
Variolation May Cut Covid19 Deaths 3-30X - elsewhen
http://www.overcomingbias.com/2020/03/variolation-may-cut-covid19-deaths-3-30x.html
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HarHarVeryFunny
The article seems to be ignoring a critical aspect of Variolation. A quick
Google on the topic indicates that it's more about being deliberately exposed
to a less virulent strain of a virus, rather than being exposed to a lower
initial viral load (which would also seem to make sense).

The term Variolation comes from the name of the Variola virus that caused
Smallpox, but critically there are at least two strains of this virus: Variola
Major and the less deadly Variola Minor. The Variolation practice, as I
understand it, was to expose people to the Variola Minor strain, which
apparently then resulted in at least some level of immunity to both strains.

Unfortunately, AFAIK, so far we don't yet have a less deadly strain of SARS-
CV-2. Apparently there are currently ~8 strains so far, and all appear are
about the same in terms of death rate.

[https://www.cantonrep.com/news/20200330/8-strains-of-
coronav...](https://www.cantonrep.com/news/20200330/8-strains-of-coronavirus-
are-circling-globe-herersquos-clues-theyrsquore-giving-scientists)

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ohazi
Although there's clearly evidence that having a low initial dose is an
important factor in the severity of many infections, probably including
Covid-19, I'm not convinced that it's the dominant factor in instances where
variolation was used successfully. In those cases, they deliberately used
different infection pathways, such as drying out and grinding up scar tissue
and applying it to a scrape on the skin with smallpox.

What would the options be for covid-19? The author seems to skip this train of
thought, but I don't think you can reduce the death rate as much as he claims
without at least considering it.

~~~
acqq
> What would the options be for covid-19? The author seems to skip this train
> of thought, but I don't think you can reduce the death rate as much as he
> claims without at least considering it.

Making the vaccine _right_. That's what science knows is the only "safe" way
to get reliable results once it is applied on vast part of population.

I don't think we can avoid making a real vaccine to be able to immunize
population. Maybe the question is only which traditional corners could be cut,
what can be parallelized, and what could be the consequences. It can be that
some fresh approaches which haven't been tried before should be tried, given
the spread and the impact of this pandemics.

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Jemm
> This is because infections at home via close contacts tend to come with
> higher initial virus doses, in contrast to the smaller doses you might get
> from, say, a public door handle.

Unfortunately COVID-19 does not trigger a low dose response, which is why the
virus spreads so quickly.

~~~
Liron
Really, what's your source for this?

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sterlind
I'm not sure it's a foregone conclusion that variolation would work for
covid-19, is it? There are theories that doctors have had more extreme cases
due to infection dose, but I could see nothing approaching a dose vs. severity
graph in this article.

It'd be worth it to try on a small scale with healthy volunteers, but it seems
disingenuous to promote this strategy as a sure bet. What works for Smallpox
might not for covid..

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nateburke
An interesting idea.

It might work in a world where the population has enough capability to
coordinate something like a variolation village.

But then again, there are plenty of people out there who throw coronavirus
parties, churches that hold service in direct defiance of social distancing
orders, and individuals that spit on doorknobs: [https://www.ibtimes.sg/are-
these-people-trying-spread-deadly...](https://www.ibtimes.sg/are-these-people-
trying-spread-deadly-coronavirus-through-this-disgusting-act-videos-39242)

I think the author does not adequately understand the challenges associated
with e.g. how the variolation village would be perceived and understood by
others--its main flaw being that it would not contain the whole population.
People don't like the idea of a ghetto.

~~~
Liron
The proposal actually _doesn 't_ require coordination beyond a single research
trial. If the research trial proves a mechanism to cut death rate 3-30x,
people will have incentive to self-variolate by comparing it to their existing
risk of COVID death.

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alexandercrohde
For context, it's estimated that BEST case scenario (flatten the curve
entirely, everybody gets medical attention) that 1.1 million Americans still
die[1]. This is assuming a quarantine for > 6 months [1]. Vaccines are a year
off [1].

Some may see this as risky, but given that containment is out of the question,
the only risk with variolation experiments would be that one catches it
earlier, currently 80% of people are expected to catch Covid [1].

Given that, but surely something akin to mixing the phlegm of the infected
with hot water, or exposed to ultraviolet radiation for a certain interval,
would be worth a shot and potentially mass-producible.

Unfortunately I imagine our slow and process-oriented healthcare system isn't
going to be innovative or fast enough for this, and more like 2 million will
die in US alone.

Maybe another country will give it a try.

[1]
[https://spiral.imperial.ac.uk/bitstream/10044/1/77482/5/Impe...](https://spiral.imperial.ac.uk/bitstream/10044/1/77482/5/Imperial%20College%20COVID19%20NPI%20modelling%2016-03-2020.pdf)

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zozbot234
This has been looked at already by amateur researchers online (at places like
/r/COVID19 and elsewhere). The problem with variolation is that you need to
culture large amounts of the virus to make it scale, and once you're doing
that you're basically 90%+ of the way to a vaccine already. Inactivating
viruses, using viral material etc. (the extra step in vaccination, compared w/
variolation) is not hard.

~~~
Liron
That doesn't sound right. I bet we can engineer procedures where you use one
person with a known COVID infection to give another person a sufficiently
small dose of it with sufficiently high probability.

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acqq
Like said elsewhere -- we don't know what would be the "safe enough" method,
on another side, desperate times...

[https://en.wikipedia.org/wiki/Variolation](https://en.wikipedia.org/wiki/Variolation)

Still, there is a nice bit of history behind the concept, as an example, the
story about how Britain learned about the method:

"It would not be until Italian physician Dr. Emmanuel Timoni of Constantinople
promoted the practice that variolation began its spread through Western
Europe. After coming across the practice in Constantinople, Timoni wrote a
letter describing the method in detail which was later published in the
Philosophical Transactions in early 1714.[6]:77 His account would become the
first medical account of variolation to appear in Europe. Although the article
did not gain widespread notoriety, it caught the attention of two important
figures in the variolation movement, Bostonian preacher Cotton Mather and the
wife of the British Ambassador to the Ottoman Empire, Lady Mary Wortley
Montagu."

"No stranger to smallpox, Lady Mary had lost her brother to the devastating
disease. Soon afterwards, she also contracted smallpox. Although she survived,
she was left with severe facial scarring. While in Turkey she came across the
process of variolation as it was practiced amongst the people of
Constantinople. She first mentioned variolation in the famous letter to her
friend, Sarah Chiswell, in April 1717.[7]:55 in which she enthusiastically
recounted the process, which in Constantinople was most commonly administered
by experienced elderly women. In 1718, she had the practice conducted on her
five-year-old son, Edward Montagu. The procedure was supervised by the embassy
doctor Charles Maitland. On her return to England, she had her four-year-old
daughter inoculated in the presence of physicians of the royal court in
1721.[1]:90 Both variolations proved successful. Later on that year Maitland
conducted an experimental inoculation of six prisoners within the Newgate
Prison of London. In the experiment, six condemned prisoners were variolated
and later exposed to smallpox with the promise of freedom if they
survived.[2]:45 The experiment was a success, and soon variolation was drawing
attention from the royal family, who helped promote the procedure throughout
England. However, variolation caused the death of Prince Octavius of Great
Britain, eighth son and thirteenth child of King George III in 1783."

[https://www.nlm.nih.gov/exhibition/smallpox/sp_variolation.h...](https://www.nlm.nih.gov/exhibition/smallpox/sp_variolation.html)

"Variolation was never risk-free. Not only could the patient die from the
procedure but the mild form of the disease which the patient contracted could
spread, causing an epidemic."

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aaron695
Anti-Vaxxers, Anti-Hand Sanitisers, Anti-Masks and Anti-Variolation are all in
the same boat.

This needs Gamification, Germany is doing this, bringing in certificates.

These people can get the country running again and go to the movies and
restaurants.

I was going to infect myself but couldn't, then learned about load, so kinda
glad I didn't jump in too early. I would have go hard to be infected since I
figured it'd be quicker. Another reason to make it formal.

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service_bus
Quite possibly the dumbest thing I have ever read on this site.

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fermienrico
Please substantiate further as to why.

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service_bus
There is no evidence yet that immunity is even possible.

Until we know that, taking away healthcare workers, healthcare resources, and
having volunteers willing to kill themselves is foolish, at best.

~~~
ericb
In macaques they found reinfection was not possible.

[https://www.biorxiv.org/content/10.1101/2020.03.13.990226v1](https://www.biorxiv.org/content/10.1101/2020.03.13.990226v1)

The news stories about reinfection are suspect because there's a high false
positive and false negative rate to the tests.

