COVID COVID-19 Coronavirus Containment Efforts

[Jarvis323]

If not needed it can make the situation worse because, as articles at the time explained, many people find them 'itchy' and scratch their face, which is a known method of transmission. It is a balance between benefit and risk. I am one of those people that even without a mask scratches their face, it's almost involuntary. With a mask it would likely be worse. If mask wearing was made compulsory, I would personally go out even less frequently (which now is on the average about once every two days and then only for short periods of time) than I do now, with a hand sanitizer in my pocket to be used frequently to avoid issues with scratching my face.

Thanks
Bill

That's a fair point.

 

[Astronuc]

If mask wearing was made compulsory, I would personally go out even less frequently (which now is on the average about once every two days and then only for short periods of time) than I do now, with a hand sanitizer in my pocket to be used frequently to avoid issues with scratching my face.

Wearing a mask in public in NY state is compulsory in most areas, but many folks ignore it. In Washington state, it seems to be voluntary, but too many folks ignore.

When I go out in public, I wear a mask. I carry hand sanitizer. If I adjust the mask, I'll use the hand sanitizer on my hands before I touch anything else. When I return to my personal vehicle, I remove the mask and use hand sanitizer. I also observe the recommended social distancing to the extent possible. When I return home, I wash my hands with soap and water, then apply hand sanitizer.

Since I have limited masks, I reuse them, but I wash them in alcohol.

 

[vela]

It was obvious to me when Fauci was discouraging mask use it was to preserve the supply for the medical workers. So, I don't feel like I was "lied to" at all.

And when he said general public use of mask was a waste, I saw that as truth - after seeing people out in public with masks on, reaching up to scratch their noses under the mask. Or wearing the mask upside down. Or having their nose sticking out above the mask.

I think officials also didn't realize the extent the virus had already spread among the population. So if they were working with the assumptions that almost everyone was free of the virus and that asymptomatic transmission was unlikely, the risk of catching it from some random person was low. Fauci implied this belief when he said, "The masks are important for someone who’s infected to prevent them from infecting someone else… Right now in the United States, people should not be walking around with masks." When it became clear that asymptomatic and pre-symptomatic transmission was a factor, it changed the equation. There were likely a lot more people walking around infected and spreading the virus. It made sense to revise the guidance about masks.

 

[atyy]

To make things worse, the denial of asymptomatic spread was actually pretty dubious at the time. It was't proven, but we had evidence of asymptomatic spread very early on. The late official acknowledgment of that wasn't the reason the truth changed about the danger, effectiveness, and advanced training required for masks to do more good than harm.

Why they were so dismissive of asymptomatic spread for so long is another issue. I suspect they were trying to avoid scaring people and at that time were likely worried about the impact on the economy. It was unproven at the time, but rather than saying that some evidence suggests asymptomatic spreading, but we're not sure, they chose to reassure us that asymptomatic spreading wasn't a concern. At the time they were convincing us that masks are dangerous, even if they weren't ready to warn us about asymptomatic spreading, they should have at least been concerned about it privately.

The possibility of asymptomatic spread was discussed early on and uncertainties were acknowledged in the WHO report on China. The early thoughts were not that there was no asymptomatic spread, rather that it played a small role in overall transmission, and thus measures like symptomatic people self-isolating before testing, quarantine of positive symptomatic cases, and hand washing and social distancing in the community would be able to manage the spread of the disease. It is still not clear whether this is incorrect (recent comments by Fauci indicates he thinks this is now wrong, whereas the WHO's recent comments indicate the evidence available to them is still consistent with this earlier view - it is important to note that the uncertainties were expressed in the original WHO comments, and it has not "backtracked").

At that time it was all about hand washing. And they had also dismissed evidence of spreading through aerosols.

It is still thought not to spread through aerosols except in certain situations in hospital procedures. Based on the choir incident, it had been suggested otherwise. However, that incident is still consistent with being driven by symptomatic spread and droplet transmission (lack of social distancing, enhanced spread of droplets by singing).

 

[kolleamm]

From what I understand a vaccine is supposed to stimulate your immune system to create antibodies to fight off the real virus.

But this concerns me. What if the immunity produced by the human body is not enough to completely eliminate all the Covid-19 symptoms for a significant amount of time?

If a vaccine is developed and approved and this is the result, then what?

 

[Ygggdrasil]

From what I understand a vaccine is supposed to stimulate your immune system to create antibodies to fight off the real virus.

But this concerns me. What if the immunity produced by the human body is not enough to completely eliminate all the Covid-19 symptoms for a significant amount of time?

If a vaccine is developed and approved and this is the result, then what?

This is what a Phase III clinical trial is supposed to determine. A large group of at risk people will be randomized to either receive the vaccine or a placebo. Scientists will then track the groups to see how many in each group contract the disease, show symptoms, and the outcome of those symptoms. A properly run clinical trial would likely be able to identify a vaccine that does not provide effective protection from the virus.

 

[Astronuc]

https://news.yahoo.com/covid-19-now-believed-attack-052400255.html

New York Gov. Andrew Cuomo (D) said Sunday that three New York children have died and 73 have become gravely ill with an inflammatory disease tied to COVID-19. The illness, pediatric multisystem inflammatory syndrome, has symptoms similar to toxic shock or Kawasaki disease. Two of the children who died were of elementary school age, the third was an adolescent, and they were from three separate counties and had no known underlying health issues, said New York health commissioner Dr. Howard Zucker. Cases have been reported in several other states.

It isn't just children struggling with arterial inflammation. In fact, for a virus originally believed to primarily destroy the lungs, COVID-19 also "attacks the heart, weakening its muscles and disrupting its critical rhythm," the Post reports. "It savages kidneys so badly some hospitals have run short of dialysis equipment. It crawls along the nervous system, destroying taste and smell and occasionally reaching the brain. It creates blood clots that can kill with sudden efficiency."

236 people got the Coronavirus after an Oregon church held services during lockdown
https://news.yahoo.com/236-people-got-coronavirus-oregon-000100604.html

60% of attendees were infected

Gatherings may become superspreading events.

https://news.yahoo.com/group-12-friends-test-positive-151901918.html
https://www.cnn.com/2020/06/17/us/group-tests-positive-florida-bar/index.html

What made Blaine County Idaho’s Coronavirus hot spot? Wealthy visitors and recreation
https://www.idahostatesman.com/news/coronavirus/article241448211.html

. . . thousands of skiers, outdoors enthusiasts and wealthy part-time residents with homes in New York, Seattle and Los Angeles flood the valley. From December to March, roughly 30,000 people from around the world usually land at the Friedman Memorial Airport in Hailey and visit restaurants, ski slopes and resorts.

Outsiders bring communicable diseases to remote areas.

February 21, 2020 - Presumed Asymptomatic Carrier Transmission of COVID-19
https://jamanetwork.com/journals/jama/fullarticle/2762028

 

[Jarvis323]

The possibility of asymptomatic spread was discussed early on and uncertainties were acknowledged in the WHO report on China. The early thoughts were not that there was no asymptomatic spread, rather that it played a small role in overall transmission, and thus measures like symptomatic people self-isolating before testing, quarantine of positive symptomatic cases, and hand washing and social distancing in the community would be able to manage the spread of the disease. It is still not clear whether this is incorrect (recent comments by Fauci indicates he thinks this is now wrong, whereas the WHO's recent comments indicate the evidence available to them is still consistent with this earlier view - it is important to note that the uncertainties were expressed in the original WHO comments, and it has not "backtracked").

This is another example. If you watch the full video, it is obvious her agenda was to advocate for a contact tracing program to track symptomatic people. That in of itself is reasonable. But she seemed to throw in a lie (if it isn't a lie they're out of touch) at the end about the evidence of asymptomatic spread as an extra argument to support their position. They didn't really need to. But it has become normalized by now.

The same thing with the masks. They were in a situation where they felt they needed to advocate for the public to not wear masks at the time. So they made their case, including an appeal to altruism, but threw in some disinformation for good measure.

Aerosol transmission was a big issue while guidelines were made for medical workers. Nurses were banned from using N95's except in specific procedures. The reason was obviously that their were shortages. So they decided to change the official guidelines, to discourage or block nurses and doctors from being able to wear them while handling Covid-19 patients. In support of that recommendation, they also stated an official thought about aerosol transmission. And that thought was not evidence based. Nurses were protesting and some quitting.

And that was really mind bending, because while they had been telling nurses that N95's aren't necessary and surgical masks were good enough, they were telling the public only N95's offered protection and surgical masks increased their risk.

 

[kolleamm]

This is what a Phase III clinical trial is supposed to determine. A large group of at risk people will be randomized to either receive the vaccine or a placebo. Scientists will then track the groups to see how many in each group contract the disease, show symptoms, and the outcome of those symptoms. A properly run clinical trial would likely be able to identify a vaccine that does not provide effective protection from the virus.

Wouldn't all vaccines provide the same amount of protection? Aren't the clinical trials just to determine they are safe to use?

 

[bhobba]

If a vaccine is developed and approved and this is the result, then what?

I will do a separate post on the state of play with vaccines.

Thanks
Bill

 

[bhobba]

The leading vaccine candidate in the sense of producing the best response in preclinical trials is the University of Queensland's Vaccine which will start human trials here in Brisbane July 13. About 120 healthy volunteers aged between 18 and 55 are needed to test the safety of the candidate vaccine, dubbed S-clamp. It produced a strong immune response in mice. When blood from the mice was tested on the SARS-CoV-2 virus in a test tube the virus was killed. The strength of the antibody response to the vaccine in mice was much higher than that achieved in samples from patients who had recovered from the virus. If this vaccine works it indeed could be the magic bullet, stopping the virus cold. Plans to produce millions of doses here in Aus at the CSIRO have been announced, but that needs to be increased to billions. If as effective as hoped I have no doubt that will happen.

Oxford University’s COVID-19 vaccine is being trialled in 6000 people for its level of effectiveness but it did not prevent monkeys from getting infected with the virus and there is concern declining COVID-19 infection rates in the UK could hamper the tests. The university has entered a partnership with pharmaceutical giant AstraZeneca, and along with other manufacturers in Britain, plans to manufacture up to 2 billion doses by September. It is by far the vaccine that is furthest along in development. But pre-clinical trials were not as good as UQ's vaccine and may not provide good immunity - still even some immunity will help - but may not actually be the magic bullet - simply lowering the r0.

Moderna reported last week that eight of the first 45 patients given its jab developed antibodies to the virus but it has not explained what happened to other people in the trial. Additional trials in vaccinated mice showed the product prevented the virus replicating in the rodent’s lungs, the company said. A further 600 volunteers will be given the vaccine in July. Moderna has signed a manufacturing deal with Swiss multinational, chemical and biotechnology company Lonza which aims to produce up to a billion doses per year. I suspect if it proved effective, like Oxford's vaccine, other manufactures will become involved and that 1 billion doses is conservative.

CanSino Biologics the medical science arm of China’s People’s Liberation Army reported in The Lancet this week that 108 people injected with its vaccine developed antibodies to the virus. However it is using and adenovirus (which causes the common cold) as a platform for the vaccine and because this virus is common in the human population, some of those in the trial had already been naturally infected dampening their immune response. It's plans to produce large quantities is unknown.

Inovio’s vaccine is currently in animal trials at the CSIRO in Melbourne. US company Inovio began human testing of its DNA vaccine for COVID-19 on April 6 and has already reported promising results with vaccine recipients demonstrating strong antibody and T cell immune responses after two or three doses of the vaccine. The vaccine did not appear to have any safety issues. One hundred per cent of people developed antibodies in their blood after three doses. Again it's production plans in unknown.

Novavax began human clinical trial of its vaccine in Australia his week. Melbourne company Nucleus Network is conducting the human clinical trials on behalf of the US biotechnology company. Six Australians received the first doses of the vaccine in the initial safety trial. The company is currently negotiating the second phase of clinical trials involving 2000 people in the US and Australia.

Pfizer bioNTech began human clinical trials of its vaccine in early May. The company said if it proves to be safe and effective it could potentially be ready for distribution in the US by the end of the year. It said it can produce millions of vaccine doses in 2020, increasing to hundreds of millions in 2021.

Clover Biopharmaceuticals Australia’s vaccine is about to be put into human trials by Perth based Linear Clinical Research. The S-Trimer vaccine targets a protein that the SARS-COV-2 virus needs to enter host cells. Production plans are not known.

So my sense is we will have a large number of Oxford University's vaccine by September, but its effectiveness is in question - hopefully it will be effective enough to help reduce the spread. Other vaccines are not as far along the development cycle, and will not be available until the end of this year or next year. But as the Oxford University vaccine shows, once proven, and by doing phase 3 trials in parallel with production, we can quickly produce billions of doses, but as of now only the Oxford Vaccine has plans to make that many, that quickly.

Thanks
Bill

 

[atyy]

This is another example. If you watch the full video, it is obvious her agenda was to advocate for a contact tracing program to track symptomatic people. That in of itself is reasonable. But she seemed to throw in a lie (if it isn't a lie they're out of touch) at the end about the evidence of asymptomatic spread as an extra argument to support their position. They didn't really need to. But it has become normalized by now.

I think her statement about asymptomatic transmission was accurate (data available to them indicates that it is rare), and also stated the uncertainties (that more studies need to be done). Fauci indicated he disagreed with her suggestion. Among the possibilities are that they have access to different data, or they are using different definitions of asymptomatic. In one study, asymptomatic people included people with cough, but who could not distinguish whether the cough was different from a condition they had chronically. I know of a case in which the person had a cough, thought it was her usual cough, and didn't think she had symptoms - as she was inquiring over the phone for a refill, the doctor heard the cough, and insisted she be tested - it turned out she was positive. I am not sure what data the WHO and Fauci had in mind, but I do know of a study in which pre-symptomatic transmission is only a small proportion of of cases, and it seems reasonable that the contribution of asymptomatic transmission is similar to that of pre-symptomatic transmission.

 

[kolleamm]

So my sense is we will have a large number of Oxford University's vaccine by September, but its effectiveness is in question - hopefully it will be effective enough to help reduce the spread. Other vaccines are not as far along the development cycle, and will not be available until the end of this year or next year. But as the Oxford University vaccine shows, once proven, and by doing phase 3 trials in parallel with production, we can quickly produce billions of doses, but as of now only the Oxford Vaccine has plans to make that many, that quickly.

Thanks
Bill

What phase is Oxford University's vaccine in?

Also thank you for the informative post.

 

[Ygggdrasil]

Wouldn't all vaccines provide the same amount of protection? Aren't the clinical trials just to determine they are safe to use?

Clinical trials are typically performed in three stages. A phase I study is typically done with a small number of healthy volunteers to determine the dosing of the drug (i.e. what is the highest dose that can be tolerated without an unacceptable level of side effects). Next, researchers will administer the drug to actual patients in a phase II study to determine whether the drug looks like it will have any effect on the disease. In the case of vaccine research, these studies help determine the optimal preparation, dose and dosing schedule. Finally, a phase III study is done on an even larger number of patients to provide efficacy and safety data to inform the decision of whether to approve the drug for use in humans. Testing a large number of individuals in the phase III is important to try to find rare side effects, especially if the aim is to administer the vaccine to billions of people. A severe side effect that occurs in 1 in 1,000 cases might seem rare, but when administering vaccine to a billion people, that means the side effect (such as Guillain–Barré syndrome) could potentially affect millions. Together, the phase II and III studies would provide a good amount of data on whether the vaccine helps to prevent disease (or at least make the disease less severe).

All vaccines would NOT be expected to provide the same amount of protection. There are a huge number of companies developing vaccines and many are based on fundamentally different technologies. Several companies are developing vaccines based on new, untested technologies (e.g. Moderna's mRNA vaccine technology or the adenovirus-based vaccines being developed by CanSino, Johnson and Johnson, or Oxford + AstraZeneca). These approaches have not yet proved they can yield safe and effective vaccines. Other companies are developing vaccines based on existing technologies (e.g. inactivated viruses or protein subunit vaccines), though it is slower to develop vaccine using these traditional techniques. Still, there are many ways where vaccine development can go wrong. For example, for vaccines there is often a trade off between designing a vaccine that stimulates the immune system too much (potentially causing problematic side effects) or too little (potentially providing little protection). There are many small details requiring careful opitimization that can also affect efficacy as well (e.g. choice of adjuvant).

Here's a nice (though long) post explaining issues surrounding the development of COVID-19 vaccines: https://blogs.sciencemag.org/pipeline/archives/2020/04/15/coronavirus-vaccine-prospects

Here's a good resource tracking the vaccines currently in development (also with a nice explainer of the testing process): https://www.nytimes.com/interactive/2020/science/coronavirus-vaccine-tracker.html

 

[kolleamm]

Clinical trials are typically performed in three stages. A phase I study is typically done with a small number of healthy volunteers to determine the dosing of the drug (i.e. what is the highest dose that can be tolerated without an unacceptable level of side effects). Next, researchers will administer the drug to actual patients in a a phase II study to determine whether the drug looks like it will have any effect on the disease. In the case of vaccine research, these studies help determine the optimal preparation, dose and dosing schedule. Finally, a phase III study is done on an even larger number of patients to provide efficacy and safety data to inform the decision of whether to approve the drug for use in humans. Testing a large number of individuals in the phase III is important to try to find rare side effects, especially if the aim is to administer the vaccine to billions of people. A severe side effect that occurs in 1 in 1,000 cases might seem rate, but when administering vaccine to a billion people, that means it the side effect (such as Guillain–Barré syndrome) could potentially affect millions. Together, the phase II and III studies would provide a good amount of data on whether the vaccine helps to prevent disease (or at least make the disease less severe).

All vaccines would not be expected to provide the same amount of protection. There are a huge number of companies developing vaccines and many are based on fundamentally different technologies. Several companies are developing vaccines based on new, untested technologies (e.g. Moderna's mRNA vaccine technology or the adenovirus-based vaccines being developed by CanSino, Johnson and Johnson, or Oxford + AstraZeneca). These approaches have not yet proved they can yield safe and effective vaccines. Other companies are developing vaccines based on existing technologies (e.g. inactivated viruses or protein subunit vaccines), though it is slower to develop vaccine using these traditional techniques. Still, there are many ways where vaccine development can go wrong. For example, for vaccines there is often a trade off between designing a vaccine that stimulates the immune system too much (potentially causing problematic side effects) or too little (potentially providing little protection). There are many small details requiring careful opitimization that can also affect efficacy as well (e.g. choice of adjuvant).

Here's a nice (though long) post explaining issues surrounding the development of COVID-19 vaccines: https://blogs.sciencemag.org/pipeline/archives/2020/04/15/coronavirus-vaccine-prospects

Here's a good resource tracking the vaccines currently in development (also with a nice explainer of the testing process): https://www.nytimes.com/interactive/2020/science/coronavirus-vaccine-tracker.html

Wow I can say I learned a lot today, thanks for posting

 

[bhobba]

What phase is Oxford University's vaccine in?

Phase 3, hopefully completed by September. This is the final phase. It goes like this - preclinical where it's tested for safety and effectiveness in animals, phase 1 where its tested for safety, phase 2 where its tested for effectiveness in a small population, phase 3 where it's tested for safety and effectiveness in a large population. Because of the seriousness of the pandemic production will be done in parallel with phase 3 - if it fails there is no safety concerns - simply money wasted in manufacturing it. They are also compressing the phases - phase 1 will start even before preclinical trials are complete, phase 2 before phase 1 is complete, phase 3 before phase 2 is complete. With modern technology actually creating a vaccine is very quick - UQ's vaccine was created in 3 weeks after the first confirmed case here in Australia. It is the safety and efficacy testing that takes up the time - that is being compressed but no shortcuts can be taken with phase 3 - all that can be done is make the vaccine in large quantities while conducting the phase 3 trials. If it is successful then use can begin immediately. Also with modern manufacturing techniques if you pour in the dosh you can have billions of doses in months. Since the production and phase 3 trials are done in parallel this is a very expensive way of doing it - I believe only something like 25% pass phase 3. This new approach is being financed by Bill Gates who warned of this in a famous 2015 TED talk. As a result he set up, with his own money, CEPI, to swing into action immediately a pandemic starts. They financed the creation of the UQ vaccine for example. He has pledged his entire fortune, and his good friend Warren Buffet as well, to beat this thing. They paid for all the initial work, and will pay for the production, even though it will cost billions. But, as I am sure Bill expected, at a certain point, and that has now been reached for Covid, governments will swing into action so in practice he probably will not spend as much as he may have had to. But it's good to know he has our back so to speak. Bill is also doing a great job of educating the public about this - it is worthwhile subscribing to his newsletter:
https://www.gatesfoundation.org/
https://gatesfoundation.secure.force.com/optimist

I admire what he is doing so much.

Thanks
Bill

 

[Ygggdrasil]

What phase is Oxford University's vaccine in?

Also thank you for the informative post.

Various news publications are tracking COVID-19 treatments and vaccines as they progress through clinical trials:
https://www.statnews.com/feature/coronavirus/drugs-vaccines-tracker/
https://www.nytimes.com/interactive/2020/science/coronavirus-vaccine-tracker.html

The Oxford team has released (non-peer reviewed) data showing efficacy for their vaccine candidate in rhesus macaques. Some critics do not see the data as very promising, however. Phase I testing began in April, and the team is recruiting volunteers for phase II and phase III testing. The Oxford team has partnered with the pharmaceutical company AstraZeneca to help scale manufacture of the vaccine. AZ's CEO has said that "If all goes well, we will have the results of the clinical trials in August/September. We are manufacturing in parallel. We will be ready to deliver from October if all goes well."

However, the "if" looms quite large with regard to testing. Testing for efficacy of a vaccine requires monitoring people for enough time to see people receiving placebos to be infected while those receiving the vaccine to not be infected, so the time required to get results will depend on local transmission rates. The Oxford team's project leader has said that there is a chance that the UK trial will yield no result due to low rates of COVID-19 transmission in the UK.

Finally, it is worth noting that there are no approved human vaccines based on the Oxford team's technology. An adenovirus vector-based vaccine is currently used as a rabies vaccine for wild animals, but the Oxford-AZ vaccine would be a first for humans. It's worth noting that there are a number of other companies pursuing a similar strategy (e.g. CanSino Biologics, which has its vaccine candidate at a similar stage of testing, and Johnson and Johnson, which has extensive experience developing vaccines), so we have multiple shots at finding a working adenovirus vector-based vaccine. Similarly, if the adenovirus-vector approach is found to have fundamental flaws, there are other vaccine candidates based on completely different approaches that will give us additional shots at finding something that works.

 

[Ygggdrasil]

The numbers in Texas (among other states) do not look particularly good:

Hospitalizations for COVID-19 has spiked significantly in recent days. The increased number of cases and hospitalizations is likely not due to increased testing because, though testing has increased recently, the fraction of tests coming out positive has also increased recently (in other words, the number of positive cases is increasing faster than the number of new tests). (Indeed, it is instructive to compare to California where, although cases are increasing, the number of hospitalizations are relatively flat and the fraction of positive tests is steady at a fairly low rate).

Speaking of government officials lying to the public:
Texas Governor Says 'No Reason Today To Be Alarmed' As Coronavirus Cases Set Record

Based on the numbers above, it would not surprise me to see parts of Texas have to shut down again. Hopefully, Texas is not foreshadowing what may happen to states that have relaxed social distancing.

 

[Vanadium 50]

Speaking of government officials lying to the public:

Lying? The article says there are cases in a nursing home in Texas. I presume that's true. It says that the Juine 10 spike is partially due to testing in prisons, which again is presumably true (and would bring that day much closer to the running average). He's saying not to panic because they have enough capacity - and one should note that they have 1.5x the population of New York State and 1/12 the Covid impact.

He might be wrong on policies - perhaps people should be jailed for not wearing masks - but that doesn't mean he's lying. Where's the lie?

But that's no what I wanted to talk about. I find the Texas plots very interesting. If you divide cases per test, you will see it fall from ~10% in early April to maybe 8% two weeks ago, with a large bipolar structure in testing in May reflected in a smaller bipolar structure in positives. (i.e. whatever caused that structure is sampling a healthier-than-average population). Then recently that average moves up again, but not all the way to the 10%.

But.

That's the running average. If you look at the daily numbers, on one day the positive rate spiked to 14%. I think that needs to be understood.

I certainly agree the uptick in hospitalization is worrying. I would like to better understand why it seems to be going up faster than the number of positive tests.

There is additional data at: https://www.tmc.edu/coronavirus-updates/tmc-covid-19-icu-occupancy-trend/ It shows currently hospitalized tracks new hospitalizations (so we aren't looking at a residual effect of something that happened weeks or months ago), but the ICU occupancy trend is flatter. I'd like to understand that as well.

 

[kolleamm]

Various news publications are tracking COVID-19 treatments and vaccines as they progress through clinical trials:
https://www.statnews.com/feature/coronavirus/drugs-vaccines-tracker/
https://www.nytimes.com/interactive/2020/science/coronavirus-vaccine-tracker.html

The Oxford team has released (non-peer reviewed) data showing efficacy for their vaccine candidate in rhesus macaques. Some critics do not see the data as very promising, however. Phase I testing began in April, and the team is recruiting volunteers for phase II and phase III testing. The Oxford team has partnered with the pharmaceutical company AstraZeneca to help scale manufacture of the vaccine. AZ's CEO has said that "If all goes well, we will have the results of the clinical trials in August/September. We are manufacturing in parallel. We will be ready to deliver from October if all goes well."

However, the "if" looms quite large with regard to testing. Testing for efficacy of a vaccine requires monitoring people for enough time to see people receiving placebos to be infected while those receiving the vaccine to not be infected, so the time required to get results will depend on local transmission rates. The Oxford team's project leader has said that there is a chance that the UK trial will yield no result due to low rates of COVID-19 transmission in the UK.

Finally, it is worth noting that there are no approved human vaccines based on the Oxford team's technology. An adenovirus vector-based vaccine is currently used as a rabies vaccine for wild animals, but the Oxford-AZ vaccine would be a first for humans. It's worth noting that there are a number of other companies pursuing a similar strategy (e.g. CanSino Biologics, which has its vaccine candidate at a similar stage of testing, and Johnson and Johnson, which has extensive experience developing vaccines), so we have multiple shots at finding a working adenovirus vector-based vaccine. Similarly, if the adenovirus-vector approach is found to have fundamental flaws, there are other vaccine candidates based on completely different approaches that will give us additional shots at finding something that works.

How about the duration of each phase? Is it approximately the same for each Covid vaccine?

 

[Ygggdrasil]

He might be wrong on policies - perhaps people should be jailed for not wearing masks - but that doesn't mean he's lying. Where's the lie?

If it appropriate in this thread to characterize government officials changing recommendations on masks early in the pandemic as lies, I think it's appropriate to say that some government officials (like Gov Abbott or https://www.whitehouse.gov/articles/vice-president-mike-pence-op-ed-isnt-coronavirus-second-wave/) are currently trying to deliberately portray the situation as better than the numbers suggest in order to mislead the public.

But that's no what I wanted to talk about. I find the Texas plots very interesting. If you divide cases per test, you will see it fall from ~10% in early April to maybe 8% two weeks ago, with a large bipolar structure in testing in May reflected in a smaller bipolar structure in positives. (i.e. whatever caused that structure is sampling a healthier-than-average population). Then recently that average moves up again, but not all the way to the 10%.

But.

That's the running average. If you look at the daily numbers, on one day the positive rate spiked to 14%. I think that needs to be understood.

It's worth noting that the number of tests performed in Texas show some weird dynamics, and that could partially be due to the fact that as some point, Texas began including serological tests in the number of Coronavirus tests, so that could be one factor to take into account.

I certainly agree the uptick in hospitalization is worrying. I would like to better understand why it seems to be going up faster than the number of positive tests.

There is additional data at: https://www.tmc.edu/coronavirus-updates/tmc-covid-19-icu-occupancy-trend/ It shows currently hospitalized tracks new hospitalizations (so we aren't looking at a residual effect of something that happened weeks or months ago), but the ICU occupancy trend is flatter. I'd like to understand that as well.

The uptick in hospitalizations began ~ 2 weeks ago and the spike is still fairly small, so the increase may not yet register at the ICU occupancy level. However, one reason why I disagree with Gov Abbott's statement that there is no reason to be alarmed is that hospitalizations are a lagging indicator. There is a delay between when people get infected to when they begin showing symptoms and another delay between when people show symptoms to when the symptoms worsen to require hospitalization. The people who are currently being admitted to the hospital were likely infected ~ 2 weeks ago, and there are likely another two weeks of exponential growth in hospitalizations likely already to come. While the numbers may not seem troubling now, two weeks of additional increases would produce troubling numbers, but if we wait until then to enact measures to better control transmission, there will have already been another ~2+ weeks of exponential increases on the way. Hopefully, the new mask mandates in some areas of Texas will help decrease the rate of spread so that the situation does not keep deteriorating there.

 

[Ygggdrasil]

How about the duration of each phase? Is it approximately the same for each Covid vaccine?

From the Oxford site:

When will the results be available?

To assess whether the vaccine works to protect from COVID-19, the statisticians in our team will compare the number of infections in the control group with the number of infections in the vaccinated group. For this purpose, it is necessary for a small number of study participants to develop COVID-19. How quickly we reach the numbers required will depend on the levels of virus transmission in the community. If transmission remains high, we may get enough data in a couple of months to see if the vaccine works, but if transmission levels drop, this could take up to 6 months. Recruitment of those who have a higher chance of being exposed to the SARS-CoV-2 virus is being prioritised, such as frontline healthcare workers, frontline support staff and public-facing key workers, in an effort to capture the efficacy data as quickly as possible.

http://www.ox.ac.uk/news/2020-05-22-oxford-covid-19-vaccine-begin-phase-iiiii-human-trials#

This would likely apply to most Phase II or Phase III vaccine studies. Phase I studies, because they are done in controlled environments and do not monitor transmission, usually take 2-3 months to gather sufficient data. One factor that may vary between types of vaccine and manufacturer, however, is the time needed to manufacture sufficient doses for each stage of vaccine testing.

 

[russ_watters]

But that's no what I wanted to talk about. I find the Texas plots very interesting. If you divide cases per test, you will see it fall from ~10% in early April to maybe 8% two weeks ago, with a large bipolar structure in testing in May reflected in a smaller bipolar structure in positives. (i.e. whatever caused that structure is sampling a healthier-than-average population). Then recently that average moves up again, but not all the way to the 10%.

But.

That's the running average. If you look at the daily numbers, on one day the positive rate spiked to 14%. I think that needs to be understood.

I think it is likely that uneven/batch testing is still the cause of that, even if it is tough to identify the specific cause (if it isn't publicized).

In my county the "real" peak in cases was on April 10 (196/day), but we had an outlier peak of double the running average on 4/28 (226 vs 115 / day). That was the day the results came back from testing every inmate in the county prison system at once. Unfortunately the county data reporting wasn't mature enough yet by April 10 to have a positive case %, but by 4/17 it was 20% overall (and still gradually rising), whereas on 4/28 it was only 16%, which was the lowest yet seen...but the test rate was triple. It could have gone either way, but as it happened, the infected % of the prison population was lower than the infected % of the rest of the people being tested.

I've been neglecting my stats for a week after the state overhauled the website, but in the first week of June we averaged 10% positive, with a spread of 6-13% (and 80 cases per day). That's a small sample size; for the state it has been 5-6%.

 

[Vanadium 50]

If it appropriate in this thread to characterize government officials changing recommendations on masks early in the pandemic as lies,

I don't think it is, but you'll have to take that up with the mentors. But I don't think following the level of rhetoric to the bottom is a good idea.

I think it's appropriate to say that some government officials (like Gov Abbott or https://www.whitehouse.gov/articles/vice-president-mike-pence-op-ed-isnt-coronavirus-second-wave/) are currently trying to deliberately portray the situation as better than the numbers suggest in order to mislead the public.

We had someone here make the opposite argument: that it's important to portray the situation as bad as possible to ensure proper behavior from the public. My reaction was (and is) " I think the idea that The Wise need to deliberately mislead The Plebs because they are too stupid to do the right thing when told the truth is, at a minimum, un-democratic. I suspect it is also ineffective, counter-productive, and likely to lead to undesired outcomes. "

 

[atyy]

There's a change in testing strategy in Singapore for close contacts. It used to be that a positive case's close contacts were quarantined, but not tested until they were symptomatic. Now close contacts will be tested immediately to try to detect pre-symptomatic or asymptomatic cases among them, so that their close contacts can be found earlier.
https://www.moh.gov.sg/news-highlights/details/enablers-to-support-safe-re-opening

 

[Vanadium 50]

I think it is likely that uneven/batch testing is still the cause of that, even if it is tough to identify the specific cause (if it isn't publicized).

But nevertheless it is important. We are treating the number of identified cases as if that is the number infected, but it's clear that number depends on how many people are tested and who they are.

 

[Astronuc]

Italians are asking why Bergamo and Brescia were hit hard by the pandemic. Prosecutors have begun an investigation into whether the failure to lock down two towns near the northern city of Bergamo contributed to thousands of deaths related to the disease.
https://www.pbs.org/newshour/show/g...gn-to-investigate-officials-pandemic-response

 

[OmCheeto]

...
We had someone here

/me raises hand

make the opposite argument: that it's important to portray the situation as bad as possible to ensure proper behavior from the public. My reaction was (and is) " I think the idea that The Wise need to deliberately mislead The Plebs because they are too stupid to do the right thing when told the truth is, at a minimum, un-democratic. I suspect it is also ineffective, counter-productive, and likely to lead to undesired outcomes. "

Like Fauci, I could have probably used better words, in hindsight.

 

[Jarvis323]

I don't think it is, but you'll have to take that up with the mentors. But I don't think following the level of rhetoric to the bottom is a good idea.
We had someone here make the opposite argument: that it's important to portray the situation as bad as possible to ensure proper behavior from the public. My reaction was (and is) " I think the idea that The Wise need to deliberately mislead The Plebs because they are too stupid to do the right thing when told the truth is, at a minimum, un-democratic. I suspect it is also ineffective, counter-productive, and likely to lead to undesired outcomes. "

I didn't characterize changes in recommendations as lies. I characterized misinformation disseminated in support of the recommendations as lies. Are we really going to pretend it wasn't misinformation?

 

[Jarvis323]

To be honest, I'm not just disappointed that public health officials have not been honest. I am also disappointed that scientific minded people, like us on this forum, are supporting that dishonesty through silence or by mischaracterizing it in defense. This is how misinformation and crack pot science is promulgated.

If the misinformation is for a noble cause, and you think it's justified, then address that, but don't obfuscate in defense of crack pot science and deliberate spreading of misinformation.