the same cell, they shuffle the deck before recombining into whole viruses that go back together as the virus emerges from the cell​

Measles and hepatitis B viruses are stable enough the vaccines for them have worked for decades.

We've yet to develop an HIV vaccine because the virus mutates continually defeating the immune response.

The point of all this is, COVID 19 vaccine will be what it will be. We don't know yet how long the immune response will be effective the same way we don't know how long antibodies will protect a person after natural infection.

There is no point in speculating. Wait for the data.

There is a lot of speculating here that there will be a vaccine. Even yourself in this post. I am less confident that there will. I sincerely hope I am wrong, but that is my opinion and it is not your place to tell meI should not post it.

 

[Skeptic Ginger]

Seriously?

Yes seriously.

Hey, I'm happy for you to produce evidence to the contrary, because the rate kids are dying at is so low I really don't have any strong opinions on it, but your link - which is almost two months old - clearly states:

Two things out of that:

1 - A headline screaming "New coronavirus studies say sending kids back to school would be a major risk" and then immediately saying you don't have evidence to back it up is very poor work, and exactly the type of thing media need to avoid being labelled scaremongers.

2 - They've had almost two months to back it up and haven't. I call BS on it.

It's yet another case of having the option of believing real-world, mathematical evidence, or going with a gut feeling.

Hey, you can check, but way back in the thread, I said keeping schools open was a shocking idea, because kids are enormous vectors of everything from head lice to norovirus to the bleeding Black death.

But when the evidence shows me to be wrong, I'm happy to take that and say I was wrong.

If you were so concerned, why not follow the links tio the actual studies?

But regardless, you missed everything I said. I will say it again. Address the variables that are of concern:
... "asymptomatic children may have viral loads as high as kids or adults showing symptoms, which could mean they’re just as contagious." ...

... "children were a third as susceptible to coronavirus infections as adults, but they had three times as many contacts as adults when the schools were opened." ...

... "The Times also mentions a third study from the Dutch government that says “patients under 20 years play a much smaller role in the spread than adults and the elderly.” But researchers have pointed out that the study has a serious flaw. It looked at household transmission, and the researchers may have tested only those people experiencing more severe cases, which would be overwhelmingly adults."


You are ignoring the limitations of the research we do have.

You are failing to consider variables like numbers of contacts kids have in schools.


This is not a pissing contest. Just wait for comprehensive research on the role kids in schools play. Why are you so intent on jumping to a weakly supported conclusion? The study you are relying on said so itself, they don't have a lot of data on kids because mildly ill or asymptomatic cases are not seen in the research yet.

The antibody tests are not reliable enough yet for decent serosurveys.

And most importantly, we have almost no data on viral shedding of mildly ill or asymptomatic children with COVID 19.

 

[JeanTate]

Thanks.

Sure they do, and poverty might be a factor as well.

Glad we agree on that then.

We can be fairly sure the IFR will be within margin of error of 0.5%.

Doesn’t the IFR depend on things like age structure of a population? Availability of appropriate medical facilities and capabilities (care, testing, etc)?

Not when you're looking at an overall rate, no.

Obviously some groups will do better than others, but the world IFR at the end of Covid looks like 0.5%. That could change, depending what happens next, but if things continue as they are, without major shift in the virus, the range is fairly well agreed to be in the 0.2-1.0%.

So "0.2-1.0%" is "within margin of error of 0.5%"?

We are very sure that 90% of cases are never counted, which means that it's not 80% of disease that's mild, it's 98% are asymptomatic or very mildly symptomatic.

Nonsense.

Except it's not nonsense at all, but established by various studies.

USA - the CDC estimates ten times more infections than positive tests.

Germany - Bonn University conducted a rigorous study and found the same.

There are other studies going right back to February, so let me know if you need more convincing.

I need a LOT more convincing ...

The rest is simple maths - if 20% of x = y, then 2% of 10x = y as well.

Take Iceland:

Nope. Iceland, NZ, Taiwan & a few other islands are outliers and don't conform.

You accuse me of posting nonsense, then try to use an example making up 0.001% of total infections when we have the other 99.999% to work with.

<snip>

Per WHO, estimated "missing" (your "90%") for places we might think have reliable data, and IFR=0.5%, ranges from ~8% (Iceland) to ~96% (Netherlands). Then there's Singapore (26 deaths, 43k cases) and Vietnam (0 deaths, 365 cases; population ~97 million). Oh, and that utterly insignificant place called China ...

Here's a simple model, for a nasty infectious disease:
- it kills everyone 70 and over, but no one under 70 (except those with condition X)
- it kills all those with condition X (BMI>40, perhaps), but no one else (under 70)

* On Island A ("young, healthy"), everyone is under 70, and no one has X
What is the IFR?

* On Island B ("old, unhealthy"), everyone is 70 or over and everyone has X
What is the IFR?

* On Island C ("young, unhealthy"), everyone is under 70, and half have X
What is the IFR?

* the world comprises Islands A, B, and C only; pre-nasty infectious disease, their populations were equal.
Post nasty disease, what is the global IFR?

Then there's Vitamin D ... if "the world IFR at the end of Covid looks like 0.5%", Vitamin D won't make any difference, will it?

Suggestion: re-read your original post (the one I first responded to), and see how many examples of poor logic you can find. Here's a good example: "We are very sure that 90% of cases are never counted, which means that it's not 80% of disease that's mild, it's 98% are asymptomatic or very mildly symptomatic." News flash: there are reliable media items galore about people who were sick, with symptoms that resembled those of Covid-19, but who were not tested, so they did not get counted as a Covid-19 "case" ....

 

[Skeptic Ginger]

Just to reiterate on vaccines, Dr Fauci - whom I think everyone in this thread would defer to - is confident we will see a vaccine by the end of this year: https://www.vox.com/2020/6/23/21300563/coronavirus-vaccine-fauci-trump-testimony-house

Count me out of that. He's already shown himself to be pussyfooting around Trump rather than coming right out and saying things that go against what Trump has said.

Fauci and the CDC have both put out interim guidelines with the following falsehoods long after the evidence was clear:

PPE not needed for people outside of healthcare
Asymptomatic spread isn't happening
Testing only needs to be done on people with symptoms or specific contact of a known case.​

Other than Fauci, however, there's enough research on vaccines ongoing that the end of the year for a not quite as well tested vaccine as we would like to be available. And given the circumstances, a fast tracked vaccine is reasonable.