Covid-19 Politics

[broncofan]

Hospitalizations are rising and case numbers will probably be approaching 60,000 new cases per day this week. Florida, Texas, and Arizona are all going to have their ICU capacity tested before this is over.

Eric Trump recently took to twitter to tout a study on hydroxychloroquine that indicated it might have some benefit. If you look at the randomized controlled trials we've run, an enormous amount of time and energy has been wasted trying to prove this drug might have some marginal benefit.

There are five major companies in the U.S. testing monoclonal antibodies. If they are effective, their benefit should be easier to establish. Although our federal government is subsidizing vaccine manufacture and helping companies produce "at risk", meaning before efficacy and safety are proven, I don't think they've done the same with monoclonal antibodies. By the end of summer there will probably be a lot of data about whether they work but limited capacity to manufacture them.

Finally, I wanted to say that I pointed out that politically we've failed to heed the advice of public health experts but I didn't point out that this also shows up culturally and not just through policies. In a public health crisis, part of the job of those in office is to educate people about what their real risks are and how they can reasonably mitigate those risks. Trump has done nothing but sow confusion, spread misinformation, and undermine the public's trust in experts. We have not done a fine job, or a good job, or an average job, and that should be fairly obvious if we actually hold ourselves to the same standard as other industrialized countries.

[Stavros]

If the key to Covid 19 is that it is an airborne virus, logic suggests that all forms of human congregation pose a risk to someone, be it falling ill, or falling and then dying, just as many can congregate with no risk at all. As there has never been a vaccine for the Coronovirus family of illnesses, suppose we can neither contain Covid 19 nor develop a vaccine? The small cohort of victims of MERS, and the apparent 'disappearance' of SARS acted against the development of a vaccine, and even if one appears, it cannot become a 'magic bullet' in so short a time, here is Costello a few days ago-

The good news is that you’ve got more labs in the world looking for a vaccine for this virus than any other. They’ve got better techniques for designing vaccines and there’s a lot of money going into it. Having said that, they’ve never had a vaccine to a coronavirus. Vaccines usually take several years to develop because you’ve got to test the safety of it. And most worrying, it seems the immune response to the virus is not very good, and fades. That suggests any vaccine you come up with may have only short lasting immunity. For all those reasons I’m cautious. The people I respect say two years would be a possible time. My guess is that we may get a partially effective one a bit quicker.
https://www.theguardian.com/world/20...ge-coronavirus

In the US and the UK the risks of relaxing physical distancing are only too evident, in England (not the whole of the UK) since the broader relaxation last Saturday, three pubs in different parts of the country have now shut again because they were responsible for new infections, so the question now is how goverments balance the economic needs of the country and the public health needs.

I fear that a cynical attitude is taking hold, call it 'Drop Dead, America' or 'Keep Calm and Carry on to the Graveyard' here. If the virus cannot be contained, it cannot be contained. If there is no vaccine, we are going to adapt to the continuation of risky behaviour, and higher rates of mortaity than before January 2020. With a President more concerned to manipulate divisions and open old wounds in the US than manage a healing process, and a Prime Minister as bored with Covid 19 as his American friend, and more concerned to 'Get Brexit Done', I see no political solution to Covid 19 as a public health issue other than, 'get used to it'. It is ironic is it not, that sociologists who predicted that with declining rates of regeneration in Europe, North America and parts of Asia the social cohort would become increasingly made up of people over the age of 50, that now they are the most vulnerable to die from Covid 19, but evidently not in Japan.

Maybe I am too negative, but I fear Covid 19 is going to be around for a few more years, and that the immunity that develops will be an immunity to social, rather than individual health.

[broncofan]

As the WHO director, he obviously knows more than I would if I had an additional 8 years of education in science. Yet I have seen some counterpoints to some of Costello's concerns about vaccines. As an alternative perspective consider the following:

Never been a coronavirus vaccine-the failure to develop a coronavirus vaccine was not the result of special challenges with that class of virus. As you point out, Sars was contained and Mers is very deadly but not highly transmissible so there was never a large demand for one. Vaccine testing requires fairly large cohorts but covid is circulating widely in some countries so inferences about whether the vaccines provide sterilizing immunity can be drawn more quickly.

It takes years to develop vaccines-it takes years when one or two approaches are tested at a time. In this case, as he points out, there are 100 different vaccines being tested, from RNA vaccines, to inactivated virus vaccines, to subunit vaccines, to adenoviral vector vaccines. The timeline has been condensed, which means if one is approved by next year, we might not know all of the risks, especially those on the order of one in a million, but with cohorts of 30,000 some of the more common complications like antibody dependent enhancement would likely show up.

The immune response is not very good-99% of people who get infected clear the virus so the immune response must be doing something.

There is a concern about the durability of the neutralizing antibody response. Titers of these antibodies seem to wane after a few months. On the other hand, the fact that neutralizing antibody titers are much lower after several months does not rule out the possibility of a more durable t cell response. Here's one article on this subject, but I'll see if I can find more.

https://www.the-scientist.com/news-o...covid-19-67695

If a vaccine is approved by early next year it is unlikely we will know the durability of the immune response to it. If it provides sterilizing immunity and there is widespread vaccination it can help countries eradicate the virus. If on the other hand it only prevents serious illness but not infection or if there is not widespread vaccination because the public lacks confidence in the approval process for the vaccines we might find out that boosters are required.

I don't know anything for certain and don't want to overstate my confidence but many of the scientists I've paid attention to are slightly more optimistic. Of course, it's possible Costello is right and I'm sure there are plenty of scientists who agree with him about the timeline.

[broncofan]

There is a concern about the durability of the neutralizing antibody response. Titers of these antibodies seem to wane after a few months. On the other hand, the fact that neutralizing antibody titers are much lower after several months does not rule out the possibility of a more durable t cell response. Here's one article on this subject, but I'll see if I can find more.

https://www.the-scientist.com/news-o...covid-19-67695

Here's what Nobel Laureate Peter Doherty says about immunity to covid. https://twitter.com/ProfPCDoherty/st...482728449?s=20

[filghy2]

In the US and the UK the risks of relaxing physical distancing are only too evident, in England (not the whole of the UK) since the broader relaxation last Saturday, three pubs in different parts of the country have now shut again because they were responsible for new infections, so the question now is how goverments balance the economic needs of the country and the public health needs.

We are facing these issues now (albeit from a stronger position) with the the recent surge in community transmission in Melbourne. That state is now isolated from the rest of the country and lockdowns have been reimposed in Melbourne. Even the Victoria-New South Wales border is now closed, which wasn't done previously.

Any Government restrictions rely on a substantial degree of voluntary compliance by the public. People have been overwhelmingly willing to comply so far, but I wonder how much that will change if periodic lockdowns continue. I think part of the willingness to comply has come from the fact that people could see that it was working and they could hope that the worst would be over after a few months of sacrifice. I'm not sure what the effect on peoples' psychology will be if they start to feel that there is no end in sight despite their previous sacrifices.

[Stavros]

Your point about patience is the key one- I think people will accept limits to their behaviour for the reasons you describe, but more than once? And if Covid 19 persists because of its ease of transmission, these spikes will occur again and again. It is an illusion to think we are emerging from a crisis that in reality has not ended, only in some countries abated in its intensity. This is why Covid 19 is the most vexing public health challenge we have had in decades, thoigh some would add obesity into that diet.
Hang in there, Oz. Even if we can live without Love Island Australia.

[filghy2]

There is another option, although it may be feasible only for countries that have been able to suppress the virus in the first place. That is the eradication strategy - keep lockdowns in place until you are confident domestic transmission has been eliminated completely and then open up domestically but keep the borders closed. That is what New Zealand has done. Obviously it helps to be isolated geographically.

I'm beginning to think that's what we should have done, rather than easing restrictions once case numbers got relatively low and hoping we could keep it suppressed. Another month or two of lockdowns would have been far preferable to the uncertainty of continued on-and-off restrictions. The problem is that even with a good system and political will suppression relies on too many things being done right, and human nature means that people will become slack and slip-ups will occur.

I am fairly resilient and have maintained a positive attitude. I've organised a domestic holiday for next month, which will help, though I am watching the news a little anxiously and hoping restrictions won't be reimposed on my state.

[broncofan]

https://twitter.com/brianklaas/statu...857771520?s=20

[broncofan]

https://twitter.com/brianklaas/statu...857771520?s=20

[broncofan]

There is another option, although it may be feasible only for countries that have been able to suppress the virus in the first place. That is the eradication strategy - keep lockdowns in place until you are confident domestic transmission has been eliminated completely and then open up domestically but keep the borders closed. That is what New Zealand has done. Obviously it helps to be isolated geographically.

I'm beginning to think that's what we should have done, rather than easing restrictions once case numbers got relatively low and hoping we could keep it suppressed. Another month or two of lockdowns would have been far preferable to the uncertainty of continued on-and-off restrictions. The problem is that even with a good system and political will suppression relies on too many things being done right, and human nature means that people will become slack and slip-ups will occur.

I am fairly resilient and have maintained a positive attitude. I've organised a domestic holiday for next month, which will help, though I am watching the news a little anxiously and hoping restrictions won't be reimposed on my state.

These are interesting thoughts and I wish that our country had this kind of strategic discussion. I watch baseball and one of the interesting things about baseball is that players can go into extended slumps even when they're doing everything right. As a result, there are some stats that tell them whether they're doing things right in the short term and just getting unlucky. One of these for instance is hard hit percent but there are others.

Given the delay between our actions and it showing up in case numbers, I think societies really need to focus on the things that are predictive of success. It can take several weeks before case numbers rise and weeks beyond that until we see deaths. Florida, for instance, spent months being lax with public health before they were hit. It was actually used as a prime example by Republicans that there isn't a correlation between public health measures and cases. Over a longer timeline, that always falls apart. The virus spreads easily....comparisons to the flu which has an R0 that is half that of sars-cov-2 should make that obvious.

I agree with you that it would be a decent idea to try to eradicate the virus and close off the borders. Getting the political will behind that would never be easy. But it's a long term strategy that would pay off. Any time a locality opens beyond its contact tracing capability and sees community transmission, it is a setback and a more careful approach would have been better economically and in terms of human life.

One thing I don't understand is that planning hasn't taken into account treatment and vaccine contingencies. A ton of data on vaccines will be available by the end of the year. If the data came back and every kind of vaccine was ineffective, I could understand people insisting we have to find a way to live with the virus as more vaccine efforts and further development took place. But there will be data by the end of the year, providing a reasonable timeline to subsidize and boost up economies that cannot operate at full capacity no matter what until then.

[Stavros]

Given the increasing number of cases in Florida, how can it be right for Disneyworld to open its doors, and can the RNC justify holding their Convention in the State in these circumstances?

And, is it not possible that the Republicans will soon be waking up to the possibility that the Americans least able to get to a polling station in November will be Republican voters in currently Republican states and counties experiencing a surge in casees -and that for this reason they might seek a post-ponement? It may even be part of a 'deep state' conspiracy to rob HIM of a second term, all those infected Democrats travelling around Texas and Florida...

As for the UK, we have got to July and the messages from the Government are contrdictory -go back to work, stay home if you can.
Wear a mask in public -if you want to; wear a mask in trains and buses- compulsory.

This is a Government pretending to negotiate a trade deal with the EU that in fact, years after making the decision, has no idea how to handle goods arriving in the UK from the EU, is building a lorry park in Kent in case there is a long queue of trucks getting into and out of the port at Dover in case their prediction nothing will change turns out to be wrong.

If Brexit poses 'challenges' four years after the Referendum, because we still don't know what it will mean, how can we trust the same crop of Brexit nutters to manage the most devatating public health crisis in 100 years when they can't make a single decision just on masks? And can you believe Michael Gove, who sneered at experts durng the referendum, is now saying Government needs... experts, one of the key recommendations of the Fulton Report, published in...1960...