PlasticCigar
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Plastic Cigar
With all due respect, when did you get your epidemiology degree? I received mine in 2002.
That’s not how herd immunity works.
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With all due respect, when did you get your epidemiology degree? I received mine in 2002.
That’s not how herd immunity works.
Aren't there at least three companies that are nearing approval?
Lindberg
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What's not how herd immunity works?
gsengle
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Gsengle
50 million is 15% of the population. Less than half of a third.
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PlasticCigar
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Plastic Cigar
As @gsengle pointed out, vaccinating 15% of the population is not “plenty.” You don’t get herd immunity by vaccinating 15%. Or did you mean it’s “plenty” to just protect 15% of the population and then just let everyone else roll the dice?
Lindberg
Final Approach
I didn't say anything about herd immunity. But is that what we're going for now? All this time, I thought it was a myth.....
Just under 16 million Americans have been diagnosed with COVID. Based on populations that have been fully tested, conservatively, we've had 60 million infections (but it could be double that). No need to vaccinate those folks, certainly not right away. So anyone who pops positive for COVID antibodies doesn't get a vaccine.
We can inoculate another 50 million Americans as soon as the FDA approves. Those should be the most at risk, which fortunately aren't kids because the vaccine hasn't been tested on kids. That's 110+ million Americans with immunity, mostly the high-risk ones. And if we focus on areas where it is a bigger problem, even better because after all, the population of the entire country isn't the herd; we don't all interact.
We really just need to get the R0 a little bit lower anyway, and there's another vaccine in the offing, plus more doses of this on in June. It isn't necessary to completely wipe out this disease next week in order to save the human race.
And of course you know that if we had taken another 50 million shots, that would have just been 50 million that didn't go to Europe. Nothing in life is free....
PlasticCigar
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Plastic Cigar
I have to admit it. You got me. At this point in your ramblings I honestly can’t tell if you really don’t get it or if you’re intentionally trying to misrepresent things you do understand.
Either way, I’m not going to waste my time. You do your thing, I’ll do mine.
Either way, I’m not going to waste my time. You do your thing, I’ll do mine.
chemgeek
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chemgeek
- Pfizer and Moderna will likely get EUAs this month for their vaccines. Both are mRNA vaccines with >90% effectiveness. They will have challenges competing for the same chemical supply chains to make their vaccines. But they have exceeded expectations. These will be top-tier choices until proven otherewise.
- AstraZeneca (a viral vector vaccine) is completing phase 3 trials now, but it is a bit muddled, as they cobbed dosing for some of their volunteer cohort, didn't have enough enrollments or events in their 55+ age category to address effectiveness in the most at-risk cohort, and less convincing (approx. 70% or so) effectiveness. It appears to be safe based on Phase 1 trials and preliminary phase 3 data. But 6 months ago, we would have taken this in a NY minute. 70% is still better than dead or disabled.
- Johnson & Johnson is developing another viral vector vaccine that is expected to complete phase 3 trials later this month or in early 2021. Stay tuned.
- Novavax and Sanofi are working on adjuvanted protein subunit vaccines (previously known tech) that have just started or will soon start phase 3 trials not scheduled to finish until maybe late Q1 2021. Phase 1 trials of these are promising.
- Merck is working on a novel viral vector vaccine based on vesicular stomatitis virus and another with a modified measles virus. They just started phase 1 trials. They are also considering dosing one of their candidates orally.
Ironically, the new technologies (mRNA and viral vectors) are quickest out of the blocks. It's going to be a long slog, and you may not get a choice of which vaccine you get. Of the vaccines listed, I think only Johnson & Johnson and Merck is thinking they may have a single-dose regimen possible for adequate protection. the J&J Phase 1/2 trials tried both single and dual dose regimens.
The tech is going to work, I think. The real pill is manufacturing scale-up and then logistics. All told, we need BILLIONS of doses world-wide. But I think humanity is up to the challenge. We have to be. I'm tired of staying near home.
GaryM
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Two hundred and twenty vaccine candidates are in various stages of development worldwide at the moment. Nearly all of them preclinical, and most won't make it into the clinic, but it's an impressive number. Chemgeek nicely summarized the front runners.
denverpilot
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Just wondering if this was added as trivia, or if it was supposed to be surprising or something?
The math hasn’t said it wouldn’t be since February. Even with a linear growth curve and the exponential one “flattened”. Heck it was predicted four times worse really.
Not a surprise to anyone.
Plan on at a bare minimum another full year at the predicted logistics rates. That could change but they haven’t updated any of them in two months.
The public is just barely starting to realize FINDING a vaccine is not even half of the work to be done.
Reminds me of how people approach other large projects.
It took one of the companies I work for from Mar until yesterday to realize that operating six companies nearly 100% from home, on a network that wasn’t designed for stay at home workers, has... a whole lot of outage risks that’ll put the companies out of business.
“We just wanted to let you know it’s a risk.”
Holy hell. I knew that 24 hours after we evacuated the building.
Anyway loved the politicians and their “100 days” garbage recently. No numbers yet support that. They needed a nice round number to drag it out for those who can’t do basic division.
Number of estimated vaccinations per month divided by number of humans.
Just like the number of humans multiplied by the death rate percentage up top. No real surprises yet.
17000 days to kill 1% of Americans. 17000 - oh let’s call it 365... a nice round year. Got a long long way to go still.
Foot race between the virus infecting people and the vaccine starts in January. The reality is, both will “win”.
If infection rate stays the same the headlines will read “record numbers!” for one to even two more years, depending on what goes wrong. And something always goes wrong. 2020 is only the beginning of that.
Anybody who thinks a calendar year change makes any difference in whether or not the suckage continues — hasn’t done the math.
Buckle up. Remember when all that was needed was two weeks to flatten the curve? LOL. Hilarious.
I’m certainly not network and infrastructure planning for anybody going back into our company building in 2021. I laughed at a friend who’s daughter was asking where to sell or give away cubicles from her company closing an office ...
Answer: “A big truck and the landfill.”
Nobody wanted used cubicles before Covid. Now they don’t even want commercial buildings.
A milestone: The first vaccination outside of a clinical trial has now occurred.
https://www.theguardian.com/world/2...ient-to-receive-covid-vaccine-in-nhs-campaign
https://www.theguardian.com/world/2...ient-to-receive-covid-vaccine-in-nhs-campaign
Until Astra Zeneca publishes more results, I think it is premature to make any statements on how effective their vaccine is relative to the other candidates. They used weekly viral tests as one of their trial endpoints, both moderna and Pfizer used clinical disease. With the role that asymptomatic cases play in the propagation of this disease, the 'less effective' AZ vaccine that doesn't have the logistics constraints of the mRNA vaccines may have a bigger effect on the epidemic than the first two that are out of the gates.
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Drake the Outlaw
Disagree with the full year assessment. Based on what I've seen the truly vulnerable 100 million (another round number) will be vaccinated by April 1, the next 100 million by July 1 or earlier, and the stragglers at the beginning of Q3. At that point, you'll be left with the anti-vaxers or some category of "not gonna's".
steingar
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There are going to be significant hurdles in widespread vaccination. Like @chemgeek so succinctly said, there are going to be some supply chain problems. Moreover, distributions going to give medical folks hairy kniptions, as they require extreme refrigeration not found universally. This thing is sadly a long way from over.
I do hope someone is able to generate an oral vaccine. Those go over far better in parts of the world where refrigeration can be problematic.
I do hope someone is able to generate an oral vaccine. Those go over far better in parts of the world where refrigeration can be problematic.
chemgeek
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AstraZeneca is initiating a U.S. Phase 3 trial to sort out the dosing and effectiveness issues raised by cobbing up part of their worldwide phase 3 cohort. Results not expected until January 2021. Sigh. Among other things, AstraZeneca needs more data for the 55+ age categories. Pfizer and Moderna did a better job of diversifying their Phase 3 volunteers.
chemgeek
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NY state collates good co-morbidity data. I don't know if the CDC is doing this. (Would be a good idea, though.) Last time I checked, about 90% of COVID deaths in NY had at least one co-morbidity. But it really sucks to be in the other 10%, and you don't know who you are. BTW co-morbidities do include fairly common conditions like type II diabetes and hypertension.
chemgeek
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Merck is developing a viral vector vaccine based on a modified vesicular stomatitis virus (VSV). They are considering this as a candidate for oral dosing, although I see that their Phase 1 trial application is for IM injection.
Thanks. FYI: The CDC does and puts the covid only at 6% but relies only on death certificates. Was reading a study on google scholar or another site that had the covid only at less than 2% and was curious what other databases were showing.
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Bob Noel
mass.gov has part of it's dashboard (the weekly one now) that shows a little over 98% of the covid-related deaths had an underlying medical condition. Note that this is for the cases that they (I don't know who "they" is) have finished investigation/analysus. As of last Wed it had about 5600 of the ~10600 deaths completed. Also note that it doesn't define "underlying medical condition"
https://www.mass.gov/info-details/covid-19-response-reporting#covid-19-weekly-public-health-report-
"Underlying medical condition" covers a lot of ground. Obesity (BMI greater than 30) is one of those conditions and about 40% of the US population is obese.
denverpilot
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Perhaps. Numbers are very fuzzy right now.
Really depends quite a bit on “what goes wrong”. Estimating without that fudge factor, wouldn’t be wise.
Was joking with someone elsewhere last night that I predict this headline eventually...
“New Covid-19 vaccine facility closed due to Covid-19 outbreak.”
LOL. It’ll happen. I’ve managed and worked too many large projects to plan for perfection on the timeline. Ha.
Never happens.
Regional shortages, political meddling, transport issues, one of the vaccines doesn’t quite work right, virus mutation ... and a multitude of other ways humans will screw up stuff... all with different big or small affects on the timeline.
Heck with the way a large percentage of so-called adults are behaving these days, “Vaccine riots” aren’t exactly off the table yet.
Hahaha.
Some of the comorbidities on the death certificates are things caused by the virus and prolonged disease. If you die of 'covid + renal failure' but the renal disease was a result of getting covid, you dont have 'covid only' on your death certificate.
Don't know if it's still done this way, but last spring in New York (at least), if you had COVID or were a PUI and got killed in a car accident, you got listed as a "COVID-related" death.
I think that it's entirely reasonable to believe that statistics surrounding COVID19 are extensively manipulated by Federal and State governments to achieve their end, whatever that might be.
That would be incorrect.
I dont see evidence of that. I see that the stats are still poor, but that is the result of failures in management from the top on down, not part of any systematic effort.
Well, it's not what you said.
If patients got incorrectly classified as covid during the first wave, we would expect other causes of death to decrease during that period. I looked at this for NYS a few weeks ago. The opposite happened, there was a number of CODs that increased without any obvious explanation. That included 'dementia', 'diabetes' and 'circulatory disorders' and a few others. If anything, there is good reason to believe that during the early phase of the epidemic, there was significant undercounting of the deaths caused by the virus. I have a few hypotheses why that could be, but absent any evidence to support those, I'll just assume that everyone tasked with assigning causes of death was doing their job to the best of their ability.
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I agree with most of this. But I thought dry ice was cold enough for the Pfizer and Moderna products? To some degree, the ability to use dry ice makes things easier. OTOH, I do expect supply disruptions as there is only so much carbon dioxide being produced that can be easily collected and liquified. The gas needs to be compressed to a liquid (other specialized equipment) prior to making dry ice. Maybe I just don't consider dry ice to be "extreme refrigeration", although I think it may soon become difficult to obtain unless you are using it to chill vaccine. The thoughts about parts of the world where refrigeration is problematic is certainly true. I agree with the logistics problems, but I think of it as a supply issue rather than a technology problem.
chemgeek
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Dry ice is pretty easy to come by in most large communities. It's not hard to make. Many gas supply companies can do it. The problem will be capacity. The good and bad news is that a lot of their usual customers are not doing as much business during the pandemic, so there will be some spare capacity for now. Shipping stuff in dry ice and styrofoam boxes is not a big deal. We did it frequently for sharing research materials around the country and the world. A bigger problem is having ultracold refrigeration for storage at the destination. It's hard to get an ultracold freezer delivered without long lead times when there is NOT a pandemic going on. They are not your everyday upright freezers, but rather expensive and complex, two-stage refrigeration units designed to cool to -80C. Fortunately, most centers that have research labs will have ultracold storage capacity already. Not so much for drug stores and doctor's offices.
We get our dry ice from a gas company, if I don't make it myself when I only need a little bit of the stuff. As long as you have liquid CO2, you can get dry ice. You can still use dry ice at the destination for storage although it isn't as convenient as the proper refrigerator by any stretch. Even a cheap styrofoam box will keep dry ice cold for a couple of days as you know from your samples.
Dr. @steingar is correct that there will still be difficulties because refrigeration is problematic in some places.
Some of the problem is that some of the places that make carbon dioxide are running at reduced levels. There were spot shortages earlier this year. A lot of the stuff is a byproduct of making ethanol
https://www.reuters.com/article/us-...upplies-go-flat-during-pandemic-idUSKBN2200G3
Edit- we are still short CO2- more recent reference
https://cen.acs.org/business/Short-CO2-supply-complicate-COVID/98/i45
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gsengle
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Gsengle
There are now reports of dry ice shortage issues. There are also limitations on the amount of dry ice allowed in a particular aircrafts baggage compartment per company opspecs and manufacturer limitations.
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That's the point I was making- Dry ice production is down, and we have increased demand.
I posted earlier in one of the threads that UAL can carry more dry ice than usual for vaccines. I don't know about other airlines, nor the conditions under which the waiver applies.
According to NY Daily News, UAL can carry 5x its usual allowance. Beyond that, I can't vouch for much in the citation:
https://www.nydailynews.com/news/na...0201128-pq3ef2zpmbfodpnbn6p2einjzq-story.html
Lindberg
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Sounds like the number of doses isn't the short-term imiting factor.
steingar
Taxi to Parking
It is, but keep in mind that dry ice is widely used for transportation, but not for storage. It sublimates rapidly, has a low specific heat and is actually a poor refrigeration medium. Vaccine doses are going to need to be kept viable for weeks, if not months. Dry ice won't cut it. Like I said, hairy kniptions.
It will work like the old iceboxes. They will simply have to replace the ice every few days. I've used dry ice to keep chemicals cold in a simple styrofoam box for 4 days before the dry ice ran out. I agree that the logistics will not be easy, I just feel it won't be as difficult as posited so long as there is a supply of carbon dioxide. Make sure the room used to keep the vaccines in dry ice is ventilated.
Easing both the refrigeration and carbon dioxide supply problems, Moderna's vaccine is apparently stable at refrigerator temperatures (2 to 8 °C ) for up to 30 days now.https://investors.modernatx.com/new...ounces-longer-shelf-life-its-covid-19-vaccine.
The demand for the vaccine will ensure that, from packaging to injection, none of them will sit anywhere for 30 days before being used, so the usual refrigeration transport can be used.
chemgeek
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Well, the good news is that we are now as a nation and world contemplating known issues like manufacturing, logistics and refrigeration rather than inventing vaccines from scratch. We will without doubt have several or many effective vaccines to choose from. So there is light at the end of the tunnel. It's better to be battling problems that we know how to solve, rather than dealing with things we do not yet know how to solve. That's where we were in March. It's pretty amazing how far and fast we have come since then. Everybody needs patience now, and a little determination and resolve to keep things from getting totally out of control while we start to deploy remedies. A vaccine, if you are not prohibited from receiving one, may be your "ticket to ride." (I'm first in line unless I find out I've had the vaccine already.) Here is to a more normal summer 2021! 
steingar
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Difference is the icebox couldn't kill you if kept in a small room. Had a student pass out from the CO2 from dry ice kept in a cold room.
Hence the last sentence I wrote in the part you quoted. Definitely not an insurmountable problem.
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