Hacker News new | past | comments | ask | show | jobs | submit login
Covid vaccine: First ‘milestone’ vaccine offers 90% protection (bbc.co.uk)
1887 points by isp on Nov 9, 2020 | hide | past | favorite | 1148 comments



All: don't miss that there are now multiple pages of comments in this thread. To get there, click 'More' at the bottom of the earlier pages. Or like this:

https://news.ycombinator.com/item?id=25033844&p=2

https://news.ycombinator.com/item?id=25033844&p=3

https://news.ycombinator.com/item?id=25033844&p=4

(Once we've rolled out some long-suffering performance improvements, all of this should blissfully disappear, including this sort of comment. Thanks for your patience.)


Good:

+ ~90% of individuals achieve immunity.

+ no significant side-effects.

Not so good:

- two doses needed, 3 weeks apart, immunity after one month from first dose. Slow rollout.

- -80C storage and transport needed. Challenging, but doable in developed countries, but still may slow down mass rollout. Not feasible in many developing countries.

I still wonder about long-term immunity. Anyone can share any insight?


The latest data (preprint, not peer reviewed etc etc) mention memory B and T cells up to 8 months after recovery from the illness. This means that an immunity of one year is probably likely. This would be probably enough to quench the spread, but not to eradicate the virus.


I think we can eradicate it by contact tracing. With 90% efficiency it will be extremely tough for the virus to spread. For any new cases you simply test everyone in the vicinity of the infected person.

But I don't think even that will be necessary. 90% efficiency reduces R so much, it will probably die out on its own.

The real problem is mutations that are not covered by the vaccine. If it mutates as efficiently as flu, it will be a challenge.


Contract tracing hasn't worked at scale anywhere. It's a nice idea conceptually, but the problem is psychological. People stop caring about tracing when 98% of all trace connections are false positives. If a person is infectious for a week and the r0 is around 1 then only 1 person of all the people they've been in contact with will actually contract the virus on average. The other 50+ people, assuming they can even be traced, get a false positive. Or to put it differently, people have to be called 50 times and get tested and self-isolate 50 times before they actually test positive. And for younger people 80% of cases are completely inconsequential. You might think 50 contacts is unrealistically high, but most people still go to work, to school, see friends, use public transportation, etc.

Covid19 would also be over if people with symptoms would just stay home. But that's clearly not happening either. We've got to be realistic about how people behave in the real world.

Mutations aren't a serious concern. Because when viruses mutate it's the strains that are more infectious and less lethal that win out.


There's also participation on the contact side. In Western countries, surveys indicate we can't convince even half of people to install a contact tracing smartphone app. According to my state's department of health, practical experience indicates we can't convince even half of people to pick up the phone and respond to a contact tracing interview.

> Covid19 would also be over if people with symptoms would just stay home.

No it wouldn't. One of the things that makes SARS-CoV-2 such a problem is that people get contagious long before they show symptoms. Similarly to for influenza and the common cold, many people get contagious without ever developing symptoms.


> According to my state's department of health, practical experience indicates we can't convince even half of people to pick up the phone and respond to a contact tracing interview.

More than anything I suspect this is a result of allowing so much unfiltered spam calls. If you only get one unexpected, unknown call a month you will almost always answer it. If you get three a day you will almost never answer it.

We are allowing private businesses and scammers to steal the “commons” of our societal attention. We are doing a very poor job of keeping useful communications channels open: almost every communication medium people rely on for important information gets cluttered with must-ignore spam, making it decreasingly likely an important message is actually received.


I got an automated message from my local states's department of health services. It simply said they're "trying to contact me and the interview will only take 5 minutes." However, having not scheduled any interviews with the government I had no idea what they were talking about, so I chalked it up to spam or polling attempts and ignored several similar calls.

I'm now wondering if it was an attempt at contact tracing. Had they simply stated what they wanted in the message I would have been pretty likely to call them back myself or answer a later call.

I have no idea where they got my cell phone number from, but the whole thing seems poorly handled at best. Anyone with legitimate business will state the nature of that business and allow for a return call. There's just so many solutions to this problem but nearly zero aligned with incentives.


It simply said they're "trying to contact me and the interview will only take 5 minutes."

Yep. That was probably about COVID. Health privacy laws prohibit even the vague mention of a condition. The caller has no way of knowing if they have the right phone number, and the last thing you want is "Attention, Rando McUltrarunner at 42 Crustacean Crest Drive, Cleveland, Ohio! You have been infected with COVID! Run, don't walk to your nearest testing facility!" on some stranger's voicemail. Or worse, "We are following up to see if you're doing well after your abortion" ending up on the voicemail or texting app of a 15-year-old girl whose parents might have access to her phone.

Source: Recently completed my company's mandatory annual HIPAA training.


how would authentication work when you/someone does pick up the phone?


Sadly, it breaks down. You ask someone if they are who they are, and that's about all you can do. Someone can lie. Has it ever happened? Probably, but I've never heard of it, and my legal department is pretty good about keeping up on these things. But the way the law is written, asking the question absolves the caller of legal liability.

It's not IT-grade authentication, but for wetware it works.


Privacy regulations (HIPAA) may forbid them from saying "Hey we think you might have COVID" on your voicemail, unless you've already filled out paperwork saying "It's okay to leave a message on my voicemail with detailed health information."

Your doctor's office can do it because you probably have an existing patient relationship, and you already filled out that paperwork on your first visit.

But in the situation of a cold-calling contact tracer, you haven't signed anything at all, so all they can say is "This is the health department and we want to talk to you."


I have seen some companies that call have pre-loaded Caller ID. Why don’t Apple or Google provide a service that guarantees that the Contact tracing service always calls with a Caller ID, and Apple/Google could even mark it as verified. I think many businesses would pay for this service as it saves money on having to contact existing customers and reduces fraud.


One thing that comes to mind, if a call comes in accompanied by screen message of a kind that I have never seen before I'd be twice as alarmed as with just some random unknown number calling. I might end up googling recently updated apps for news of a malware takeover instead of answering the call.

But it would be a good idea nonetheless, it only requires to be accompanied by a serious information campaign preparing first time receivers for the surprise.


Semi related, but some services (trapcall, for one) offer a very cheap service that punches through called ID spoofing via AMI, and offer blocking on public and private lists, really help.


I believe they already do this.


Then why aren’t pollsters and contact tracers doing this so none of miss those calls?


I don't want pollsters calling me. Nor contact tracers. They can send an email if it's essential.


I imagine contact tracers would at least leave a voicemail? I always let numbers I don't recognize and aren't local (my cell phone number is out-of-state and spam calls usually originiate from that area code, not my current local) go to voicemail since I assume if they're important, they'll leave a voicemail.


We already have contract tracing scams. I got a call claiming to be a contract tracing call asking for my SS# to tell me if I was at risk.

No clue how widespread this is, but I can't exactly blame people for assuming any call or voicemail they get is a scam, there are so many out there.


That's...both unsurprising and super disappointing.


FWIW I get lots of spam voicemails, to the point where the 'new voicemail' notification doesn't glass any confidence that a human called me.

I can, of course, listen to every voicemail, but that's not much better than just picking up the phone when I get a spam call.


I would say 95% of the voicemail is spam. The other 5% also sends me an email if they couldn't reach me.

So basically the only reason I check my voicemail is to get rid of the notification on my phone


It's funny how you remain completely unaware of the merits of your country's set of laws unless you hear from how things are elsewhere. We do have spam calls, but they are rare enough that people bonding over spam call infuriation might reference one that happened a year earlier.


yeah it's a total shitshow in the United States; I get 20-25 spam calls a week unless I shell out for a service to block them (TrapCall, Robocaller, etc.)

I'm sure there are bills in the works, but those same bills are likely bundled along with completely unrelated nonsense.


Use something like Google Voice that gives you a transcript. In fact, I bet Google could probably automatically flag spam voicemails if they tried.

Of course, you may not be comfortable with giving Google access to this data...


I have transcripts, but I still have to read them. You're right though, it's better than listening to the audio.


That only works if you have and check your voicemail. Many people either don't have a voicemail or don't bother ever setting it up. When the carriers start charging you a lot of money to have a voicemail, plenty of people will forgo it, and instead say things like "if it's important enough they'll call back" or "they'll send me a text message".


> Many people either don't have a voicemail or don't bother ever setting it up.

I actively turned my voicemail off completely.

There is simply no-one who I want to talk to who would choose to leave me a voicemail if I don't answer.


I've got enough IRS and social security calls on my voice mail as to ignore them all too. If I don't know the voice and I'm not expected the call it is ignored.


I have a similar problem with voicemail: the spammers leave voicemail too so I don't want to check that either.


Yeah, I use Google Voice and just read the transcript since that takes a lot less time.


> More than anything I suspect this is a result of allowing so much unfiltered spam calls.

Yep. I never answer unrecognized numbers anymore, and nobody I've talked to about it does, either.

Welcome to what society looks like when social trust declines. It will keep getting worse unless and until people discover that the commons actually matters and is more than something to scam and find some way to parasitically monetize.


Or, like me, your health department doesn't even bother to contact you. I had to do my own contact tracing when I tested positive.


How is that possible? Did you call all of the places you were and got contact information from anyone in that area that day?


It isn't a western thing. Less than half of Singaporeans installed their TraceTogether app[0].

[0] https://www.zdnet.com/article/less-than-half-in-singapore-wi...


People are contagious a few days before they show symptoms, but most infections are by unambiguously symptomatic people, because they carry the highest viral load. If symptomatic people stay home you cut down infections by 2/3rd if not more. R0 goes from 1.5 to 0.5 and that's sufficient.



The work you cite is speculative.

> Available evidence from contact tracing reported by countries suggests that asymptomatically infected individuals are much less likely to transmit the virus than those who develop symptoms. A subset of studies and data shared by some countries on detailed cluster investigations and contact tracing activities have reported that asymptomatically-infected individuals are much less likely to transmit the virus than those who develop symptoms.

http://www.emro.who.int/health-topics/corona-virus/transmiss...


> No it wouldn't. One of the things that makes SARS-CoV-2 such a problem is that people get contagious long before they show symptoms. Similarly to for influenza and the common cold, many people get contagious without ever developing symptoms.

Agree with the main thrust of the point but if everyone did stay home for 14 days you may well eradicate the virus. Problem of course that its economically/socially/medically impossible to facilitate a complete 14 day lockdown.


Another reason why that synchronous 14 day lockdown would fail to eradicate the virus: unless you are going for total solitary confinement, intra-family transmission chains would be able to sustain the virus much, much longer than those 14 days. Even a household as small as a two child nuclear family could sustain the virus quite long if each infection happens to have a fan-out of one and happens rather late in the contagiousness window.


China did isolate infected people away from home for precisely this reason. Seems to have worked.


But that surely was only known positive isolation, not the blanket "everybody stay home" thing grandparent was suggesting. That's a huge difference particularly wrt (child)care: someone will take over until you are healthy again vs nobody can take over because everybody else is going through the same solitary confinement thing.


The big question is do they really work. Not according to country which measure traveller from china. We know in the long term. But trusting on their stat., not my default.


>if everyone did stay home for 14 days you may well eradicate the virus

This would not be possible. There are at least several species of animals (mikes, civets, and bats) than can transmit this virus. We would need to quarantine and test, or kill, each and every one of these animals to be sure we eliminate this virus, or else it will eventually make its way back to humans.

My opinion, based on what I read, is that this will be a bit of a scourge until such time as enough people have immunity from either catching it or getting vaccinated.

Over time, as this new coronavirus makes its way through the human population, the experts it to become less virulent in general and/or appear less often. [0]

[0] https://www.statnews.com/2020/02/04/two-scenarios-if-new-cor...


Also, cats and dogs can catch Covid-19. We think it's rare, but it is documented.

https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/...


Latest headline I saw, didn’t read because I didn’t want to be depressed, was that asymptomatic carriers were shedding the virus for months.


> One of the things that makes SARS-CoV-2 such a problem is that people get contagious long before they show symptoms.

I also wonder how effective the vaccine is at preventing its receivers from even reaching that asymptomatic but already contagious stage. If "90%" is just "90% less reach symptomatic stage" then the percentage of receivers that are prevented from reaching contagiousness could be much lower.

This would basically mean that the virus is almost guaranteed to become endemic despite vaccination (unless another vaccine also removes the contagious stage quite well) and that everyone who doesn't get a vaccine will eventually test their immune system against the virus.

Natural immunity often follows a similar pattern. After a while you become susceptible to a light reinfection but the immune system will be in a very good position for a quick - but not instantaneous - victory on its second encounter with the virus. Under those circumstances, herd immunity effects fail to realize unless the first wave is so lightning fast that it fizzles out before the immune systems of early survivors (or the similarly vaccinated) fall back into standby mode.


don't know about other countries but in Switzerland somehow people do not get the codes for Covid app with positive test results. even if they had the app installed and running the crucial step of entering the official code is failing


I'll line up to get a vaccine because I trust in the scientific/medical community. I haven't installed my local contact-tracing app because ...

1) When I did try to install it said I need to update to a new OS, meaning my five year old phone likely wasn't good enough. 2) My local app doesn't provide alerts to me rather it alerts government contact tracers who today stated that they are only responding to alerts regarding medical/care home workers. I am neither. 3) My phone is not with me at work, the place where I interact with the most people by far, rendering the entire scheme basically useless.

But yes, I would get a vaccine in a heartbeat.


that people get contagious long before they show symptoms

I don't think that's correct. Pre-symptomatic phase is supposed to be about 2-3 days. I wouldn't describe that as 'long' before they show symptoms.


if it's before though, then how would isolation after symptoms prevent the spread? I think the original post stand if perhaps overstated.


Not symptoms, but positive test results...

In the US, people are going to work (or other events) WITH positive test results. Some because they won't get paid otherwise, others because they want to make a political statement, and some because they're ... well, I dunno why...

So, yes, even having people stay home after a positive test would be helpful, because currently, they aren't even doing that.


Why on earth would allow some government agency to track me.

Some health departments have taken it upon themselves to arrest people that won’t sign documents.

It’s like HOA battles, except now you can be put in jail on a whim.

Even being an common case, and will likely be overturned in courts, it’s just too risky.


> Some health departments have taken it upon themselves to arrest people that won’t sign documents.

Which health departments, what documents, and how many people?

And how did they get arrest powers?


Health departments can order you to quarantine. In practical termss that's like house arrest.


Not like house arrest. But actual house arrest. Ankle monitors.

http://www.wvih.com/wp1/index.php/2020/07/19/couple-on-house...


That web site looks sketchy



Oh, that's what they meant? That's not about signing documents at all, really. It's about whether they will agree to supervise their own quarantine, or whether the state has to do it. Then there was some stubbornness and/or misunderstanding in regards to making that decision and agreement.

"Some health departments have taken it upon themselves to enforce quarantine on people that just tested positive." doesn't really inspire the same kind of outrage.


It should.


Thanks


>Some health departments have taken it upon themselves to arrest people that won’t sign documents.

[citation needed]



Contract tracing seems to work just fine in the Asian countries that have successfully stopped the virus in its tracks, and if China's 1.3 billion people isn't at scale, I'm not sure what is.

But yes, it does require having few enough infected people to make it feasible, and places like the US and most of Europe are waaaaay beyond that point now.


China has also done mass testing when their contract tracing broke down.

If we could get high compliance with isolation of positives, the US/Europe could use mass testing to "reset" without lockdowns. Test all of Michigan across a couple days and you will identify a significant portion of the infected. Then do Wisconsin. Encourage people to limit travel during those periods and so on.

You wouldn't get to 0 in one cycle, but it would hammer the transmission rate.


> If we could get high compliance

For better or worse [1], complying with mass government orders is simply not part of the collective American psyche.

1. it still remains to be seen if this individualism and distrust of government is one of America’s greatest strengths, or its future downfall


Yes, I phrased it that way quite on purpose.

I'd prefer not to get Covid19, but the real worrying thing about it is the potential for a worse disease. Say it's almost as transmissible but much more deadly. How will we respond?

I'm sure many people would do more to protect themselves, but I wonder how deadly it would have to be for some people, and how deadly would it have to be to make community minded cooperation the obvious path (this is a reasonable description of mask wearing…).



"Covid19 would also be over if people with symptoms would just stay home."

That is unlikely to be true. There are asymptomatic super spreaders. The fact that R0 is currently hovering around 1 is that society has greatly reduced contacts. Even in areas where social distancing is a mere suggestion, most people are not behaving completely normally (a good thing). Flights are super low, movie theater visits are super low, hotel occupancy is super low. Social distancing and contact tracing work. Better social distancing and contact tracing work better.


> Mutations aren't a serious concern. Because when viruses mutate it's the strains that are more infectious and less lethal that win out.

If only it worked that way! It doesn't, of course.

A random walk can lead anywhere in the adjacent landscape. That includes moving up in lethality without moving down in infectiousness. What you have written here is plausible-sounding nonsense; if it were true, the 1918 flu would never have occurred.

The good news is that influenza is almost pathologically mutation-prone, and coronaviruses are not.


The oft-cited theory about 1918 is that WWI upended the traits that were selected for in the virus. Whereas in peace time a more serious case would reduce the mobility of the victim, in war a serious infection would result in the patient (a soldier) being transported off the front lines, spreading the more serious version of the virus more.


Moving up in lethality while maintaining the same "infectiousness" still results in a real-world decrease in infection rate, as more infected hosts will die (and/or infected hosts will die more quickly), preventing them from spreading it further.


In the case of COVID-19, which is highly contagious, has a long latency period, and is in fact not especially fatal by the standard of diseases ending in -RS, this might be true on paper, but would be cold comfort in practice.


Thank you for pointing this out.


> Contract tracing hasn't worked at scale anywhere.

Could you go a little deeper in this? It seems to have worked in Australia, South Korea and NZ as far as I’m aware, what am I missing?


The claim becomes conveniently tautological when you equate "at scale" with "tracers getting overwhelmed". GP might argue that all successful tracing never reached scale. That would make it a completely worthless claim, but, well "truth" (big sarcasm quotes).


It completely broke down in Victoria, Australia when daily case numbers got into the hundreds, so a full lockdown was imposed.

It’s working fine again now that case numbers are negligible.


Worked to slow down the spread, but not to catch all cases. Remember the gay pub in South Korea?

Many people are not going to say they cheated on their SOs, or went to a swing bar, or a gay pub.


They didn't have to catch all cases. They reduced the fatality rate per capita by 90% compared to western countries. South Korea has less than 5% the cases per capita of the US.


I was referring to the following (grand)parent:

> I think we can eradicate it by contact tracing.


And Japan. To be fair, Aus and NZ caught their epidemics very early, and are islands.

Korea and Japan appear to have contained theirs through the use of reverse contact tracing.

The big problem in the "West" (i.e. Europe and US) is that lots of people don't engage with the contact tracing system, which makes the epidemic almost impossible to control.

Any amount of community transmission will eventually lead to an out of control epidemic, unfortunately.


I keep hearing the 'they are islands' thing and it has never made much sense to me. Can you explain why being an island is intrinsically better than not being an island?

Does the size of the island matter? Does the location of the island matter? What if there are multiple islands?


Travel into islands is far harder than travel into cities in large land masses. You need to get a ticket on an airplane or a boat, which makes travel time a minimum of 1 hour usually and costs a whole bunch of money. This creates a natural barrier where people on islands don't interact with people on mainlands nearly as much.

Look into covid numbers and you'll notice cities even in the same country that are on an island of some sort have significantly less covid numbers, such as Hawaii or Vancouver Island in Canada.


How do you apply the “islands do better” logic to the UK or Hawaii? Hawaii might have done well by US standards, but it has performed badly compared to other islands. The UK has not done well.


Yes. Also Australia is an island, but Victoria (my state) peaked over 700 cases/day and other states during the same period managed to keep their case numbers controlled at the same time (~10 cases / day in NSW iirc). It wasn't magic. We closed the state borders, making each state basically its own island. Victoria imposed strict lockdowns to get the case numbers down and the rest of the country went about business as usual.

I don't see why the same strategy wasn't used in Europe or the US. Its hard to control a virus when there's a constant stream of new cases coming over the border. I suppose its way too late for that now.


The UK is a remarkably un-island-like island in terms of the frequency and ease of travel between it and the mainland.


In particular, the UK and France are connected by a high-speed train tunnel: https://en.wikipedia.org/wiki/Channel_Tunnel

The travel times quoted by that article: "London to Paris taking 2 hours 15 minutes, to Brussels 1 hour 51 minutes."

That's faster than some people's daily commutes into NYC.


Islands don't really matter, but closed borders do. Europe has very different policies and rates of spread, but open borders mean that no country in the EU can eradicate Corona if the rest doesn't eradicate it at the same time. Case in point, Germany was at practically zero (around 1% positive tests with a 1% false positive rate) 6 weeks ago, currently it is lagging 3 weeks behind all its neighbors in the number of cases, rising exponentially.


agreed. if anything, being an island would be worse because you have to condense a lot people into confined spaces just to cross the border


> Any amount of community transmission will eventually lead to an out of control epidemic, unfortunately.

The countries mentioned have had community transmission, but they use contact tracing, testing, and shutdowns to stop it.


How is north america not an island?


porous border with Mexico? and by the time it arrived it was too late.

if you say Mexico is in your definition of North America then it should include all of central america, almost all these countries have a lot of land-based trade.

In Canada we have not had any cases related to truckers, but there's a lot of them who have to do the cross-border route, as well as people who commute daily across the border. heck in Canada and the US there are a few spots where crossing the border is necessity -- the only school is in the other country, nearest hospital, the local library, a popular golf course, etc.

or places like point roberts, extremely small but extremely isolated, or Hyder, Alaska.


A sea border is used more for trade -- Australia trades nearly as much with China as Canada does with the US! This idea that islands are somehow LESS dependent on foreign trade is afactual, you can see it in the 2019 import/export figures. And people have been barred for US/Canada crossings for those reasons for months. And there's not a lot of Coronavirus coming from Canada... So really, what advantages does an island have?


It is a continent.

A primary landmass on its tectonic plate.

Plus it's connected to South America.


Not debating your point, but I want to point out that there is literally no overland travel between South America and North America because of the Darien Gap. If you want to get to the US from Bogota, you'll need to fly.

https://en.wikipedia.org/wiki/Dari%C3%A9n_Gap


I guess the key point is being an “island” is not enough when you have 300M+ people with huge amounts of intermingling, and the virus has already taken hold.

Australia and NZ were able to control their outbreaks (even then with great difficulty in the case of my state of Victoria AU) because the populations are much smaller and the virus was not widespread when the severity of the threat became apparent.


> the virus was not widespread when the severity threat became apparent.

It was pretty bad in Victoria and it was an impressive effort to get it back down. Not many places have achieved success like that. To me the key was the population and its leaders having the will to fight.


Yep, I lived through it.

I'm talking relative terms; our numbers were 50-100/day when they realised the problem was getting bad, and up to 700/day when we hit crisis point, but that's still lower than the figures that some U.S. and European cities had even back in March/April when the world was still yet to understand what was really going on.

And yep, I think what's happened here has been impressive, but we've had some factors in our favour that other parts of the world don't have.


I thought there was a ferry there, but it only operated for three years!

https://en.wikipedia.org/wiki/Crucero_Express


Contact tracing is working extremely well here in New South Wales. But we have very low incidence of virus in the community, sufficient to get useful early warnings when DNA analysis picks up virus in the sewage system.

So once you're down to low levels of incidence in the community, given a robust well organised system, efficient contact tracing does prevent the virus from spreading in the community unchecked.


Reference if anyone cares: https://www.abc.net.au/news/2020-09-08/why-pm-says-nsw-is-go...

They have done very good at tracking and locking down the few cases that get out, even with very low mask use in the general community based on what I've seen. People were sensible when it mattered most.


> Contract tracing hasn't worked at scale anywhere.

I am not sure this is true. At least some articles I read attribute the successes in many Asian countries to aggressive contact tracing and quarantining. You don't ask people kindly to self-isolate, you move them to hotels and quarantine them. You don't ask them to remember their contacts, you aggressively investigate them using every source of data available.

I think an argument can be made that Europe simply got it wrong in the details. In order to find less invasive means of controlling covid that respect privacy we ended up limiting freedoms much more and for longer.


Taiwan did ask people kindly to self-isolate at home in most cases, and it worked extremely well. Certainly a lot better than telling travellers returning from high-risk areas to go straight to work the next day, as the brilliant minds in charge did in some other places.


Asia results are from strict compliance to protocols across the population.


> In order to find less invasive means of controlling covid that respect privacy we ended up limiting freedoms much more and for longer.

There is limited freedom during a lockdown, but a short sharp one can lead to almost complete normality soon after. Short and sharp or long and drawn out?

The drawn out option would seem a dubious freedom. My perspective is heavily skewed by being in NZ and reading US and UK news.


Yep. People seem to think that more lockdown = worse economy. NZ shows the relationship isn't so simple. A stricter lockdown seemed to work better from both a health perspective and an economic perspective.


Asian and Italian strain were different covid strains.



“Anywhere” as in “the western world”?

Because contact tracing seems to work very well at scale in Asia.


I would say most specifically in the US.

It's a cultural thing. Asian cultures vary dramatically between each other (don't mistake Koreans, Chinese, or Japanese for each other -it won't end well), but they have one thing in common: They have a real sense of every person is part of a collective. Maybe it's because most Asian societies are quite crowded.

The US, on the other hand, has a real sense of everyone is an individual, to the point of actually considering people that follow rules and norms to be "sheeple" (see "antimaskers").

Europeans seem to be in the middle.


In the UK, and England specifically, another factor is ideology - vast amounts of money have been spent on outsourcing contact tracing even though the statistics suggest the result performance isn't very good. Meanwhile, local government run contact tracing has been really effective but seems to be starved of resources because they are public sector and therefore, apparently, must be bad at what they do.


Those comparisons are misleaidng and themselves the result of ideology - the local contact tracing and national contact tracing have different success rates in large part because they handle different kinds of contacts. Local contact tracing handles "complex" cases, which are generally things like workplace outbreaks where they have the help of employee records and attendance lists. National contact tracing handles all the other, less robustly recorded social contacts. I believe that in Canada, where all contact tracing is local, a lot of areas have recently abandoned tracing the kinds of contacts that are handled by the UK's national scheme altogether because they don't have the resources and it doesn't work well.


I found this informative. It is often the details that make the difference.


Contact tracing should not be the the responsibility of the individual, it should be the responsibility of the government (with cooperation of the individual of course). This is how Asian countries have succeeded at it. The US isn't even trying yet - I still don't think I can even get a rapid test where I live.


China is a full blown police state.


It isn't just cultural, it is also genetic.

The 5-HTR1A gene affects whether we more easily make relative versus absolute judgments. And this seems to be true for everything from the length of lines, to quality of life. The allele that is most common in East Asia makes relative judgements easier, in America it is absolute judgements that are easier.

Politically, having the relative form of the gene encourages more community thinking while the absolute encourages more individualism. This leaning holds within whatever society you're in. But when a culture is dominated by one form of the gene, it will naturally shift the entire society.

I learned this from pages 183-186 of https://www.amazon.com/Whos-Charge-Free-Science-Brain/dp/006... and I've wondered ever since how many of my opinions are reason (as it feels) versus genetics.


Scanning the Wikipedia page for 5-HTR1A, it looks like most of the studies were done in the first decade of the 21st century, when the candidate gene (https://en.wikipedia.org/wiki/Candidate_gene#Criticisms) approach was at its height, before it became known that many of these studies were statistically underpowered and thus likely detecting noise. So I'd be skeptical of any associations between 5-HTR1A and personality unless there's been recent follow-up.


That would make sense given that the book I read was from 2012. Thanks for the correction!


Spot on


Did it work at scale, or did it work because it was employed early enough (along with other strict measures) that it didn't have to scale much? The latter is my understanding.


Luck of choice, human rights, data protection and privacy, collectivist society and strong government enforcement bodies are prerequisites for a successful contact tracing. I guess that work much better in Asia than in the "western world".


Yes, because Korea, Taiwan, and Australia can all be defined by lack of human rights and a collectivist society.

And yet, just like China, they have also beaten the virus. Meanwhile, Russia has failed on all counts.

The West has the laws on the books, and the legal precedent necessary to enforce them, when it comes to epidemics. What it lacks is the political will.

It doesn't matter how effective these measures are, or how bad an idea it is to let the virus run unchecked - under it's current leadership, states like Kentucky will never do what is necessary to get the virus under control, because these measures are anathema to it's current regime. And states like Washington won't either, because while those measures are not anathema to them, their governments are afraid of a backlash that will replace them.

This wasn't an inevitable outcome - nothing fundamentally stopped bipartisan cooperation on this point. Political expedience and the desire to own the libs did. Had the right not used the pandemic as an opportunity to grab power, and start a culture war, we wouldn't be where we are today.


Just a nitpick, but Russia isn't a collectivist society. It's very individualistic in many ways since 1993.


Don't be partisan. The democrats pulled shenanigans too, like tacking on random stuff about green energy and international trade on the covid relief bill.


A Covid relief bill is not sufficient, or even necessary to stop Covid. Quarantine, lockdown, and widespread testing is. The bill just deals with some of the financial fallout.

And you can't blame the Democrats for choosing to make resistance to following best practices in disease control a wedge issue.

Don't equate the damage caused by 'a relief bill didn't pass because two parties couldn't agree on which pork could be added to it' and 'one of the parties is not following basic epidemic control practices'.


The financial aid is required in order to get public support for the lockdown.

Sweden squashed their cases down from a massive peak without any lockdowns or masks, but with a social welfare system that supported anyone who felt even slightly sick to stay home


"Contract tracing hasn't worked at scale anywhere."

It works 'at scale' in Taiwan/Korea if by 'scale' you mean 'large country' but yes, it does not work when there are many infected, it's best suited for when there only small numbers and the government can keep a lid on that.

But that's entirely possible. Remember that countries have local agencies and national numbers are not everything.

Ontario is only 12M people, British Coloumbia 5M people and they have active contact tracing of literally every patient.

So with 90% effectiveness, the numbers will be brought way down, and in many areas, the threshold of cases will be low enough that contact tracing can be enacted.

So about the 50 people - we have to basically still maintain a degree of isolation, and that's entirely possible.

We don't need to tell the grocery store workers to 'self isolate' because someone came into the store with COVID that's already happening, those are low-risk events.

During social isolation, people should absolutely not be contacting 50 people.

So masks, basic social isolation at very least (no unnecessary contact) can remain in place.


Covid would be over if everybody used a properly fitted respirator.

I stayed at home even before symptoms, I infected 3 adults and my daughter in my house.

It was only luck that the adults showed symptoms like myself on day 3 and day 3 was a Sunday and my test results came back that day.

Otherwise, they woul have infected others just like I infected them, before I showed any symptoms.


> Covid would be over if everybody used a properly fitted respirator.

AND gave up all human interaction. It is absurd to suggest that we should sacrifice civilisation for a virus


I'd happily give up all human interaction for a month or 2 if it meant that this annoyance wouldn't last an entire year like it has.

Also, we _are_ sacrificing civilization for a virus. Or at least 1.2 million people's worth of civilization…


That's a false bargin. People did similar universally do the above in many nations and it had little benefit. In turn they have lost and entire year. In turn that is the foundation of circular logic as above

> Or at least 1.2 million people's worth of civilization…

1.x million natural deaths with an average age of 82 years old, in the UK.


Contact tracing has been working in South Korea and many other countries from the beginning.


> Contract tracing hasn't worked at scale anywhere.

It's worked pretty well all over Asia.


It seems to be working here in New Zealand - we have an ongoing problem getting people to use the Covid app, but that just makes it easier, doesn't replace calling people on phones

Of course it helps to get the actual rate so close to 0 that the contact tracers are not overloaded


It worked really, really well in South Korea and New Zealand. Besides, that's just your opinion and epidemiologists agree that contract tracing plays a significant role in reducing the spread of COVID.


Contract tracing has worked at scale at South Korea for example.


> Mutations aren't a serious concern. Because when viruses mutate it's the strains that are more infectious and less lethal that win out

What if it has the contagiousness of covid but the long term lethality of hiv? The long term lethality would have low evolutionary pressure to be less harsh to its host as the implications only follow after many infectious years.

Is there anything fundamentally prohibiting the emergence of such a virus, or are we just lucky?


Virusses mutate all the time. What if a normal flu virus mutates and kills us all? There is no reason to believe that covid is more likely to become more lethal compared to any other type of virus.


> What if it has the contagiousness of covid but the long term lethality of hiv?

What if we get hit by a comet?


To me it's not so obvious that the probabilities are that low, thats why I was asking


What you're describing is not a false positive as it is usually used. A false positive is a test that returns a positive result when the person does not actually have the virus. What you're describing is that most of the contacts return a negative test (and don't have the virus).


Contract tracing worked in Vietnam.


It worked in a few countries that now have close to zero cases.


> Contract tracing hasn't worked at scale anywhere

In South Korea it did. They now have very few cases and deaths in single digits per day.


Except that contact tracing has worked at scale, in most countries of Asia, Africa and Australasia.


> Contract tracing hasn't worked at scale anywhere.

It's worked in South Korea


It's worked in Australia.


So how is the corona situation currently in South Korea?


It's different now - because of the strict quarantine requests, coupled with the knowledge that there's no known treatment/vaccine, coupled with the fact that you have literally tens of thousands of cases per day - means that people don't cooperate that much, and the system is already over-stretched.

Also, "hasn't worked at scale anywhere is false" - AFAIK it worked fairly well in South Korea, Japan, New Zeeland, China.


> I think we can eradicate it by contact tracing.

People (rightly, or wrongly) don't trust technology enough, after the reputation Silicon Valley has built and can't shed, around privacy.

I'm on an Android phone, and sure, Citizen and a local State app can do the contact tracing. But what's Citizen doing with that data? It also requires interactivity (another Silicon Valley favorite thing to do - call out for people to perform actions via alerts and notifications).

It's a lower bar for people to wear masks than to accept to use an app for contact tracing, if you were to compare the policy actions. Now, you can have the contact tracers call people, but how many spam calls do you get that you ignore? And phishing attempts? I received numerous texts from "the Democrats" with a person's name, urging me to vote, from all sorts of US numbers, and asking for a reply. To this day I don't know how real that is.

There are too many people to blame for this state of affairs, but the greed and competition for eyeballs are the definite drivers.


Some of the contact tracing apps collect full GPS history; some just use the BLE token exchange mechanism. Unfortunately, the former is the mechanism my state has chosen to roll out in their app.


Luckily, contact tracing can be done efficiently the traditional way, by gathering the contacts of an infected person that tested positive and contacting them manually.


But in a world of telephone scams and texts, how do you trust who's calling you and why?


The emergency alert system (which plays its own alarm tone) seems pretty trustworthy.


Maybe, but it doesn't sound targeted? I have no idea how it works in that back end, but I've never heard of emergency numbers being specific to individual phone numbers.


> If it mutates as efficiently as flu, it will be a challenge.

It doesn't. Coronaviruses have a proofreading protein which prevents significant RNA changes: https://www.cell.com/molecular-cell/fulltext/S1097-2765(20)3...


Corona viruses cannot mutate as efficiently as flu. They are very different beasts.


17 million mink culled in Denmark for mutated Covid which was passed on to humans.

https://www.reuters.com/article/us-health-coronavirus-denmar...


"as efficiently"


This vaccine targets the entire spike protein. It is very difficult, from an evolutionary point of view (very high affinity for the ACE2 receptor), that the spike protein would change so much that the vaccine would be completely ineffective.


So why are they slaughtering millions of animals, on the basis that any mutation might reduce the effectiveness of a vaccine? If you're right then Denmark is engaging in mass cruelty to animals on an epic scale.


They slaughter 80% of a given mink farm stock every year for their fur anyway — after raising in horrifically unpleasant stacked, cramped, caged conditions which are ideal for disease spread, mutation and recombination with coinfections.

Sweden already has around ten detected SARS2 outbreaks on mink farms and is planning not to cull the entire population for the above harvest cycle related reason; the survivors will have ‘more space to socially distance’ and a ‘resultantly lower herd immunity threshold’.

Dense factory farming of all kinds is a biohazard nightmare.


I believe the mass cruelty was farming minks on a massive scale. Culling them is likely merciful in comparison. Never mind the fact that I'd happily trade 10 million minks to save a few human lives.


I think both are mass cruelty. The way we treat animals is the slavery of our time, if not much worse.

We keep using words like "cull" instead of "kill" or "mass murder", as though it's not killing if the animal doesn't look like us. Just because you're more intelligent or more capable than a different kind of animal, that doesn't mean that your life is worth more than theirs. And it definitely doesn't mean your life is worth millions of times more than theirs.


>The way we treat animals is the slavery of our time, if not much worse

The woke police would like a word with you lmao...

>Just because you're more intelligent or more capable than a different kind of animal, that doesn't mean that your life is worth more than theirs

What kind of rinky dink PETA argument is this? If you have kids I hope you explain to them that in an emergency you are likely going to save the dog and not your child because "your life isn't worth more than the dog's."


[flagged]


No. It's addressing a nonsensical claim in the parent comment. It is relevant in the context of that comment. And it's no more an appeal to emotion that the original comment was - which is to say not at all.


You do understand the end state of effectively all animal farming is slaughter - right? This culling does absolutely nothing to make an already incredibly cruel process any more cruel.


As if their life in small cages wouldn't be cruelty enough.


That doesn't make it a rational act. Welcome to the zero risk society.


Flu has a unique capability to recombine that allows it to mutate more readily than other viruses. Hoping that the more simple coronavirus will be less fortunate.

https://en.m.wikipedia.org/wiki/Antigenic_shift


Ability to recombine is not unique to the flu. SARS-CoV-2 is suspected to have been formed through a recombination event in vivo. [1] Mutation rates can also be manipulated through selective pressure e.g. vaccine-based herd immunity. For example, a vaccine-resistant polio virus has recently emerged. [2]

[1] https://advances.sciencemag.org/content/6/27/eabb9153 [2] https://www.sciencedaily.com/releases/2014/11/141104111408.h...


The comment you respond to states "more readily." This is undoubtedly true. Influenza virus is designed to recombine at every single replication cycle. Coronaviruses as a whole do not do that. We have a lot of data on coronavirus mutation rates and they are dramatically lower (1000x) than influenza. The point is not that mutation/recombination can't happen (it can and will happen), it is just that this mutation/recombination is relatively rare and we will not get the standard twice-yearly seasonal flu effect where we have to tweak the vaccine every year.


Influenza undergoes recombination seemingly exclusively through reassortment whereas betacoronaviridae undergoes homologous recombination -- but to think of the latter as much less effective at producing genetic diversity may be incorrect.

> In fact, there is evidence of at least seven potential regions of recombination in the SARS-CoV genome in the replicase- and Spike-coding regions, with possible recombination partners that include porcine epidemic diarrhea virus (PEDV), transmissible gastroenteritis virus (TGEV), bovine coronavirus (BCoV), HCoV-229E, MHV, and IBV [1]

> Unlike other viruses that have emerged in the past two decades, coronaviruses are highly recombinogenic. ... For coronaviruses, however, recombination means that small genomic subregions can have independent origins, identifiable if sufficient sampling has been done in the animal reservoirs that support the endemic circulation, co-infection and recombination that appear to be common. [2]

> Recombination seems to be rampant in HCoV-OC43 viruses and contributed to originate the A to E viral genotypes, as well as viruses that do not belong to these major genotypes. [3]

Unfortunately, nature doesn't "design" anything, it's just the consequence of natural selection and fitness of new generations. While the mutation rate might low compared to influenza, the mutation rate is very high compared to something like a prokaryote, enough so that there's an article entitled "Why are RNA virus mutation rates so damn high?" We've already seen a gain of function mutation creating enhanced infectivity and a recombination event involving ferrets, so it's not a stretch that we might see a new more of this in the future. Whether or not it will impact the toxicity of the virus or whether or not its susceptible to a vaccine is up in the air, but once an effective vaccine exists strong selective pressure will be placed on versions of the viruses that evade it.

[1] https://jvi.asm.org/content/84/7/3134 [2] https://www.nature.com/articles/s41564-020-0771-4 [3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7111218/


Check out Figure 1 of your cite [3]. Of course mutation rate is high compared to a prokaryote. The point is that coronaviruses (as proven by Fig. 1 of [3]) do not have a high mutation rate for an RNA virus. Indeed, the mutation rate is much lower than influenza.


> a vaccine-resistant polio virus has recently emerged

A perfect example of why we won’t be able to eradicate Coronavirus. Polio was an easier target with stronger reasons to wish it gone, and we have failed.


Yup. But we do need the government to step in and do this (contact tracing etc.). Hopefully, with the new administration...


I wrote a post about it above. I live in the bluest of blue states, which in the other comments here, in that narrative, you expect cooperation and all this stuff. A false media narrative, if I do say so, but that's not the point - the point is no one trusts the folks behind the technology, nor do we trust random phone numbers.

So the Citizen App has contact tracing. But you have to check into the app, and furthermore, do you trust some private company with the information? About you? Your location and all this ? And contact tracing via government calling you - do you trust random numbers calling you and asking you questions? No one knows when Silicon Valley (in the case of the app) wants to steal some more of your private data, and no one knows when some phisher is phishing as opposed to some volunteer calling you up for contact tracing.

There's a breakdown of trust.

Oh, and saying, 'maybe this administration' is further evidence of that. I live in a blue state, and your perceptions are, I believe, wrong, about the magic around that or the cooperation of the citizenry.


Exactly this. I'm not installing anything on my phone, and I don't answer phone calls that are not from my contacts. I've never been tested because I don't trust the testing companies.

If I'm sick, I'll stay home. I wear a mask where I'm required to. That's the limit of my participation in this hysteria.


Well over 250,000 dead Americans with over 100,000 new cases per day and your word is "hysteria"? I'd rather use the word "crisis." In a bad year the flu kills 61,000 here. We're over four times that now and with no signs of slowing down.

And I'm really not sure what there isn't to trust about the testing companies.


I'm not that extreme. I'm happy with being tested, and I'll be happy with vaccines and so forth.

It's Silicon Valley and its entire "you signed an agreement, you belong to us" morality and "get your attention span" business model that I distrust. Well, that and phishing phone calls/texts (I seem to get those regularly, after all this time).


I assume you're talking about the US.

My belief is that contact tracing is a cultural non-starter here. There are people who protest with large, semi-automatic rifles because they don't want to wear masks inside private businesses.

There's absolutely no way they're going to trust a contact-tracing process championed by the government, even if there's no way for the government to access the data.

I suspect much of the population will continue to ignore the virus and winter weather will cause a spike that will cripple hospitals.


They don't mean make sure everyone is comfortable with it. They mean by force via executive order and penalty of fines or imprisonment. If people don't want to obey they will make you obey and a large part of the country thinks this is a great idea.


Please don't push false narratives here. There has never been a mention of an executive order, let alone fines or imprisonment.


Are you kidding me? Its all over the news. Have you read a single article since the election? Literally every single article is talking about the executive actions he's going to take. And the consequences for violating an executive order are fines and imprisonment.

Maybe they should compare your throwaway account Ip with the rest of the account ips and see if this is a sock puppet account.

Select ip_addy as source_ip from account_log where account_name=throwaway4220 join account_log on ip_addy=source_ip

Ban you.

Please stop pushing your fantasy narratives and puppet accounts here please.


This will never happen, no matter how much you want it to. Nobody but isolated pockets of extremists think this way.


It appears one person's "extremism" is another person's "wisdom". If you've ever worked in state/federal government you'll get the sentiment. Sure it's speculative, but definitely not extremist.


I'm screenshotting this comment.


Why? Sounds hostile and isn’t additive. Go ahead, flag. I am not the throwaway account you commented under.


If you don't mind me saying, Nick is just claiming your comment won't age well.


I forgot comments can't be deleted from HN.

I'll be responding to you early to mid 2021 with a link to an article about Bidens executive order for a mask mandate.


Our rate of transmission is too high to do a nationwide contact tracing effort I think. We need to reduce the daily number of cases before we properly implement a contact tracing program.


Perhaps a better way to say this: we need to implement a national contact tracing program immediately so that when the transmission rate declines to manageable levels it is operational.


This disease will never be "eradicated" and it is not helpful to use that word to discuss policy decisions. Sars CoV-2 has numerous animal reservoirs and an incredible transmission rate. It will never be gone from this Earth.

We will get vaccines and we will come up with better treatments negating its effects, but this coronavirus is here to stay. It will be a fifth endemic human coronavirus.


There are a lot of coronaviruses and all tend to become mild overtime. In 1800, Influenza killed thousands of people daily. This endured through the 19th century,

Coronaviruses also have plagued humanity in the same way, for instance look up “bovine coronavirus”


Case in point, these poor things ...

"Denmark to cull millions of minks after mutated coronavirus spreads to people"

- https://www.euronews.com/2020/11/05/denmark-to-cull-millions...


Only time will tell. At the beginning of the pandemic the strategy was to simple hold out until a vaccine is found (Which is the strategy developed for influenza). Doing lockdowns reducing the infection rates to almost nothing or even eradicating it in some countries was seen as impossible. Yet that’s exactly what we did. I think eradication is possible.


Can't believe I had to scroll down this far to find this - but this is exactly true. Since the virus has a non-human animal reservoir that means that even if every human receives the vaccine, all it takes is re-transmission from the animal reservoir back into the human population after the immunity period expires.

This means we'll probably have to receive Covid vaccination on a regular basis along with the flu vaccine in order to maintain a permanent broad-scale immunity. At least until we have a radical new treatment for this family of viruses that can confer a "permanent" immunity - something that for now is in the realm of science fiction.


This is 90% protection against disease, not necessarily 90% protection against infection. There's an important distinction:

* Protection against disease means that you don't get sick. You may still contract the virus and spread it to others (the Salk vaccine against Polio works this way).

* Sterilizing immunity means that you can't even get infected, so that you can't pass the virus on to other people. It does not look like there's any information about sterilizing immunity in this press release.

Importantly, this means that even with this vaccine, the virus may still be able to spread, and only vaccinated people will be protected (i.e., no herd immunity).


> Importantly, this means that even with this vaccine, the virus may still be able to spread, and only vaccinated people will be protected (i.e., no herd immunity).

Can't we still hit herd immunity as a byproduct of this though? If everyone can pass it along without symptoms, then eventually everyone will have it...


Herd immunity is when people who are not immune are protected by other people's immunity.

If enough other people have sterilizing immunity, the virus doesn't spread, and the susceptible people are safe.


Without sterilizing immunity, will the amount of virus a vaccinated individual carries match that of a non vaccinated individual, though? I guess what I (a layman) is asking is, even if the vaccinated individual contracts the virus, won't they spread less of it than someone truly sick?


Someone truly sick is likely to isolate at home, due to the social stigma if nothing else. Someone who is asymptomatic may continue as normal, spreading the disease more easily.


It depends on the virus and the vaccine. We'll have to wait for further data on this vaccine candidate.

The Salk polio vaccine does not prevent infection in the digestive tract, so you can still spread the virus, but it does prevent the virus from spreading beyond the digestive tract and causing paralysis. You could imagine something similar happening with a SARS-CoV-2 vaccine: that it would block infection in the lower respiratory tract but not the upper respiratory tract, allowing you to spread it by coughing and sneezing while never getting severe respiratory issues.


Contact tracing might work really well with a submissive populace. We don't have one.

Said another way: I don't think voluntary contact tracing will work in the U.S. And I don't think you can implement involuntary contact tracing in the U.S.


Contact tracing: must be required. I work someplace where we have been grappling with the legality of telling coworkers about infected colleagues (when exposed)—the government needs to create liability for failure to inform others as opposed to threatening liability for over sharing!

If I’m wrong, PLEASE provide a .gov link and I will personally make sure that our large academic org pulls out of reverse, and into first gear!


It can’t die out on its own. Animals are getting infected by it, meaning it will be around forever. But as long as we can tolerate it, that’s all that matters.


Animal reservoirs make it harder but not all animal reservoirs have as big of an effect. Birds don’t seem to be able to get infected which already is a very good sign.


IIRC there have been infections that had animal reservoirs and still were eradicated.


> 90% efficiency reduces R so much

You’re assuming 100pct of the population takes the vaccine. I’d be surprised if it’s more than 50% the first year


Can only make 1.5b doses in 2021, and 2 does/individual required, which is 750m individuals out of a world population of 7.8b.

Less than 10% can get it I the first year.


I haven't seen much chatter about it, but this will only be prescribed for adults (18+) correct?


Yes, and only/primarily/first at-risk groups, incl. at risk to themselves or others because of workplace in healthcare/residential home/etc. - but nothing firm I don't think.

https://www.gov.uk/government/publications/priority-groups-f...

We're still months away from all 20M (of a >60M population) people that vaccines have been ordered for being administered with them, (BBC reports 'up to' 10M doses 'may' be 'delivered' this year, i.e. 5M people max) so I suppose they still have plenty of time to decide the most effective pecking order.


I would assume the trials in kids will start soon. Though today I haven't heard of them so far. (kids are hard to test because each age reacts differently)


> With 90% efficiency it will be extremely tough for the virus to spread

Aren't you assuming 100% coverage at 90% effectiveness?

What if it's - say - only 50% coverage, at 90% effectiveness. That's not looking so good.

I'm still trying to understand why an otherwise young and healthy person would want to get take one, or more likely multiple, shots of a C19 vaccine, given the risk from C19 is so low. What's the benefit to them?

In HN-speak: how well does a C19 vaccine deployment scale?


There are long term complications from contracting the virus


To return to a less paranoid culture is reason enough. The possibility of international travel. To prevent the spread to the vulnerable.


That will work in Europe, it will never go over in the USA people are very averse to being tracked or giving up privacy or health information.


To continue this... I don't think the flu vaccine is nearly 90% effective. I am pretty sure the flu vaccines hover around 60-70% effective. A 90% effective vaccine would stop the spread drastically to the point where it might just stop it wholesale. in addition the virus envelope is so fragile that it won't stay in the environment for more than a few days compared to something like the norovirus that can last for a long time on surfaces(iirc) because of a lack of a fragile lipid enclosure.


Measles et al never died out, despite very aggressive, and for years successful vaccination programmes (thank you anti-vaccesrs for messing that up).

But even if we all need to get vaccinated once a year, for a 90% immunity, that sounds manageable. So good news, if it all holds up.


Measles is also famously contagious, with R values on the order of 3-6x higher than COVID-19.


Measles was eradicated in the Americas. Wasn't until an antivaxer brought it back from Europe we had an outbreak.


Which is another way of saying, it wasn't eradicated.


It's not possible to totally eradicate a virus that has animal reservoirs. The virus apparently jumped from bats to humans once before so it will probably happen again. We can't vaccinate all the bats.


Why not?

What if we can? How would we do that?


Because it's cost prohibitive to find every animal on the earth that has the virus and medicate or eliminate them.


Humans already eradicated a disease (I think it was a virus). It was done with a vacine of an altered version of the virus. The vacine itself was a virus which could infect others and spread among the population.

So, you don't really have to find every animal. Most should be enough.


There have been efforts to put vaccines into treats that various animals would eat. However not all vaccines can be delivered in this way, and even of those that can, getting the right animals to eat them is tricky.


It is fairly efficient with rabies. Aside from bats, most European wildlife is now rabies-free. But to pull this off worldwide is not realistic.


> We can't vaccinate all the bats. It is possible. It isn't "vaccination" as we traditionally know it but there are gels that take advantage of bats' grooming behaviour. Put gels that kill virii on some bats. Other bats groom these bats and the gel(s) get(s) into these bats [0]

[0]https://www.ted.com/talks/daniel_streicker_what_vaccinating_...


If you get the vaccine then get infected I wonder for how long you will be spreading it to others while you don't show any signs of virus.


I'm not sure about this vaccine, but it is a real possibility with other vaccines.

The injectable vaccine for polio stops the symptoms, but it doesn't stop the propagation of the virus from person to person.

The oral vaccine for polio also stops the propagation (that is better) but it is a live virus that can escape and produce polio in other unvaccinated persons (that is bad).

[So the current recommendation is to use oral version when polio is endemic, the injectable version when there has been no cases for a few years, and a mix of them in between.]


That's not how vaccines and viruses work.

Normally when you get infected you get small number of viral particles in your system. Those then hijack your system to create more, and those new particles spread to other people through sneezing etc. In time your immune system learns how to recognise and kill the virus and eventually removes it from your system.

Now let's say you get vaccinated and you get that same small number of viral particles in your system. Your immune system will already know how to recognise and kill the virus, and immediately starts doing this. It doesn't multiply in your body, so it can't spread to others either.


I think we can control it well with a vaccine and contact tracing. But though this is not my area, I've heard experts say that "eradication" is unlikely, in that we've still only actually eradicated one human viral disease. But if covid-19 was well enough controlled that most of us wouldn't come across an infected person in normal life, or need to think about it for months or years at a time ... I think that's good enough for most of us to think of it as "gone".


>we've still only actually eradicated one human viral disease

SARS-CoV-1 was eradicated.


It seems that this is a subject of debate among experts. From what I understand, the disagreement is over when we can say that a reduction in cases to zero is "permanent" if animal reservoirs still exist.

> To date, the World Health Organization (WHO) has declared only 2 diseases officially eradicated: smallpox caused by variola virus (VARV) and rinderpest caused by the rinderpest virus (RPV).

> Although successful containment strategies eliminated transmission of SARS among people, the continued presence of an animal reservoir means that SARS is not yet an eradicated disease.

https://asm.org/Articles/2020/March/Disease-Eradication-What...

> ... the 2003 SARS epidemic was permanently reduced to zero as a result of deliberate efforts, requiring no further intervention methods. This is precisely the definition of eradication.

https://biomedgrid.com/pdf/AJBSR.MS.ID.001017.pdf


it's a mRNA vaccine and a lot easier to change in case of a mutation


Except people like me refuse to participate in contact tracing and will actively evade it.


What are your fears exactly?


This is incorrect. They tested SARS patients over 17 years later and they still exhibited an immune response. As long as SARS-CoV-2 doesn’t mutate dramatically the body probably has long term immunity.


There was some response. Was it sufficient or not - it has never been verified. Attempts to vaccinate animals with SARS vaccines ended with terrible outcomes of ADE.


You’re talking about a vaccine, which was never successfully created for SARS. I’m talking about immune response from those that contracted SARS and recovered. You can’t compare a failed vaccine to actual survivors.


What I am saying is: 1) No one tried to check the suffiency response by attempting to reinfect the person, because that would grossly unethical; unless there was such attempt, we cannot say anything about the reponse, it even might have been cross-reaction from common cold antibodies 2) Even if there was the response, there was high chance of ADE. It does not matter was that immunity acquired through vaccination or natural infection; ADE does not pick and choose; weak immunity causes worse response than no immunity. Having said that, SARS-CoV-2 does not seem to produce ADE.


This vaccine is against the entire spike glycoprotein. Some in production vaccines are only against the RBD (the protein that actually latches onto ACE2). There are variants out there that have been shown to escape RBD antibodies. However, since this vaccine encodes the entire spike, there are other areas that antibodies can bind to. They stated in their press release that the vaccine elicits a Th1, CD4+, and CD8+ T-cell response against both the RBD and other areas on the spike. I think this is the most promising aspect. This means it should hopefully be effective against even escape variants.


Can you tell me why I shouldn't worry that vaccines which are made to flood the body with fake ACE2 proteins won't affect blood pressure, body water and sodium content? What happens to all the angiotensin II that connects to dummy ACE2 connectors?


I haven’t seen what you’re describing. I’ve seen hrsACE2 which is recombinant ACE2. That will both provide a target for the virus to latch onto as well as supplement the body’s actual ACE2 to complete the cycle which seemed to be more of the focus.


>vaccines which are made to flood the body with fake ACE2 proteins

There is no such thing as a vaccine that floods the body with fake ACE2 proteins.


That's a therapy being worked on, not a vaccine.


I'd happily take a shot a year for a decade in return for getting rid of lockdown.


I am very curious if the adenovirus carrier candidates can even be used for a booster at all.


It's an interesting question, especially in light of the fact that the leadings viral vector candidates require a booster shot after the initial vaccination except the J&J candidate.


Let's not forget that we can start with this vaccine, get life back to normal and then buy some time to develop better vaccines.


s/a decade/in perpetuity

We'll almost certainly need an annual covid vaccination for the same reasons we get annual flu vaccinations - with our current medical technology we can neither rid the planet of the virus nor obtain permanent immunity.


Sure, that works.

I didn't get flu shots in the past mostly because the shot hurts more than the flu, but COVID is another animal and pretty scary. Maybe they could be combined into a single poke.


We'll almost certainly need an annual covid vaccination

In fact we have no idea how long this vaccine or any other [of the experimental covid-19 vaccines] will last for. They've got projections out to at least a year, but uncertainty becomes too great after that. It may last quite a long time, we don't really know.

for the same reasons we get annual flu vaccinations

No. We get annual flu vaccinations because flu viruses mutate significantly and quickly, so we're always getting vaccinated against new threats. Not against threats that we've forgot how to defend against.

[edited to clarify that the uncertainty is around the experimental vaccines; for old standards, we do have a very good idea]


> projections out to at least a year

You're right - I should have said "periodic vaccination", not annual.

Also yeah, there's a subtle difference between why we'd need periodic covid vaccinations vs flu vaccinations. But in the end the result is the same, we'll probably need to be re-vaccinated against covid over time.

Covid isn't going away because it has a non-human animal reservoir, so it's all about a strategy to prevent it's re-emergence into the sapiens reservoir. It's possible that periodic vaccinations of the population as a whole would be overkill and we could reactively immunize smaller populations as re-infection occurs.


Another interesting open question is what's the "failure mode" as our immunity wears off. Do we become vulnerable to the full danger again? Or can we expect to contract the virus again, but this time the body will be better able to jump to defense quickly, making the most severe cases less likely?


Right, we're about 8 months from the first recovery, so that's what's known. As time goes on, that number may increase.


That is immunity after illness, isn't it? I would not be sure you can extrapolate that for immunity after a specific vaccination. The vaccine from Mainz / Mayence for example trains your immunity by introducing just parts of the shell / shell dna / rna. Could work even better for immunity or worse, one has to study that for every vaccine seperatly, I think.


Just to clarify, what you're saying is with respect to an actual infection, and not the vaccine, right?


Where is the preprint?


Also not so good: this is a corporate press release. The data will come later.


The results came from the independent data safety and monitoring board that is analysing the trial results on PFE/BNTX's behalf. PFE/BNTX themselves don't currently have access to more data. But there is no reason to suspect that these results are not accurate.


At least this one has a decent looking 'n' value. The BBC also address this in part

> There are still questions - how long does immunity last, does the vaccine work as well in high-risk elderly people, does it stop you spreading the virus or just from developing symptoms?

I'd rate the news as "vibing" on a scale of clickbait to party for the world


The current n=94. The real n=43.5k data apparently will come later. Article doesn’t specify when, but “hopes” to have enough of the larger n analyzed to submit to regulators by 3rd week of November.


No, 43.5k is the number of people in the trial and 94 is the number of confirmed COVID cases within the entire population.

The trial will be complete from an effectiveness perspective once there are ~150-200 cases.

Safety is a different story and may take more time to wait for side effects.


Thankfully safety is looking pretty good according to the press release. However I look forward to reading expert analyses of the actual data to confirm.


> However, the data presented is not the final analysis as it is based on only the first 94 volunteers to develop Covid so the precise effectiveness of the vaccine may change when the full results are analysed.

Thanks! Misread the 94, but the n=43.5k is also misleading since they have not analyzed all of the results and duration of the study vs exposure risk is still tbd. If the 94 participants that got COVID also abided by all the other precautions, such as masks, etc, then it stands to reason that the actual infection rate in the population approximating pre-covid behaviors may also be higher.


To be clear: 94 out of 43500 people in the trial got covid, and if the vaccine is rated at > 90% effectiveness, that means at least 85 of those 94 people were in the placebo group, and less than 10 people were in the vaccinated group.


Does it say how many people got the real vaccine?


FWIW, N=94 seems ridiculously small to me. I realize there's ethical concerns in increasing exposure etc but in my experience, that's in the ballpark of sample sizes where unacknowledged heterogeneity can be manipulated to distort findings.

I'm not suggesting Pfizer is up to something nefarious, just that the biomedical literature is littered with studies with N < 100 for the outcomes of interest and they don't replicate. The N > 40k in some ways is irrelevant if none of those participants have the processes in play. It's more like recruiting N >40k to get N=94 to study.

I'm also not suggesting with 90% effectiveness that there's probably no effect, just that my guess is a true value of 60% isn't outside the realm of possibility once you consider all the factors that could be in play besides the random sampling variation that's assumed by their tests.


Seems fine to me. 85 people from the placebo group caught covid. If the vaccine was completely ineffective you'd expect roughly the same number in the vaccinated group. The actual number was 9.

What you're saying is the 9 is pretty close to 34 (60% effectiveness). No, it isn't. You'd need to quadruple the number of vaccinated cases to get there. Even if you double them, you're still at 80% so I'd take that as the realistic worst case.

Edit: Also, this is BioNTech's vaccine, not Pfizer's. They partnered with Pfizer as they have the facilities and scale for a massive rollout, but it was developed by BioNTech. I wish they were getting more credit in the US & UK coverage.


Judging from other threads these trials have been independently reviewed, so it appears it's not "just" a press release.


> these trials have been independently reviewed

That's how clinical trials are done.


Yes, but in other cases there have been "independent" reviews that weren't really independent, e.g. test makers who did their own test validation but got academics to do the writeup ... who worked at the university the manufacturer was spun out of. There's a lot of bad behaviour going on right now in the scientific world that would normally not be tolerated, but standards have dropped lot in the name of speed.


That seems wrong. The data probably came first, but in less popular publications.


-80C is dry ice (frozen CO2) temperature. So you can carry vaccine vials around in a cooler with a block of dry ice. Pfizer has a dry ice shipping container good for 10 days. FedEx can ship that. Then the vaccine can be stored at refrigerator temperature for maybe 5 days. Dry Ice costs maybe $3/Kg.

The SF bay area has dry ice delivery.[1] Lagos, Nigeria has dry ice delivery.[2] Bismark, North Dakota has a dry ice plant.[3] It's not hard to get.

Coolers for holding items in dry ice are about $100 on Alibaba.[4]

This doesn't look like a big problem.

[1] https://bensdryice.com/

[2] https://www.businesslist.com.ng/company/256889/greatsmith-re...

[3] http://www.dryiceweb.com/Praxair/Bismarck_ND.htm

[4] https://www.alibaba.com/product-detail/Vaccine-Carrier-Biome...


It's still more difficult and expensive than the alternative.

It's not a big deal for the first world, but poorer nations may hold out for future vaccines that remain stable at higher temperatures and only require a single dose.


Base technology first, then convenience features.

Merck is working on a one-dose pill, but that's not expected before mid-2021.

There's micro encapsulation for vaccines.[1][2] The vulnerable active molecule can be put inside a coating that is stable in storage but dissolves after injection.

[1] https://www.academia.edu/33376119/Microencapsulation_of_Vacc...

[2] https://www.sciencedirect.com/topics/immunology-and-microbio...


>but poorer nations may hold out for future vaccines that remain stable at higher temperatures and only require a single dose.

Valid point, but I feel there's never been a better time for massively pushing this vaccine (after proper testing and regulatory approval, of course) to medium/low income countries.

Winter should make it much easier in managing the temperature range stability required for storing/shipping the vaccine, especially in countries around the equatorial region.

Doing it in late spring/summer will not be a good idea (assuming a better vaccine doesn't come out by then).


By late spring/summer you mean midwinter in the southern hemisphere.


Having something is different than having something at scale and being able to effectively implement it. Logistics in less developed countries is already more difficult. Adding in specialty refrigeration requirements further complicates that. Large scale logistics should never be assumed or hand waved away. Mass toilet paper shortages in first world countries this year is a perfect example of how easy it is to massively disrupt logistic chains. What do you think shipping 100 million plus vaccines a month that require specialty refrigeration and dry ice will do to the supply of dry ice in Nigeria or Albania? Or the US for that matter? How many of those dry ice shipping containers does Pfizer have? How quickly can they be manufactured?


How many of those dry ice shipping containers does Pfizer have? How quickly can they be manufactured?

That's a big issue. The N95 mask shortage demonstrates that the US manufacturing industry has far less surge capacity for simple items than previously thought.


This is good news but I'm worried about the mutation already showing up in minks in Denmark. Minks apparently have a near identical respiratory system.

https://www.nbcnews.com/news/world/denmark-plans-kill-15-mil...



The tweet doesn't mention the claim of antibody resistance, and the article just says that the evidence for it is yet to be announced. The article says that no single mutation is likely to cause resistance but doesn't explain why there would be only a single mutation.

I am yet to be reassured.


Yet another reason to move to a plant-based lifestyle. Covid came from some folks in China using exotic animals for some purpose. Now a new variant seems inevitable from animal populations. Is it worth the burgers and coats?


You're being downvoted for no good reason. Mass farming is what brought us here. This will keep happening, unless we change our behavior.


Wet markets and mass farming are two different beasts


Are they though? Mass farming puts humans into orders of magnitude more contact with animals than wet markets. In the case of covid, a wet market led to the disease. There are plenty of cases — just about the majority of plagues — where a domesticated animal led to disease


In some ways the dangers are different, perhaps more manageable in some cases. For wet markets, it's the unknown from nature. In the case of Domesticated markets, it is more typically an issue either from failures in procedure (i.e. e.coli/listeria/salmonella) or because of over-industrialization (Mad Cow Disease)


[flagged]


The true origin isn’t known. Maybe escaped from a lab, we don't know yet.


And maybe it was aliens, we don't know yet. But it's not really helpful to suggest random theories without a shred of evidence on the off-chance that they might be accurate, because that rabbit hole has no bottom.


People have really overacted to my comment. It’s also “not helpful” to just dismiss the truth.

Without China cooperating and trying to save face, we don’t truly understand the origin of this virus and how it initially spread so well.

I responded to a post that said “we need to go plant based to avoid these things happening”.

Well going vegan won’t do so any good if this was released from a laboratory?


Fortunately it sounds very contained. All cases (fewer than 15) were confined to a single location and there haven’t been any more detected since September. So most likely the mutation is now extinct.


Let's see how this comment ages. I give it 50-50


I’m not saying anything with certainty. However, a lot of work has been expended in trying to contain this cluster and currently this is how it looks with the data we currently have.


It's not just this cluster though. If it happens once it could happen again and we may not notice the next until it's too late. So here's hoping the vaccine catches all likely mutations too...


Hence the genociding.


The minkocaust :'(


In my opinion this sounds extremely good. They say that 94 people got covid. We do not know how many of them were from the placebo group and how many were from the vaccinated group. But the wording "was found to be more than 90% effective" probably means that much more than 85 of the covid-patients came from the placebo group. The reason is that they need to be a few standard deviations away from the mean to make such assumptions with high probability. I think probably at most 2 patients of the 94 covid-patients came from the vaccinated group (only then you could make such a statement with high certainty). And that means that probably the vaccine is more than 97% effective. This would be extremely good news. But let's wait for the data.


Fortunately, it isn't the only vaccine in the pipeline. Curevac, another German company located pretty close to BioNTech, is also working on a similar vaccine which can be cooled in normal fridges, so is easier to roll out. They supposedly are only a few months behind. The -80c storage should be no showstopper for all densely populated regions and these are where the vaccine is most urgently needed. Over time, there will be easier to handle alternatives or we just build more deep-freezers.


There's many vaccines in development, even some to be available as nasal sprays and oral vaccines. I'm hopeful that by the end of this year, we'll get 1 or 2 more vaccines successfully completing Phase 3, and then several more in 2021.


About the logistical part. Wendover did on Youtube a really great video explaining the cold chain in international shipping and what companies are already doing to be ready for it. https://www.youtube.com/watch?v=byW1GExQB84


-80C storage is an issue, you are definitely right, but it is a common requirement for many biological samples and protein-based drug therapies. -80C lab freezers are not that expensive and all over the place. I used to work in biotech and, at one company, all of our intermediate drug substance storage was -80C. we had freezers big enough to drive a forklift into; one such a freezer could store millions of doses... and we had several.

There are numerous companies which specialize in -80C transport and shipping. These containers can be used as temporary (3-7 day) storage at destinations where they do not have infrastructure.

So this vaccine can be distributed to regions with the infrastructure to store it and we can preserve vaccines with less stringent requirement for developing countries, etc.


Why, biologically speaking, does it need to be that cold? I'm guessing something breaks down at higher temperatures?

(That's -112 F, for anyone else wondering.)


It’s an RNA vaccine. RNA degrades at room temperature.


Yes, but why that low?


Because it degrades at higher temperatures.

They do stability studies on these molecules, holding samples at different temperatures and measuring how much "is left" after a period of time.

This particular RNA sequence and carrier might be particularly unstable, so it require -80C if you want it to last longer than a few weeks.


Because RNA is not a stable molecule. At lower temperatures, it's less likely for a given bond to reach the Gibbs free energy of activation, thus preventing degradation.

In a biological context, the vast majority of RNA use falls within the 'central dogma' of DNA -> RNA -> Protein. It is merely an intermediate, albeit one with important and complex regulatory processes.

In RNA viruses and other contexts where stability is required, the RNA is stabilized by its environment, namely by associating with special proteins.


Is that literally 1.5C colder than dry ice?

If that temperature could be obtained with dry ice, that would simplify things a bit. But AFAICT dry ice sublimates at -78.5C.


Could you name some of the companies? Are any of them public?


> There are numerous companies which specialize in -80C transport and shipping. These containers can be used as temporary (3-7 day) storage at destinations where they do not have infrastructure.

But what kind of capacity can they handle? I imagine the scale of a Covid vaccine rollout would overhelm prior existing infrastructure


There are a lot of other things that need this treatment. There is also limited ability to make doses. If you don't already have the infrastructure in place, then you will get notified when you shipment is arriving, and you get a few days to administer it. You schedule everyone who will get a dose for their shot and they are in and out quickly. If it takes more than half a day to use up their entire shipment it is because some dosages are reserved for 3rd shift and will be administered 12 hours later. Then repeat 3 weeks latter.

Of course larger institutions already have everything in place and will get shipments with less warning (but they will also get smaller shipments since they don't have to get everyone done at once)


> -80C storage and transport needed. Challenging, but doable in developed countries, but still may slow down mass rollout. Not feasible in many developing countries.

True but it's also a bit more complicated than that. The YouTube channel Wendover Productions has a great video on the subject: https://www.youtube.com/watch?v=byW1GExQB84 (skip to 5:01 for the talk about the cold chain).

TL;DW, there are other factors:

- Whether the hospital is able to maintain the vaccine at the required temperature (many, especially the smaller ones, don't have the equipment)

- This is medical technology and unproven options (like buying a random box off Alibaba like someone suggested) are unlikely to be used

- Pfizer (vaccine in TFA) has developed a shipment container that uses dry ice and lasts 10 days but it can only be opened twice a day, for less than a minute at a time, so facilities administering vaccines need to be able to accurately predict how many they'll administer in a given day

- Pfizer's box is only built for multiples of a thousand doses and only lasts 10 days so isn't well-suited to smaller areas that can't administer 1000 vaccines in 10 days


This is all true but is missing some important detail - the box (shipment container suggests shipping container sized things, it's more of a flight case size thing) is meant for long distance transport, rather than local distribution. It holds the vaccines at -80C for ten days, and can be refilled with dry ice (which is widely available anywhere that has a carbonated drinks industry) to extend that period. The ten days is how long it's expected to be in continuous transit, worst-case. The vaccine must be thawed before use, and can be stored in a regular freezer for a few days, just not indefinitely.

Since the transport cases are reusable, and don't need to be completely populated, what will likely happen in rural areas is that they'll have a case for shipment, refill it with dry ice on site, and use a second case to transport a small number of doses to the point of use. Repeat until used up, refilling with dry ice every few days at a central location (less than a week's travel from administration sites). I don't think it's going to be a major problem in practice.


My understanding is that the -80C storage is most likely simply because they haven't tested at higher temperatures yet.


Probably due to DNA storage because I used to work with genomics and we had the same temps


RNA* You can leave DNA out on your bench for a month and it will be fine.


I'm highly skeptical. Needing -80C is a major disadvantage. Pfizer would have collected stability data at higher temperatures if they could get it.

The fact it's -80C means they can't prove it stable at higher temperatures.


Not so good: Safety data is for 2 months only


One point they made on NPR is that it's hard to imagine any sort of vaccine that would be as harmful as the virus itself, which is killing 1000 people per day.


The issue is that a vaccine would be given to billions of people, whereas the virus is only infecting hundreds of thousands per day. Because vaccines are given to healthy people that may never be exposed to the disease the bar for safety is different.


How does this compare to the chinese vaccine?

It's already in use around the world[1], but I haven't heard of how many people gain immunity thanks to it in percentage, nor if that one also requires multiple jabs.

1. https://www.aljazeera.com/news/2020/11/3/uae-pm-and-dubai-ru...


Or the Russian one /s


Who knows. This is the first to track and announce scientific results. It may be better or worse, we don't know. Maybe numbers are being kept and we can figure out in a few years. Maybe the Chinese are not keeping track in any way and we will never know.


I looked a bit further, and they shared data on their vaccine already in August, but there are gaps:

https://www.fiercebiotech.com/biotech/sinopharm-shares-phase...

"unlike other COVID-19 vaccine trials, the study lacked a comparison arm featuring serum samples from patients previously infected with the coronavirus, complicating the task of interpreting whether the response is likely to confer immunity."

It seems that a vaccine needing a 2nd booster jab is also something that is quite common.

Anyhow, good news all around... The more viable vaccines we have, the more likely that the pandemic will be controlled sooner.


The Ebola vaccine required -80 C storage as well and they got it into literal war zones.

It’s a difficult problem, but a solved one.


Ebola was localized. COVID-19 is not.

I like your optimism, and what you said isn't incorrect about Ebola at the time, but I don't think it's correct about our current situation. How many locations globally have this level of refrigeration? Given that there would be high demand for it, wouldn't prices on any available refrigerators exceed what even the most altruistic companies and organizations could pay?

This still needs to be solved. We have a lot of entrepreneurs, investors, and engineers reading this, so let's not be hasty in hand-waving over something serious.


On one hand you're right to be concerned:

* The largest chilled supply chains, for things like frozen food, don't get anywhere near -80°C

* The question of what to do in poor countries is very much unsolved

On the other hand:

* Developed countries have at least some cryogenic supply chain in place, for things like fertility medicine.

* You can get a surprisingly long way with couriers transporting insulated boxes full of dry ice (or liquid nitrogen).

* The prize on offer here is absolutely huge, because lockdown is so expensive. $10 billion a day buys a heck of a lot of couriers.


We manage to get $1M cruise missiles anywhere on the globe quite quickly. If the world can mobilize for WWII - the US alone built 1,200 warships in a four year period, 2,700 Liberty ships, 300k aircraft, etc. - we can mobilize for a global pandemic... if we choose to.


The world didn't mobilized for ww2. One country mobilized and started to threaten the existence of all.its neighboring states, and those who managed to leverage geographical and climate barriers managed to prepare themselves to intervene.

This is by far not the challenge covid19 poses to the world. It wasn't when it was China's local and regional problem, and it is not after it spread out of China and became a pandemic.

Objectively, at most Covid19 causes a slight increase in the global death rate, and this is only observed during the initial spread before herd immunity kicks in. Ww2 killed about 90 million people in 6 years, while covid is bound to have killed about 1.3 million in one year.


The analogy is imperfect, but it's imperfect in both directions - we don't have to make 300k planes and fight Nazis, we "just" have to produce a bunch of vaccine and some freezers.

It should be substantially less difficult than winning WWII, which again - we were capable of scaling up industrially to accomplish.

> this is only observed during the initial spread before herd immunity kicks in

When will that be? NYC's new spike is demonstrating even their enormous outbreak didn't generate enough of it.


The US has the manufacturing capacity for ships and planes before WW II. Do we have any factories left making refrigerators? Or are we just going to have to order them from China?


> Or are we just going to have to order them from China?

It's a global pandemic. Order them from anyone who can make them at scale. Coordinate with the WHO to avoid silly bidding wars.


I do not believe herd immunity is a thing when every 6 months the herd has to become re-immune


I dealing some on the distribution side of this. NYT has a pretty good article explaining all the infrastructure that is being rolled out. (1)

Even dry ice in coolers is low tech but gets you a lot of time considering storage for the second booster dose will be centralized.

The risk is real though. Breaks in cold chain storage have inactivated vaccines have been documented to leading to outbreaks in other disease states. Still, at this point, from my boots on the ground perspective -- so far, so good.

1. https://www.nytimes.com/2020/09/18/business/coronavirus-covi...


>Breaks in cold chain storage have inactivated vaccines have been documented to leading to outbreaks in other disease states.

Surely there's got to be some existing shipping indicator to track if a shipment has exceeded the temperature limits during transit. Even just a vial filled with a liquid that freezes at e.g. -70C would work just by tipping it upside down when frozen.


For what it's worth, one of the organizations that I've been following regarding COVID vaccine's in less developed economies is GAVI:

- https://www.gavi.org/vaccineswork/cold-supply-hot-demand

I don't have much more on that front, but it's worth a look to see what well developed agencies are aiming at.


> Ebola was localized. COVID-19 is not

You could easily localize COVID-19, just make a vaccination passport. No entry to a country if you're not vaccinated.

> How many locations globally have this level of refrigeration

Almost all developer countries, urban centres, where majority of people live anyway.


> Almost all developer countries, urban centres, where majority of people live anyway.

At -80C?

Edit: There are hardly storage places right now for these temperatures.

https://www.youtube.com/watch?v=byW1GExQB84


> > Almost all developer countries, urban centres, where majority of people live anyway.

> At -80C?

Absolutely. This is a solved problem.

You can buy dry ice at your local supermarket. I buy meat from a ethical farming operation that ships their product in insulated packages packed with dry ice. There's almost always dry ice left over. I made a bottle bomb out of the remainder once.

Every major medicine manufacturing company will already have had supply chains in place to deal with this for other medicines.

Storage is a red herring. It won't last more than a day in any given medical facility.


If you are on the Concordia Station you can just leave it at the windowsill and it will be just fine. One of the perks of living in Antarctica. :)


What if a freak heat wave comes and suddenly it is -55 overnight? :-)


Yeah, imagine that! You could like have just three layers of jackets or something! :)

Well, as long as the temperature is under zero, all is fine - otherwise the 4 kilometers of ice under your station might pose a problem.


You can buy dry ice at your local grocery store. You can probably buy a cooler to put it in. And you get a week to use it after thawing, so if there is a break in the supply chain you only need to detect it and announce a vaccination clinic to that area. There might be some small town that gets 100% vaccination early on just because the truck broke down nearby and so local doctors were suddenly called upon to vaccinate their whole town just to use doses that couldn't be shipped any farther.


The linked video claims Pfizer has a similar solution and the currently tested parameters limit the cooler can only be opened 2x per day, and not more than 1 minute at a time, and the box only lasts 10 days, and carries doses in multiple of 1000s.

A breakdown scenario in a rural area could mean 1000s of wasted doses


> A breakdown scenario in a rural area could mean 1000s of wasted doses

Don't you think Western countries are ordering many thousands more doses than they actually need?

Breakdowns happen - places don't need to have perfect infrastructure in order to warrant treatment.


No. There isn't the ability to deliver more supplies than needed - at least not through the end of 2021. Until then every dose is urgently needed by several people only one of who can get it.


I'll happily wager the UK and US will over-order and then tacitly use the argument you have made to say that African countries are wasteful and don't deserve their supply.


US and UK may over order, but they will not get deliveries. Medical companies tend to have policies in place that will distribute to Africa ahead of richer countries if the richer countries are not seeing outbreaks. Obviously there is more money in the richer countries, so the early delivery will skew that way. However once enough are vaccinated (from all potentially passed vaccines) that a country can safely open they will start redirecting vaccines to poor countries.

Once the world is open the US and UK will be happy to say that they were able to cancel some unused vaccine supply if it turns out not needed. (which will be easy - between focusing on poor countries and moving production to something else (or winding down) as they recognize the need is gone they will be willing to end those contracts not completely filled. Politically it is a money saving move.

Of course the above assumes best (or at least) case. There are many ways things can go wrong. If all approved vaccines need a booster every 6 months things will be very different. (this is an unlikely but still possible very worst case)


I can't think of a rural area that is more than 2 hours drive from a city large enough to take thousands of doses.

They should be able to put out a general announcement and get thousands to get the vaccine if they need to. A lot of people who can get off work on short notice if there is an emergency. Obviously not everyone, but thousands can be redirected to someone else on short notice. Of course this requires emergency shipments to those who should have got the original, but the breakdown would require that anyway.

I don't know what the thawing protocol is though - this is a real concern that needs to be handled. I assume those who deal with the logistics have plans and backup plans that account for all of the above.


There are warehouses extremely well equipped for this. I saw a recent documentary where they were preparing for such a vaccine.


My understanding is that -80c cold storage isn't widely available. The Ebola outbreak might have shown how to get small numbers of doses into a warzone, but scaling this up might prove to be a logistical difficulty.

"Once a provider receives that vaccine, it really starts the clock that the vaccine needs to be administered within five days of when it's put in the refrigerator"

Source: https://www.cbsnews.com/news/coronavirus-vaccine-distributio...


Sure it is. Any small city (> 50,000 people) has someone who can get you liquid nitrogen in far larger quantities than will ever be needed (thus stuff is used for a lot of industrial processes). Put it in a cooler from wal-mart and you have a week.

Any you get a week after thawing it to use is anyway, so you don't need the cold storage where the end user is. I don't know what the thawing protocols are of course.


i'm involved in some state government COVID vaccine projects. The issue is you can't just knock together cold storage like this, there's (naturally) a long process to get "approved" and "certified" for vaccine administration. Storage is one of these criteria, they're not going to hand over a batch of vaccine to some doc with a cooler of dry ice.


Of course not. they need to ensure the cooler is packed correctly - those standards exist.

Those I don't think the doc even needs a fancy cooler, if I understand correctly they need to thaw this first, by the time the individual doc gets it they need to be thawing it and then using it quick. (I don't know what thaw procedures are though)


Don't they know their's a plague on? There are lots of rules that should have stopped the Atlantic Conveyor from sailing.


So I appreciate that liquid nitrogen can keep things cool. And I appreciate that it can keep things cooler than the required -80c. (Nevermind that keeping it inside of a temperature range might be important as well).

But I think you're overlooking something rather important: Storing liquid nitrogen in a vacuum flask only keeps the liquid nitrogen cold for hours or days. It doesn't keep the thing cold that you're cooling with liquid nitrogen.

The week you get to use it is after the dose has been created. If it's brought below temperature for any length of time, it can presumably DESTROY the dosages affected by temperature.

See the current flu vaccine storage protocols, for example: https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/vac-sto...

"Regular temperature monitoring is key to proper cold chain management. Store frozen vaccines (Varicella, MMRV, and Zoster) in a freezer between -58°F and +5°F (-50°C and -15°C). Store all other routinely recommended vaccines in a refrigerator between 35°F and 46°F (2°C and 8°C). The desired average refrigerator vaccine storage temperature is 40°F (5°C). Exposure to temperatures outside these ranges may result in reduced vaccine potency and increased risk of vaccine-preventable diseases."


While you may call it a 'solved' problem, in reality, its a problem that every single pharma company in the world wants to avoid, due to the high costs and other challenges.

Source: I work in vaccines, and our company works on thermostable formulations, among other things.


Depends on the scale - we are talking mass vaccination of the whole planet here.


Not really, if every airport runs a vaccination program that takes 2 months before someone can fly there's very little need for more global infrastructure. The problem with lockdowns, etc is reinfection mostly by air travellers.


How could that possibly be the problem?

This maybe _was_ the problem in the beginning of the pandemic. Now, it's in the general population and will spread even if you ban all airplanes and repurpose airports into petting zoos.


We already know how to drop the R value in a given place. It is pointlessly expensive to do so for long enough to eliminate the virus in any place that is going to be reconnected to the air network until travellers have a very low chance of infection.

Sure some places will find total vaccination the best option, but places with out the infrastructure and money can simply do one lockdown that isn't compromised again by air travel.

China is an example that would have left the pandemic if not for the need to resume Air travel.


One other factor to consider is that this is an mRNA vaccine, which is of a newer generation of technology in vaccine production.

From what I've read it is the first large scale adoption of mRNA vaccines so the really long term risks are less known. That said, theoretically mRNA vaccines should have a lot of advantages. Later in 2021 there may be a few other options for vaccines to take as well, so I'd do some research at least.


For how long do the vaccines remain effective? I couldn't get any predictions on that.

Some links that might be relevant:

https://edition.cnn.com/2020/10/27/health/russia-coronavirus... Moderna vaccine requires storage at -20 °C Sputnik V at -18 °C; so that would be easier to handle.

https://www.ndtv.com/world-news/after-pfizer-russia-says-its... 90% effectiveness says the Russian vaccine Sputnik V

https://www.globaltimes.cn/content/1206008.shtml "No infections among 56,000 people who traveled abroad after receiving Sinopharm-developed COVID-19 vaccine"

https://www.jpost.com/health-science/hadassah-bringing-15-mi... Israel is bying Russian vaccine shots, the head of Hadassah hospital says there is quite a lot of power politics involved in the discourse (Hadassah is one of the major hospitals in Israel)

https://www.berliner-zeitung.de/wirtschaft-verantwortung/cor... (in German) for the EU some producers of COVID vaccines got an exemption clause for liabilities, they say because of very tight development schedules (says an unnamed speaker of the European Comission)


These are the most difficult numbers to have because the vaccine and trials are still only a few months old.


Incomplete:

- Trial is only halfway complete.

- Preliminary results have not been peer-reviewed.


Only time will tell. But usually, vaccines will induce longer immunity than the real diseases themselves because they have been optimized for immunogenicity.

There will be no eradication of the virus, certainly not world-wide, short of multiple waves of vaccinations. Not even with one type of vaccine, but more likely more than one.

Some of the developing world might get vaccinated with a cheaper, more traditional vaccine, but later. But there is no good vreason why you can't have huge vaccination campaigns with cooling trucks at least in their bigger cities.


Another good point: not developed using fetal stem cells.

That makes no scientific difference, but there are a fair number of people in the US who will not use a vaccine if it is developed that way.


Note it is at least 90%. Case number is likely too low to give a tighter estimate with high enough confidence. That is, even if no one vaccinated is infected they still can't claim a much higher effectiveness with confidence as there are only 94 cases. So they are giving just a lower bound.


Long term protection will be achieved by a significant % of the population being vaccinated at any given time, yielding herd immunity. Exciting news for the world!


Also bad:

What did they use to stabilize the mRNA?

If they’re managing to do it with just temperature and maybe glycerol, that’s great.

If it’s RNAlater, then that’s going to have safety issues. If it’s something else, how was the additive tested for long term safety? (Vaccines like this have been in the works for a long time. There has been time for safety studies.)

Edit: RNAlater MSDS sheet: https://tools.thermofisher.com/content/sfs/msds/2012/AM7020_...


I don't read safety sheets often so I'm likely off base here, so please correct me if I'm wrong. My interpretation is that when used correctly it's safe.

Section 2 states it is non-hazardous.

Section 4 states it is not expected to present a significant ingestion/inhalation hazard under anticipated conditions of normal use.

Finally, Section 11 indicates that the Ammonium compounds present in RNALater may be harmful, but only when they are administered at LD50 concentrations.


What is wrong with RNAlater? Seems like it is just EDTA and Sodium Citrate and Ammonium Sulfate.

https://www.protocols.io/view/RNAlater-Recipe-c56y9d


Given the unbelievably aggressive timeframe that this vaccine was developed under, it'a still a huge achievement


I believe that temperature is achievable with fairly simply-insulated dry ice containers, in situations where mechanical cooling is not feasible.

https://www.nytimes.com/2020/09/18/business/coronavirus-covi...

I guess you should invest in dry ice manufacturing companies!


Yes. Pfizer have published info on their logistics, there are details in the wall st journal. Basic idea is a little box of ~1000 doses goes in a big box filled with enough dry ice for up to ten days. Average delivery time will be around 3.

edit: See https://www.wsj.com/articles/pfizer-sets-up-its-biggest-ever...


dry ice manufacturing companies?

Do You mean the Co2 supply chain? We make a lot of carbonated beverages; there will likely be no shortage.


There is a glut in the CO2 supply - it is a byproduct of several industrial processes. (even before carbon capture for environmental reasons.)


ttest


no significant side-effects _for now_.


The mechanism of action is known, so potential side effects are largely predictable. I'm not an expert, but I don't see any reason to think there would be unexpected long term side effects from this sort of vaccination. Is there reason to think otherwise?


There is always some effect whenever any foreign molecule is injected in your blood. Simply knowing ONE 'mechanism of action' doesn't tell you the 'mechanism of reaction' or all the other cross reactions that happen. It also doesn't tell you what will happen when some one is already on medication for other health issues. The body is simply too complex to many any definitive statement like that.

So there are many reasons to think otherwise, but the simplest one is - Every single medication and vaccine that we've ever made has known side-effects. Not all side-effects are known right off the bat, and many take years to detect.


Do you have any examples of a vaccine that's had side effects not show up for years after it went into use? I'm not saying there hasn't been—I really don't know.


Aside - I re-read my earlier comment and I don't mean to come off as a crazy anti-vax person!

I work in vaccines, but I can't think of a vaccine that was completely recalled due to long-term safety issues of the top of my head. Most recalls happen because one lot or the other had some production issues. Certainly, vaccines are extremely safe by the time they get approved - because the approval process is careful, methodical and takes years.

However, in this case, if a COVID vaccine is approved by the end of this year or in the near-term, we won't have any long-term data, and so I do worry about those aspects, about the compounds used in the final formulation as well as the untested nature of RNA/DNA based vaccines.

A few places to do research for those interested:

https://vaers.hhs.gov/data/datasets.html?

https://www.fda.gov/vaccines-blood-biologics/safety-availabi...


> Good: ~90% of individuals achieve immunity.

As far as I recall, the high R0 of COVID-19 meant that >90% was needed for herd immunity. You then also have to factor anti-vaxxers into the equation.

It's a good stop-gap for the 90% who develop immunity, but we need a better vaccine even in developed countries.


Estimates for herd immunity are between 20-80%.


Thanks for the correction.


How do we know that there are no significant long-term side-effects? These vaccines seem to be developed so quickly while others take years or even decades... I do not know if this is irrational fear, but I fear that this is rushed and there might be potentially serious side-effects that are missed.

Why am I being down-voted? Is it really of no concern?


Short-answer: we don't and can't, since you'd need to use the vaccine for a long time.

Better answer: the vaccines are new but the individual systems used to develop them are not, and we have historical trials of a lot of the same techniques which show no long term risks. The biggest unknown has always been the risk of triggering a short-term, unexpected primary immune response that causes harm to the recipient. In the vaccines being developed, that has generally not been found to be the case, and since they're based on the virus currently infecting people we would not expect a response worse then that (which is to say: the components of vaccine use are all well studied, these are understood and safe materials).

The other issue is when we talk about "rushing" vaccine research, this does not involve shirking safety research - i.e. consider the influenza vaccine which year over year is basically a new vaccine we develop quite quickly. What it does mean is that you overlap the stages of vaccine development: normally if you have a P3-trial vaccine, you'd wait till that trial was successful before building the factory to make it. Instead, companies are being paid (or paying themselves) to build facilities and scale up production as soon as they get to the P3 trial stage - financially it's a huge risk, since what they have might not work, or might have an unacceptable risk profile in those trials - which means all the investment is a dead-loss.

This is where government steps in (and has stepped in in places): by guaranteeing the investment on getting those facilities out, it means if your vaccine works then you're ready to go and it's in production right away - as opposed to being another year to 2 years down the line while you work on manufacturing.


I just ignore the down votes. You probably hitting the target.

This is of concern. The medical industry has a history of covering up the direct know effects of their medicine, AKA poisons. That system has been know for a very long time to lead with arrogance and it sometimes takes them a very long time to pull things they know are killing people. Its just too much $$$.

See vioxx and merck, for just one example.


I for one agree with you. There is no rush to get vaccinated.

Personally, I doubt I will get it at all. The authorities have a very long way to go to win back my trust, after the chain of screwups over the last year.

We've seen that they will lie to us, we've seen that they apply rules to us that they themselves don't follow, and we've seen them take advantage of the situation for their own benefit.

It is a huge shame that so many people are not going to take it solely because they've betrayed our trust so many times that now that they might be doing something good, we won't cooperate.


You are getting down-voted too by people who do not even bother replying, probably some blind followers, government-loving NPCs.

You know how you could turn this against them to make them think twice about it? Get the Russian vaccines, or the Chinese. Yeah, do it! Suddenly they are not so keen... Now imagine if their beloved State made it mandatory to get Russian vaccines inside them. They would most likely be against it, and our votes would not be down... It is not even the votes I give a damn about, but the fact that we do not know THAT much of COVID-19 but people seem to believe the claims that we have extremely safe vaccines ready just within a few months. Yeah, they say that of the Russian vaccines, too, are you going to take it, down-voter? Would you like the State to make it mandatory for your kid to get vaccinated? I am curious.

My entire family tested positive for COVID-19, and my grandma most likely has it. None of us has/had symptoms. I do not want to get vaccinated. If you (not you, the down-voters) really care, go get vaccinated by the Russian vaccines.

My country plans to vaccinate the elderly, kids, and people with chronic diseases first, then the rest of the population. I really, really wonder how many people are going to have FORESEEABLE side-effects. I think they are also planning to make it mandatory.

P.S. I am not an anti-vaxxer, but these claims by pharmaceutical companies sound shady as heck. If they said they found the vaccine after 5 days and they claim it is super safe because 5 people did not die from it within 10 days, would it make you OK the vaccine? Come on. My problem is that. It is too quick, and too many promises of lack of side-effects, and lots of financial interest. For that I do not believe them. We (medical workers) even have to lie about people dying from COVID-19 so we (the hospital) get more funding. How about that? Governments put price control on the tests, which resulted in zero competition as it was not worth it for private businesses to continue testing. How about that?


> I still wonder about long-term immunity.

The current understanding is that there will be likely no long-term immunity, just like the flu virus (as it mutates).

> -80 Degree Celsius storage and transport needed.

This is actually typical for vaccines storage/transportation needs. Unfortunately this will also means that it cannot be easily distributed into developing countries where supply chain requirements are largely unmet.


+ ~90% of individuals achieve immunity

It could also refer to 90% reduced severity.

A 60% vaccine can reduce the severity of the illness by 40% so only 40% of the expected number end up in hospital.


I thought it was that 90% show production of antibodies.


No, they showed an antibody response in the spring. That's the easy part. This is the real-deal clinical trial: they gave tens of thousands of people the vaccine candidate, tens of thousands a placebo, and then counted the resulting cases for months, as well as watching for side effects. The 90% reduction is in actual cases.


The first line of the article states:

"The first effective coronavirus vaccine can prevent more than 90% of people from getting Covid-19, a preliminary analysis shows."


Problem is it is all from a press release. They can mangle words to be correct but very misleading. We will have to wait for the scientific paper which will take some time.


They say that every time they talk about vaccines but if you look at articles like this:

https://www.cdc.gov/flu/prevent/misconceptions.htm

and this

https://www.cdc.gov/flu/prevent/vaccine-benefits.htm

you'll see that that's not how it always works.

> Flu vaccination can reduce the risk of flu-associated hospitalization for children, working age adults, and older adults.


The complexity of the distribution of such a vaccine on such a large scale will be a major bottleneck in a return to a society without imposed pandemic measures. A much less sexy and more human bottleneck, which permits of far more classes of failure of getting the virus to people well. The distribution is important work which we will see being the subject of much criticism. I hope everybody can keep their expectations in check. Getting working vaccines is incredibly important, but this is just the first step. There are no easy fixes - we'll be in this situation for the foreseeable future.


> - two doses needed, 3 weeks apart, immunity after one month from first dose. Slow rollout.

Yeah, this alone is bad news.

Last year my parents got a two-dose shingles vaccine. The two doses are supposed to be separated by two to six months. My parents struggled to find their second doses in the window. Apparently there was limited supply and no one had the foresight to reserve second doses when people received their first, or even to prioritize second doses over first.

The covid vaccine will have much more demand and apparently a tighter window, and our health system isn't exactly well-coordinated right now, so I anticipate a lot of people will be unable to get the second dose with the proper timing.


It will be an incredible challenge, but there is at least some economy of scale on our side.

Wendover did a nice video[0] on this topic month ago, explaining how UPS/FedEx/DHL/… are already massively upscaling their cold chain infrastructure. Retrofitting planes, building giant freezers in transport hubs.

[0] The Greatest Logistics Challenge Ever - https://www.youtube.com/watch?v=byW1GExQB84


Thanks for sharing this. I learned a lot from watching this video and I have another channel to subscribe to now :)

One thing that I found interesting was how they identified today's announcement of the BNT162b2 vaccine candidate (back in September) as one that would require the massive investment in cold chain infrastructure. They also highlight Pfizer's engineering of a separate series of cold boxes that would keep the vaccine at temperature for up to 10 days, thereby enabling it to be shipped through standard logistics networks. Great stuff.


I'm curious, which country is this?

In the UK, the NHS are generally on top of things like this, so it should not happen in most cases.


US. I believe they got these vaccines through pharmacy chains like Walgreens or CVS. This is one of several ways people get vaccines here—it's common for seasonal flu shots especially to be available at employers (medical staff travel from one employer to the next) and pharmacies (sometimes even grocery stores with in-store pharmacies) in addition to the general practitioners' regular clinics. I think for the first dose they got it wherever was convenient—probably the pharmacy where/when they were picking up a prescription—and for the second they looked everywhere for months.


Same experience for Hep A vaccine. Got the first dose, then there was a global shortage when it was time to get the second dose - not available.

If there are 7 billion people and 1 billion doses in the next year, it's going to be awkward.


People are going to discover where they sit on the global privilege scale. 1.3 billion doses next year and 50 million this year. Let's call it 1.4 billion by the end of 2021. The USA + Canada will get half (USA gets 100M guaranteed and the option of an extra 500M). I assume Europe gets the other half based on the numbers I'm seeing that UK has ordered. Africa, Asia, and South America will probably not see meaningful levels of this vaccine until 2022.


The study is suspect end points. I cannot elaborate - too long. I will let the virologist PHDs weigh in here to take this point forward.

Tldr: i have a team in a top institution. There are gaps and the news is TGTBT.


What's the point of even commenting if you're too busy to so much as string together a few coherent sentences?


Developing countries have youth immunity. When you convolve covid hospitalization / IFR as function of age with age distribution, developing countries have no risk whatsoever from COVID. that's why Brazil and India are nearing herd immunity with basically no serious medical infrastructure saturation. Median age in Africa is 19... No fks given. Covid vaccine is just for old people/developing countries.


> that's why Brazil and India are nearing herd immunity with basically no serious medical infrastructure saturation.

[citation needed]


Coronavirus: Overwhelmed India hospitals turn Covid patients away. Hospitals in the country are struggling to cope with the number of patients they’re getting. Many are dying without getting the treatment they need. https://www.bbc.com/news/av/world-asia-india-53014213


At the time of writing (2020-11-09 12:04 UTC) the article uses "90% of people" and "90% protection" interchangeably. I assume it means "90% of individuals achieve immunity", rather than "individuals achieve 90% immunity".

EDIT: See child comment re: Pfizer press release.

EDIT 2: See [1] for said press release, which has more detailed information than the BBC article.

[1] https://investors.pfizer.com/investor-news/press-release-det...


Excellent news it's so high. For comparison, MMR is 88% effective on Mumps

"One dose of MMR vaccine is 93% effective against measles, 78% effective against mumps, and 97% effective against rubella.

Two doses of MMR vaccine are 97% effective against measles and 88% effective against mumps."

https://www.cdc.gov/vaccines/vpd/mmr/public/index.html#:~:te....


If new pfizer's vaccine has similar numbers, e.g. 90% after two shots and 80% after one shot, can it be more efficient to just use one shot, considering current race with time since we need to deliver vaccine to billions of people? Are there numbers for protection level after one shot somewhere? I couldn't find it at first glance.


You're probably right, but since that has not been tested, I don't think it can't be used, by FDA rules.

The FDA is not known for its improvisational disposition :)


The phase 3 only did two shots. Afaik the only one shot vaccine in phase 3 trials is the J&J one.

Looking at the phase 1/2 results, the booster shot seems to help a lot in getting the antibody levels up. See Figure 4 of their paper, https://www.nejm.org/doi/full/10.1056/NEJMoa2027906


I think the parent is asking (if 1 shot of this vaccine confers 80% immunity) would it not be better (for the purposes of curbing transmission) to give everyone a single injection now for 80% immunity among a broader population rather than giving half the number of people two doses for 90% immunity. The implicit constraint is that it will take a relatively long time to scale up production and distribution to the extent that we can get two doses to everyone.


I understand what OP meant, but the data we currently have shows that one shot of this vaccine is not likely to convey a decent amount of protection.


I am sure I misunderstood something, but what does that 80% mean, and how does it differ from "the data we currently have shows that one shot of this vaccine is not likely to convey a decent amount of protection."?


The 80% number was made up in this conversation. The vaccine has not been tested using only one shot and we don't know how effective it might be.


Oops my bad


Yep, maybe they had some data about protection level rising since first shot, fewer people getting sick already etc. It's hard to understand from just the Figure 4 how much of that increase is booster shot and how much is just level rising with time, too bad they didn't investigate this. Having top level protection vaccine with 2 shots is of course great and may be what you would be aiming for in "normal" times, but when it's race against the time trading several efficiency percents for quicker population coverage may be worth it. Yep, J&J one is the only candidate requiring one shot. Hopefully it will show some good results soon as well.


It is great news.

I didn't see the case numbers but I've inferred to arrive at 90% that there were 9 cases in vaccinated group vs 85 in controls. (95% C.I. 80-99%)

Very interested to see forthcoming results from competitors that don't face the -80 degrees issue.


Out of 45,000 people, only 86ish people got infected in the trial arm? Isn't that too few? Even for the control arm, that's still only 774 people infected.


No, 94 people total got infected. At least 85 were in the control group.

Those are the numbers that matter, statistically. If the total number of people in the study were 2 thousand or 2 billion doesn't enter into the math.


That's not true, population size absolutely 'enters into the math'. 9 vs. 85 does not give the same result independently of whether N=94, 200, 2k, or 2B.

It affects confidence, and potentially the result of the test entirely. I won't be more specific because stats was never a strong suit and my memory's hazy, but I remember enough to know it matters!


I'm thinking that 85/21,750 or 0.4% of the controls developed the disease (vs 0.04% of those who received vaccine).

It does seem low for the US where you have 3% of the population had disease already in 2020. Perhaps more data came from Germany? Or it could be they measure not just PCR +ve results, but antibody levels and/or severe symptoms?


First phrasing makes more sense than the second one to me -- what would it even mean for somebody to be "90% immune" to a disease?


In terms of D&D you have +8 to constitution saving throw vs this infection (assuming DC is 10) :)


No, it's probabilistic, about the 'amount of protection' from or 'decrease in likelihood' of contracting it, which is why generally people are happy / would have been happy even for a much lower percentage - protecting ~everyone a bit is higher impact than protecting a few people a lot.

It's the same as 'herd immunity', where each member is '90% immune' and as a result the herd is 'more immune' than if only 10% of its members were 100% immune.


> what would it even mean for somebody to be "90% immune" to a disease?

Hasn't this virus already mutated to a bunch of different strands? Could it mean you're immune to 90% of the known variations of the virus?


The variations are enough to have differences in infectiousness and to allow us to trace the spread a bit, but as far as we know immunity to any of them is immunity to all of them.


I think someone should clarify the strands vs. genetic variations here.

Because the reports from Denmarks Mink fiasco indicated that antibodies were not as effective on the mutation that appeared there short time ago. This would contradict the one-fits-all immunity argument.


The Danish mink mutation is the exception to the rule; that's why the government is taking extreme measures to contain it.


What I was trying to say is: I think in the thread above people are talking about different things.

For the "danish mink mutation" - even if the exception to the rule - some of the above statements might not be true.


> This would contradict the one-fits-all immunity argument.

I don't think that argument is being made at all.

In fact, you only need to consider that the max efficiency that's advertised is 90% to acknowledge that this vaccine is not a silver bullet.


But, that's literally what was being said above..?


> as far as we know immunity to any of them is immunity to all of them.

What are you basing that on, when there are known cases of people getting coronavirus and then still contracting the other strain of it?


Do you know the reinfection was a different strain? Or did the immunity to the first strain weaken?


Maybe there is a slight semantic misunderstanding here, but in fact a "re-infection" is defined as such:

A patient must present a infection and the particular virus must be sequenced, and then present with an infection later on where the virus is again sequenced and identified as sufficiently different from the first sample. Otherwise it cannot be deemed a re-infection.

If these small differences in the genomic sequence are already a different strand, I don't know, not an expert. But all 5 (?) cases known so far had a different sequence identified the second time.


https://www.ajmc.com/view/first-case-of-covid-19-reinfection...

> The genomes of the patient’s virus samples from April and June displayed significant genetic differences between them, suggesting that the patient was infected twice by 2 distinct COVID-19 infections.

I’d read of known second infections that are from different strains, but scientists also question lasting immunity from COVID-19 infection because other coronaviruses are seasonal.


My take is that this is a "correlation does not imply causality" case.

It was possible to positively identify a reinfection because the two infections were due to different strains. That was just the means of positively and objectively identify a reinfection. However, nothing was asserted regarding if the patient was immune to the first strain the first time around. In fact, it seems that the hallmark of reinfections is that they are far more critical than first infections. This also means that the first infections is far milder than the second one. Well, the thing about the immune system is that it is able to fight mild infections without developing immunity if they are too mild to trigger a full response from the immune system.


[flagged]


Assuming you are really interested.

Mostly because the world is not one-dimensional.

"Hard lockdown" has drastic socio-economic implications.

"No lockdown" has dramatic/catastrophic socio-economic implications. The easiest to understand: In very short time the ICUs are overrun and people die. A lot of people die.

"Soft lockdown" depends on the people to play along. Which seems more difficult than the people in charge thought it would be (and some still don't believe).

Notably I am not arguing here for what the "right" choice is. It is simply not that easy.


[flagged]


With no intervention, healthy people start to die because they cannot receive medical care. There is a lot of COVID care going on in hospitals other than ventilation. Ventilators are somewhat of a last resort.

We are on track for COVID to have 10x the deaths of the seasonal flu, and that is after the effects of the significant interventions that have happened here and around the globe.


> No lockdown and 1% of old and obese people die.

This is incorrect. When hospitals are overrun, healthy people can't be treated and die. The old and obese die in higher proportions even when receiving treatment, but healthy young people often need treatment to survive.


> but as far as we know immunity to any of them is immunity to all of them.

OK. The longevity of the immunity is also an issue perhaps; at least they have written articles about people becoming re-infected; so even the people who do become immune may not stay that way forever...


> so even the people who do become immune may not stay that way forever...

In my country there have been hundreds of thousands of confirmed Covid infections. There have been <100 confirmed re-infections.

It's very early to draw the conclusion that people in general don't build up lasting immunity, and there is more than enough data to support that most people do build up immunity of several months at least. If the latter wasn't true you'd see much more re-infections.


> there is more than enough data to support that most people do build up immunity of several months at least.

OK, some (needed) good news..


The reporting on reinfection is actually a pretty positive sign. If 10% or even 1% of people could be reinfected, you’d expect to see huge numbers of reinfections, so the fact that the news is still reporting individual cases of reinfection suggests it won’t be a practical concern.


Immunity isn't binary


only your feet get ill


It means reduced severity so that people still get ill but you get 90% less people than you would expect hospitalised.


Perhaps its something like "90% percent of the individuals' immune system are successful in quick eliminating covid without any symptoms or adverse reactions".

I admit I know very little on how immunity to diseases work, but I imagine that with viruses there is a chance it'll progress to a full blown infection even if you are vaccinated in some cases.


I would assume something like with the influenza vaccine, where you have immunity to i think around 70% of currently available virus mutations, if the vaccine works.


That's a percentage on a different axis. Influenza is a diverse family of related viruses and strains vary much more than those of SARS-COV-2. No surprise given the very different time since taking foot in humans, and in addition to that (I think, working on weak knowledge here) that influenza is even part of a group of viruses that is prone to create mashup versions of itself when two strains meet in the same host. Think Dangermouse, Grey Album.


I'm explaining a concept, nothing specific to the flu or covid.

I'm just saying how you can have a single person that's 90% immune to something vs. Having 90% of people immune against one strain of a virus.


The way these studies (most of the big trials finishing up soon, and this one too) are set up is that they measure the percentage of people that will not get symptomatic covid-19, so the only thing that is measured is whether they get symptoms or not. So the result is that 90% (within a confidence interval) of people who are given this vaccine will not develop any covid symptoms. Transmission may be impacted, and the data will reveal hints about this, but it's impossible to draw hard statistical conclusions about that, and in general a different type of vaccine technology will be needed to end transmission and thus the pandemic. This will save countless lives though, and may end lockdowns, so a great day nonetheless.


From Pfizer's press release, they use "vaccine efficacy" which has a very specific definition.

"Vaccine efficacy is the percentage reduction of disease in a vaccinated group of people compared to an unvaccinated group"

So basically a 90% reduction in Covid infection.


This CDC page defines it in terms of cases:

https://www.cdc.gov/csels/dsepd/ss1978/lesson3/section6.html

So "disease" is probably an infection there, not relatively milder infection.

90% still crushes the transmission rate.


> 90% still crushes the transmission rate.

Unfortunately, there's yet another property of vaccine performance: some prevent the virus from reaching any level of footing in the host, others only make the body's eventual response stronger, preventing initial footing to cause heavy illness. SARS2-COV is rather peculiar in how its transmission performance is particularly strong in early, mostly presymptomatic stages, so it's perfectly possible to end up with a vaccine that reliably protects carriers from disease, but does not remove them from the spread equations at all, or only very little.


So what does it mean? Less severe symptoms or sterilizing immunity?


Neither of those. It means you don't get sick if you get in contact with the virus. Whether that means you're immune (i.e. not spreading the virus to others) is a different question that apparently hasn't been answered by this preliminary data yet. (And I can see this is more difficult to study.)


Meaning you can get a virus, but your body will produce enough antibodies to neutralize it so it doesn’t spread to detectable levels.


Can't that be interpreted as either of the options in the parent comment?


90% of the time it works every time. :-)


Thank you, do you happen to have a link?



There's no such thing as "Covid infection". There's SARS-CoV-2 infection, which often causes CoVID-19 disease.

Pfizer is saying that their vaccine is effective at protecting against CoVID-19 disease. They haven't said anything about preventing SARS-CoV-2 infection yet, as far as I can see. The difference is important, because there are vaccines (such as the Salk polio vaccine) that only protect against disease, but not against infection. People get infected and pass on the virus without ever getting sick, so there's no herd immunity.


Pretty confident it's the former, which if the case, essentially ends the pandemic in a month after it's distributed, given that the R0 would drop precipitously.

The challenge will be reconciling this with the antivax crowd given that as the vaccine rolls out the rate of infection will come down correspondingly among the whole population (including the unvaccinated). They'll immediately claim that the virus is "going away on it's own" as opposed to the truth, which is that potential spreaders are being steadily removed from the susceptible population due to the vaccine.


It's a 2-dose regimen, needs to be stored at -70C, and Pfizer already said they'll only have 1.5B doses over the course of the next year.

It's going to be a very slow roll out.


While true, the approach they took is extremely similar to several other vaccine candidates which is a good sign that the approach works and other vaccines will be equally effective.


It is. I’m saying after that period.

Not withstanding the rather enormous caveat of antivaxxers. They have grown significantly in number during this pandemic what with all the wild conspiracy theories. It’s worth checking that out.


More vaccine for me.


Same.


Which is completely sufficient to vaccinate the elderly, teachers, immunocompromised, and healthcare workers in the Western world, and probably anyone else who really wants it.

There's no need to completely eliminate COVID - we don't aim for the same for regular influenza. We should aim to reopen economies as soon as possible instead.


Why aren’t we using _all_ the factories to make as many doses as possible? There should not be “companies” making these to their capacity. This should be a public effort


I would guess that a lot of the factories that are capable of producing these type vaccines also produce a lot of other important drugs and vaccines that we can't just put on the back-shelf without even greater harm.


You first: why aren't you making this in your garage right now?

For the most part the same answer as to why you aren't making it yourself also apply to most factories in the world. Only a few have the equipment, supplies, and experience to make it.


R only drops if this vaccine provides sterilizing immunity. The press release only discusses protection from disease.

A vaccine that only prevents disease, but which does not prevent infection, does not necessarily create herd immunity.


We should be clear about the goalposts. Reducing the transmission rate to a manageable level will be very easy with even just some fraction of the population being vaccinated. What exact percentage is unclear, but it's a lot less than 100%. No realistic number of anti-vaxxers can change that.

Eradicating the virus is a whole different goal, and there could be lots of different impediments to that. After all, we still get vaccinated for a large numbers of illnesses that we haven't eradicated but are just very rare. That's not a terrible endgame for COVID.


It’s not terrible. It’s not ideal.

Letting this thing circulate seems dangerous given it introduces the possibility of a vaccine-resistant mutation. If anything it drives the evolution of the virus towards vaccine resistance similar to what happened with MRSA bacteria and antibiotics.


Note that they provided 'Confirmed COVID-19 in Phase 2/3 participants without evidence of infection before vaccination [ Time Frame: From 7 days after the second dose of study intervention to the end of the study, up to 2 years ]'

as their primary outcome in their study registration

https://clinicaltrials.gov/ct2/show/NCT04368728


thank you, this makes more sense


It's the BBC, I wouldn't expect any scientific rigour from them.


I'm feeling a deep-seated wave of relief that I never thought possible. Like waking up from a year-long nightmare. Thank God.


>I'm feeling a deep-seated wave of relief that I never thought possible. Like waking up from a year-long nightmare. Thank God.

Moderna is also only weeks behind Pfizer/Biontech here with a very similar technology and manufacturing capability of hundreds of millions of doses. We'll be seeing the first EUA's by December, and shots in the arm before the end of the year. Pretty incredible that we can just science our way out of things like this. Humans are awesome.


>We'll be seeing the first EUA's by December

Emergency Use Authorization, for anyone else who hadn't encountered the term yet


>We'll be seeing the first EUA's by December, and shots in the arm before the end of the year

What makes you say that? That's quite fast, no?


They're already manufacturing millions of doses of the drug and have been for months. The military already has an action plan for distributing it nation wide. Realistically they're ready to go right now they are just waiting for FDA approval.


The national academies of Science have been working on a framework for distribution, they've been getting public feedback on their draft since August.

https://www.nationalacademies.org/our-work/a-framework-for-e...


Lol you vastly overestimate the capabilities of the US Gov and Military. I wouldn't be remotely surprised if you can't get a dose if you want one until well into 2021.


The US military is (to make up a number) 85% logistics. Supply chain management is the one thing they absolutely excel at. We can move troops and keep them supplied even in the most remote, most dangerous areas of the world. It's what the military does.

What makes you say this, other than a knee-jerk 'US-bad'?


Well the government has handled logistics related to covid horribly so far. They were completely unable to distribute tests, even months after there were tens of millions stockpiled. They were similarly bad at distributing PPE. They couldn't even get toilet paper distributed properly. Of course there are major differences here, but I don't have a lot of faith.


Government != military. The military has its own logistics command that, like the parent comment mentions, is unbelievably well tuned. Vaccines are something they do extremely well-- every sailor, soldier and airman in the entire 5 arm military needs regular vaccinations, even when deployed. Can't have GI Joe catching a flu, giving to the rest of the battalion only to sitout the rest of the conflict. All the stuff you need to safely distribute a vaccine, they've got, and know how to use it. Things like a chain of custody to keep cold things cold, and SLAs to meet perishable goods requirements, transport and delivery from remote locations with little infrastructure, the command and management to ensure enough supply gets to where it needs to be, etc. From what my friends who served in the Navy & Air Force said, they don't fuck around with vaccines. You get lined up, jabbed or misted with the vaccine and sent on your way. There's no reason they can't scale up from hundreds of thousands of soldiers to millions of civilians.


Ah, yes, I remember the days of pneumatic vaccines. Can get a lot of people vaccinated in a hurry that way.


Was the military given this task?


What part of that 85% usually transports stuff at -80C?

They have the manpower and logistics in place yes, but you still need special equipment keep it at temperature.


Good news: A 463L pallet is a 463L pallet, and the military plans this stuff out long in advance: https://armypubs.army.mil/epubs/DR_pubs/DR_a/pdf/web/ARN1858...


Equipment can be bought. Cooling containers are not only available for every mode of transportation, they are standard and people handle them daily, even for air freight.


Other Good news: The cold transport requirement has been a known requirement since beginning of development, for at least the Moderna and Pfizer vaccines. And the Moderna and Pfizer vaccines have been among the leading candidates since March.


You probably won't get a dose until late 2021. This is because you are probably not in a high risk area where you can't isolate effectively. The first shots will go to doctors/nurses, moving down a risk scale. Next is up for debate.

I'm sure my company will do everything they can to ensure factory and retail workers will be next. Factory because shutting down our factory would be a disaster to our finances. Retail because all employees who are supposed to not go anywhere still get groceries, so protecting those workers reduces are contact. The the CEO is next, probably only slightly above the rest of us office workers who can stay home.


The problem is that "late 2021" is a date you just made up. The people deeply involved in vaccine development are talking about Spring and Summer of 2021 for a return to normalcy, with widespread vaccinations starting before the end of Winter. This is from people are Oxford, Moderna, various governmental health agencies, including our own reliably conservative Fauci. Where do you get "late 2021" from?


>The people deeply involved in vaccine development are talking about Spring and Summer of 2021 for a return to normalcy

Any update on this figure? I'm seeing a lotta different stances


I made a somewhat educated guess. I'm not as educated as the people you name, but they too are just guessing. I'm trying to be reasonable though, and I don't have any reason to spread an optimistic hope.

If this is the only vaccine that passes trails - well they can't make it fast enough for a late 2021 opener. If some of the others also pass trails then early 2021 is a possibility (so long as you don't have some reason to prefer a specific vaccine as opposed to whatever you can get first)


I'm fine not getting a dose for months because I'm not in a high-risk group, and not working with high-risk individuals.

If we can vaccinate hospital workers and high-risk individuals, that will already make fatalities go down very quickly. That will help us get out of confinement faster.


This is great and all, and I'm not against vaccinations, but is this safe long term?

Am I the only one here who doesn't want to get inoculated in basically the first batch?


> but is this safe long term

Is getting COVID safe long term? There are plenty of viruses that cause issues in the long term. HIV causes AIDS, HPV and Hepatitis cause cancers years later. We have no clue on the long term effects of SARS-Cov-2, other than that it causes COVID-19 in the short term.

It's a choice between the pest and the cholera at this point.


> Is getting COVID safe long term?

For most people yes

edit: so the whole world is studying this virus 24/7 for almost a year and nobody detected anything, yet you think it might give us aids v2 ? Feel free to link any study that hints to anything remotely going in that direction because I couldn't find anything at all.


I'm guessing you're saying that based on the number of people that remain asymptomatic &/or don't die, but you are incorrect.

We already know there is a strong possibility the virus has a negative effect on cognitive ability even in people who don't get any serious symptoms [0]

Those might go away. They might not. There could be other effects we're unware of. What we do know is that you're unlikely to find any expert on this who will unequivocally say "no longer term effects".

[0] https://www.medrxiv.org/content/10.1101/2020.10.20.20215863v...


> This article is a preprint and has not been peer-reviewed


Yes, which is why I said it was a possibility.

Pre-print or published or not, it presents evidence that shows it's incorrect to assert there are no longer term effects of COVID. Even if peer review shows flaws that invalidate this particular study, research into the full effects of COVID are still underway, and we simply don't have the data required to assert "no longer term effects for most people"


Citation needed


> so the whole world is studying this virus 24/7 for almost a year and nobody detected anything

I think you might overestimate what we can detect, when it comes to how viruses interact with a living human body. Yes, the whole world is studying it 24/7, and we really do not have a clue on long term effects. Science is pretty good, but some problems are pretty difficult too.

30 years ago, we could not have this ubiquitous testing capability and probably could not develop these tests at all. 10 years ago, we would definitely not have this vaccine one year after patient zero. Today, we really have no clue on long term effects until they happen on a statistical scale. Science and biotech progress rapidly, but there are still a lot of things we can't do.


you literally can't possibly know that. nobody does


We cannot be sure. Like, we have no idea.


It's amazing how people have consistently acted throughout 2020 as if coronaviruses are entirely new, never seen before and everything known about the immune system or viruses has to be thrown out.

People have been getting infected with coronaviruses of various kinds for millennia. Nobody has ever linked a low severity cold-like infection with long term severe consequences, and given the sort of longitudinal study that would be required to establish such a link, any such claims would need to be treated very carefully.


It is amazing how wannabe public health experts, with zero expertise in virology, are failing to understand that difference just in handful of nucleotides may make the pathogen a completely different beast compared to its nearest relative. And we are not even talking about the nearest relatives, common cold coronaviruses diverged like many thousands years ago from the SARS1 and similar viruses.

Nonetheless, the original SARS-1 (which is way closer to SARS-2 than say OC43), is known to be causing long term, debilitating health complication among significant number of survivors.


It's not a completely different beast, is it? It's basically like a regular flu or severe cold, and yes rhinovirus can be deadly to the elderly, it's just nobody normally notices or cares because rhinovirus isn't "new". If anything it's actually less bad than flu because flu kills children too and this one doesn't.

Nonetheless, the original SARS-1 (which is way closer to SARS-2 than say OC43), is known to be causing long term, debilitating health complication among significant number of survivors

And yet it didn't turn into a worldwide outbreak, so one must ask how much value this classification scheme actually has, given that SARS-2 is really nothing like SARS-1 in either infectiousness nor severity.


I usually stop arguing when I know that no one reads the discussion, because it is pointless at this moment, for the reason of me having no intention to convince you in anything, if you fail to see obvious things. I think we need to stop - no one is reading our conversation anyway.


Risk of COVID19 long term effects is far worse than mRNA side effects IMO.


We do not know yet.


>We do not know yet.

Sure we do. mRNA vaccines have been under development for over a decade now. And while none have been approved for human use yet, it's not for lack of safety data. There have been zero serious adverse events reported in the Moderna or Pfizer phase 1, 2, and 3 trials. The only side effects are mild fatigue, headache, and soreness that you would associate with an immune response. Furthermore there is no possible way that the vaccine can even cause long term effects; the mRNA breaks down naturally in the body almost immediately. Any side effects will be immediately present and related to acute immune response. Worrying about some vague long term "what if" problems that have no mechanism for action is just non-scientific magical thinking.


This is not how drug approval works. This will be distributed on a planetary scale. Even 0.001% of side effects can be a big issue at these scales. history actually has lots of evidence of "unquestionably safe" drugs, causing lots of pain eventually - read about Thalidomide, Aspirin and Reye syndrom etc. There is also chance of ADE, a very complex unpredictable phenomenon, which was present with the original SARS vaccines.


I think bringing up ADE is fear mongering at this point. In vaccines where we’ve seen ADE we usually see it in monkey trials and if not there, we see it in phase 3. SARS vaccines never made it to phase 3 because we kept seeing ADE early on and then it died out. To keep bringing it up at this point, when none of the hundred or so vaccines have seen it, seems a little ridiculous.


I agree, SARS-2 does not seem to produce ADE. However, it might be rare, but if it is there it is often fatal. On global scale this might be important.


>There is also chance of ADE, a very complex unpredictable phenomenon, which was present with the original SARS vaccines.

Again, apples and oranges. This is a completely different class of drugs compared to SARS vaccines from a decade ago. Those were based on live viruses, which the mRNA vaccines are not.


And? How can you make these kind of claims it has not been verified? Just because the mechanism is different it does not mean it is free from ADE. ADE is result of using improper antigen for creation of immune response. mRNA is not an antigen, the protein produced from it is. If you choose wrong antigen, and deliver it in any possible way, it will still create wrong immunity and will result in ADE.


The possible long term side effects of the vaccine are unknown.


Probably, but to be fair, noone has had either mRNA or COVID19 for "long term" yet.


A tricky odds calculation.

It's kind of annoying to have to be fearful on public transport, having to avoid infecting older family members and therefore not seeing them, and much else. Then there's the risk to yourself with COVID, which varies based on your lifestyle, age, and good/bad genes. Clearly some percentage of the population die, and a bigger have long-term very unpleasant effects.

On the other hand, the vaccine can be discovered, 12 months from now, to cause an autoimmune reaction in some people and their immune systems attack their joints or something.

I think this pandemic teaches us all one thing - almost the entire world of understanding can be boiled down to probability.


Have there historically been issues with vaccines causing problems for the long term that didn't show initially?

I've never heard of such a thing, but then again I have only a surface understanding of vaccines.


There have been a few cases. However we think we understand why they happened and so it won't. Anything is possible.

If you are a doctor/nurse working in a covid ward we know for sure that the risk whatever happens long term is a lot less than the risk of getting covid. For someone like me who has no reason to go anywhere (I'm not even allowed in the office until this pandemic passes) I can afford to wait until there is more data - and I also have to because I'm low on the list of those who will be vaccinated because I'm relatively low risk of getting it.


Pandemrix causing narcolepsy comes to mind: https://www.who.int/vaccine_safety/committee/topics/influenz...


I have no idea, that's why I am asking. I'm hoping someone could clarify with decent knowledge on the matter.

I vaguely remember this story (from years ago) about a drug or vaccine during the 70s, where apparently everything was fine but then kids (or kids of kids, can't remember) ended up with birth defects.


You might be thinking of https://en.wikipedia.org/wiki/Thalidomide_scandal

The name of the drug was "Contergan" in german which german-speaking readers might recognize more easily.


Or Primodos (https://en.wikipedia.org/wiki/Primodos). Or Sodium Valproate (https://www.bbc.co.uk/news/world-europe-39657139). These cases really undermine my confidence in the system.


Be aware of availability bias here. If a medication did not make it into the news because of problems, we are a lot less likely to have ever heard of it.


Agreed. But in the case of Primodos, there were cover-ups with government involvement for decades. The end result was that Matt Hancock apologized. That was it. No holding to account. No fixing the system so it wouldn't happen again. That's what undermines my confidence in the system.


That's Thalidomide which wasn't a vaccine.

A more relevant example is Pandemrix, a flu vaccine launched in the EU in 2009. A year later it was discovered that it seems to increase the risk of narcolepsy in teenagers sixfold. The vaccine was produced and licensed in an expedited fashion because of a "pandemic" (of swine flu), which used a then-new and slightly experimental technique (adjuvants) which interestingly, German doctors flagged up as a risk and suggested the German government use a different H1N1 vaccine that was less experimental.


The 1976 Swine Flu outbreak and subsequent bungled vaccination campaign comes to mind


>The 1976 Swine Flu outbreak and subsequent bungled vaccination campaign comes to mind

Given that viral genome sequencing didn't even exist in 1976, I don't think it's a meaningful comparison.


the people in the trial are the first batch. these vaccines are following all the standards we have set for vaccines just at an accelerated pace and with accelerated funding. i know a lot of people who are hesitant about this shot, but it does sound antivax to say you aren’t sure it’s safe

id get this today if i could


That 'just' is where the valid concern lies. Nine women cannot make a baby in one month, and one important reason vaccine trials take the time that they do is to observe for side effects within the test population. You can't give ten people a shot, watch them for a month, and draw conclusions on the effects that will show up in an individual in ten months time.

There is no shortcut for that, and there is an obviously huge pressure to cut corners.

It's fair to be concerned, not anti-Vax.


I'm definitely not antivax. I've gotten pretty much every common vaccination. In my view there is a difference between antivax and a new drug or vaccine that has not been widely tested.


Yes, this is an incredible scientific achievement. Before calling all humans awesome, I have to point out though, that there are a lot of countries which managed the pandemic really well, especially in Asia, but most western industrial nations quite badly failed at this. A faster and better reaction to the outbreak would have helped a lot. Both with all the casualties which sadly were the consequence and with the ability to eradicate the virus via vaccinations.


thank god Biden was elected, otherwise this news would have been thrown in the trash.


Why is this a Biden vs Trump issue? They both have campaigned on Covid19 relief. Just because Trump isn't unconstitutionally forcing lockdowns, testing, & contact tracing doesn't mean he isn't doing anything. Pfizer and other vaccine makers got assistance with expediting their vaccine R&D, approval, & distribution as part of Trump admin's Operation Warp Speed. https://www.hhs.gov/about/news/2020/09/16/trump-administrati...


Yeah except Pfizer didn’t join Operation Warp Speed:

https://www.washingtonpost.com/politics/2020/11/09/no-pfizer...


[flagged]


Trump was one of Big Pharma's biggest enemies and even got them to lower the drug prices. That was a big, big no-no. So it's no surprise that they hate him so much.


Feel the same. Can't stop smiling. Never felt like a more accurate time to use the phrase "light at the end of the tunnel".

The US government is paying like $20 for each dose. I'd pay 100x that without batting an eye.

Thank you thank you thank you to everyone working on this vaccine and related Covid treatments.

Can't wait to get the needle in the arm!


Same here.

Congratulations and thanks to everybody who worked so hard on this.


Screw the media for pushing this and lockdown as the only possible solution. This will still take ages to be rolled out.


No, it won't. they are projecting 50 million doses to be ready in 2020 and 1.1 billion next year. That means that mom and dad and grandma are likely to get it within the next few months and that by mid next year, you'll probably have access to it if you are a healthy thirty year old.


Those 1.1 billion doses are not for the US alone. The vaccine was actually developed by Biontech in Germany before Pfizer was involved. Pfizer is the partner to scale up the studies and production. But you can assume that those doses are not US only. And then I'd doubt that a healthy 30 year old will get it in summer of 2021.


I believe 300M of them are accounted for by the EU vaccine purchase program. That said, it looks like those doses will be made in Europe; Pfizer seems set up to make it this in multiple facilities, which is a good sign.


Indeed. If you're in a low-risk group - no comorbidities, under 35 years old, not working in a front line role that exposes you to Covid, it's going to be a long time before you get the vaccine.


A vaccine is most effective if it manages to break chains of transmissions. That means you'd want to optimize for likely chains of transmissions, and not only for giving it to those vulnerably to the virus.

So grandma might need to wait, and the grandkids going to school might get it first, then healthy 20/30-somethings working in public facing jobs etc.


What are the other solutions?


Look, I get that you find lockdowns an inconvenience but the real world isn’t a TV show where a cheap and easily distributed cure will be invented 10 minutes before the end of the episode. People will reliably die until a vaccine or highly effective treatment is widely available, and the only way to slow that is to rely on proven public health techniques.

While you’re being inconvenienced remember that you’re better off than most people who’ve ever lived. Isolation and fear of early death were a pervasive part of life until the 20th century brought vaccination and antibiotics, and we’re getting only a small reminder of what used to be normal.


The lockdowns are causing immense economic damage. Even the WHO has pointed out that one of the main things they do is make the poor poorer. I have a feeling that this cure will cause more damage than the virus.


This is a common misunderstanding encouraged by certain politicians but it’s misattributing the cause: the pandemic is causing the economic damage. Most of the businesses worst affected are ones like restaurants and bars, which were going to collapse as soon as their customers realized that patronizing them is inherently risky. For example, Sweden famously didn’t have lockdowns but still saw a major economic decline - perhaps a little better than some other countries in Europe but still ruinous without government bailouts. Even if it’s legal most people will change their buying habits.

The other mistake is assuming that this is endless. Countries which have strict safety measures are able to reopen after having controlled spread - Australia had a hard lockdown and has now gone without any cases for a while. In contrast, the United States’ leaders chose to squander the sacrifice of the spring lockdown by not making it effective and then relaxing restrictions before the viral spread was controlled, ensuring the maximal cost for minimal benefit.


You criticized the commenter for objecting to lockdown. Why are the people you refer to dying? Is it possible it is because they aren't quarantining and staying at home?


Until we have an effective prevention or cure, we have to reduce the chances of catching it, especially during the period where people are spreading it before they show symptoms. Since it spreads mostly from prolonged time breathing the same air, the point of lockdowns is preventing those situations from arising. Quarantining after you become symptomatic is too late and without legal weight too many people won’t avoid situations to stop community spread.

That matters because there are things that you have to do, and you don’t have a way to control other people’s decisions. Closing high-risk recreational activities means that someone can go shopping with less risk because the people near them weren’t hanging out at the bar the night before.


The vast majority of Americans live in households where someone has to physically go to work in order to feed their family. Many others must leave their homes to purchase basic essentials.

The value of a lockdown isn't in changing the behavior of those who are already voluntarily avoiding exposure -- its value is in changing the behavior of those who inconsiderately spread it to others during their essential travels outside of their house.


That's strange because Argentina and Peru stayed locked down for months over their winter, yet there case numbers kept rising.


1. What would the rate have been without doing anything?

2. Do you have data showing how effective the lockdowns were? Did they have a problem with compliance?

Here’s a recent publication which could inform your opinion - note especially the part about employment forcing people to leave their houses to work:

https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

“ Latin American countries have long had some of the most scarring income inequalities in the world, and they are predicted to worsen. The informal labour market is huge, making up 54% of all work across the region (up to 70% in some countries, such as Peru). Informal workers have little access to social protection and have no choice but to continue to work daily to earn a living. The result is that their capability to follow quarantine and social distancing measures is limited. Informal workers also have less access to health care.”

“The increases in obesity and diabetes in Latin America are surely major contributors to the high mortality rates. In Mexico and Chile, more than 75% of the female population is overweight. Nutrient-poor and energy-dense processed foods are often the only type of food readily affordable to the most disadvantaged people. Although some countries, including Brazil and Costa Rica, have a universal health-care system, most Latin American countries have large gaps in accessibility caused mainly by out-of-pocket health expenditure, which is 34% of total health spending.”


It's difficult to say because most places did lockdown. Everyone expected Sweden to Spiral out of control but they didn't. Neil Fergusons models predicted an order of magnitude more deaths there (https://www.aier.org/article/imperial-college-model-applied-...) .

"Sweden had more deaths than Norway and Finland" yes they screwed up sending people to care homes when it first hit - over half of their deaths occurred there. like most of the countries that got hit early. Plus a lot of dark skinned immigrants (vitamin D levels have been shown to be a big factor). Those alone account for a lot of the difference. There is little reason to believe that lockdown had a very positive effect.


Neil Ferguson is a popular target by people misrepresenting his research. There’s a reason why you’re citing a self-published essay by a guy with no relevant experience who gets a paycheck from the Kochs for general right-wing activism rather than peer-reviewed research by someone with public health or medical expertise.


Doesn't sound strange to me. Rising case numbers is 100% a likely (or even expected) condition under a successful lockdown.

1. We have no idea what a null hypothesis scenario would be in Argentina or Peru.

2. Regardless, "flattening the curve" is more of a statement about the first or second derivative of case numbers.


Victoria, Australia had a lockdown that lasted for only 3 months and completely eradicated covid from the state.


Hypothesis about why Asia and nearby countries got affected so much less than the West, with what seems to be a decent data analysis. TLDR, exposure to bats in these countries and travel between them.

https://twitter.com/gummibear737/status/1298956333941743616?...


Victoria had an exploding case count that was set to match the rest of the world before the government did a hard lockdown. And not just the feel good ones they do in the US, the lockdown meant you could only leave the house for 1 hour a day for exercise within a 5km radius and anyone who absolutely had to leave the house had to show proof and wear a mask. The case count fell sharply only after these measures were put in place.


Nobody can 100% stay home. The more every does though the better the less than 100% works. When someone getting their prescriptions refills gets it they are just as sick as someone who goes to a bar and gets it. The only difference is someone who goes to a bar is out a lot more and so has a higher chance of getting it.


> Thank God.

God also gave us this virus, if we stick to the religious logic.


It was a figure of speech.


Actually, no - if one follows the 'religious logic' as you call it, we live in a Fallen World under the dominion of Principalities and Power of Darkness. It is from there that the virus came.

The 'God will smite thee' beliefs largely came about as a form of control over people, and do not line up with New Testament biblical teaching.


> New Testament biblical teaching

For amen I say unto you, till heaven and earth pass, one jot, or one tittle shall not pass of the law, till all be fulfilled.


Which is contradicted by Kosher dietary restrictions being struck down in the New Testament.

Part of the power of the Bible is its contradictions. Like in math, you can use one contradiction to prove any statement true.


Distinguishing between moral law and Jewish ceremonial law eliminates all of those supposed contradictions.


You assume Christinaty.


I thought it was bush meat. So human decided to eat something that they shouldn't. Geniuinly asking.


Did god put warning labels on things we should and shouldn't eat?

How do I use God's wisdom to decide if if a certain pig is "safe" to eat or not?


Since you asked!

Deuteronomy 14:3-20

3 “You shall not eat any abomination. 4 These are the animals you may eat: the ox, the sheep, the goat, 5 the deer, the gazelle, the roebuck, the wild goat, the ibex,[a] the antelope, and the mountain sheep. 6 Every animal that parts the hoof and has the hoof cloven in two and chews the cud, among the animals, you may eat. 7 Yet of those that chew the cud or have the hoof cloven you shall not eat these: the camel, the hare, and the rock badger, because they chew the cud but do not part the hoof, are unclean for you. 8 And the pig, because it parts the hoof but does not chew the cud, is unclean for you. Their flesh you shall not eat, and their carcasses you shall not touch.

9 “Of all that are in the waters you may eat these: whatever has fins and scales you may eat. 10 And whatever does not have fins and scales you shall not eat; it is unclean for you.

11 “You may eat all clean birds. 12 But these are the ones that you shall not eat: the eagle,[b] the bearded vulture, the black vulture, 13 the kite, the falcon of any kind; 14 every raven of any kind; 15 the ostrich, the nighthawk, the sea gull, the hawk of any kind; 16 the little owl and the short-eared owl, the barn owl 17 and the tawny owl, the carrion vulture and the cormorant, 18 the stork, the heron of any kind; the hoopoe and the bat. 19 And all winged insects are unclean for you; they shall not be eaten. 20 All clean winged things you may eat.


If you go by the Koran or Bible, pork is forbidden. If you go by the Bible, most (if not all) bush meat would also be forbidden.


> If you go by the Koran or Bible, pork is forbidden.

Correction - if you go by the Old Testament, pork is forbidden.


Is this really a "correction"? It's not as though other parts of the Bible (or Koran) explicitly repeal said forbiddance (even though the most popular interpretations prefer to see it that way)


Hey man, some people have multiple gods.


Thank Science! :p


Seeing the light at the end of the tunnel means it's more important than ever to isolate and stop this third wave ASAP.

It's hard enough to see loved ones die or to suffer life long side effects if lockdowns only delay it. But to have it happen just a couple months before a vaccine was available would be incredibly hard.

The prospect of a vaccine should make isolation much more bearable mentally. We're past halfway, folks!


This is not a panacea, it will still take time to fully vet the data and it will likely be months before doses start going out and even more months after that until sufficiently large numbers of people have been inoculated before we can even approach normality.


"it will likely be months before doses start going"

Where do you get that it will take "months" between emergency approval and actual vaccinations? The communications out of the leading vaccine teams clearly state otherwise.


>Where do you get that it will take "months" between emergency approval and actual vaccinations

Because this is a press release from a corporation with a vested interest in being "first" and not an approval by the FDA.


Oh, so just blanket cynicism with no evidence, got it.


Oh because you have lot's of evidence that vaccines will be available to the public in a few weeks?

https://news.yahoo.com/hhs-secretary-coronavirus-general-vac...

HHS expecting availability for the public in March. Let me see 1..2..3... ah yes that appears to be MONTHS away.


It will still take a long time before a sufficient number of people have been vaccinated that life can return back to normal.


True. But seeing a potential path towards making a sifnificant dent to the uncontrolled spread of the virus is a welcomed respite from nearly a year of darkness.

EDIT: I upvoted you because you make a valid point. Things will not recover overnight. But at the same time, we can still celebrate the hope of a promising solution.


One of the lead doctors in the UK is saying life will start to look normal in Spring 2021 (albeit, I assume he was referring to the UK alone). There's good reason for cautious optimism & patience.

Science has done its job; now we need to push for coordination between infrastructure, government, and business to finish it.


>One of the lead doctors in the UK is saying life will start to look normal in Spring 2021 (albeit, I assume he was referring to the UK alone). There's good reason for cautious optimism & patience.

I'm sure they have no incentives to say that right. The reality is that the UK and many others are in the middle of a massive surge of cases. The idea that life will be "normal" a few months from now in Spring seems farcical.


I guess it depends on what they mean by "start". Lead doctors in Germany say that it'll probably take until 2022 to vaccinate most people.


depends. If this provides spread prevention as well, then places can start opening up in about 6 months as enough locals get vaccinated as to slow the spread to the rest. On the other hand if this provides only some immunity but you are more infectious (ie the body doesn't fight the virus off, just makes it less dangerous - I don't think this is possible but....) we can't open up for years as anyone vaccinated is a risk to everyone else.

Of course there are other vaccines in development. If any other them pass trails that changes things too. we can only speculate as to how.

No matter what though, there is now a real light at the end of the tunnel.


> Thank God.

Wait who developed this vaccine again?


I'm glad we are going to have a vaccine, but I'm not so happy about 90%

I have built up in my head the idea of all the things I'm going to do 'once I get vaccinated', but at 90% that gets pushed off to "once most people get vaccinated". If it were by myself, I might push my luck. But I want to do those things with friends, or family. .9^n is pretty shitty odds once n gets to around 5.

There's a sort of rhetoric that's pointed out by 'Thinking, Fast and Slow' as a warning sign for agendas, and I've seen a bunch of them used by both sides this election cycle. But at the same time one of the defenses against these rhetorical devices is reframing: rephrase the bargain from another context and see if you'd still accept it. They don't seem to reconcile that in public discourse this reframing happens in public.

"If I go out for steak, I'm probably okay at 90%," versus, "If we have our family reunion at Disney World, there's a 50% chance we're all going to be attending a funeral in a month, even if everybody got the vaccine." You could call the latter shrill, sure, but "there's a 50% chance everything will work out fine," is self-deception. You're trying really hard not to look at all of the potential, statistically significant outcomes.


> "If I go out for steak, I'm probably okay at 90%," versus, "If we have our family reunion at Disney World, there's a 50% chance we're all going to be attending a funeral in a month, even if everybody got the vaccine."

How in the heck do you arrive at a 50% chance of someone dying? You might argue that there's a 50% chance of someone getting the virus (that's really debatable, it's not highly contagious), but even if someone did, their chance of survival is several orders of magnitude higher than 50% unless they are in a high-risk group...


0.9^n are the odds where you all go and get exposed simultaneously. When a large enough portion of the population is vaccinated, that prior probability goes way down.


Which is why I said,

> but at 90% that gets pushed off to "once most people get vaccinated"


I wake up long time ago when I realized the virus is not as dangerous as the media reported it. You too should wake up right now and live your life. Stop being afraid.


Three of my dead family members (edit for clarity: not my immediate nuclear family, but people I'm still close to) don't feel the same way (nor do those who were impacted by the hundreds of thousands of excess deaths in the US), but I'm glad you've found this whole thing to be overblown.


[flagged]


In my whole life (and I'm not young anymore) I have never known or been acquainted with someone who died of the flu. And I've also never known anyone who were still completely out five months after they had the flu, unlike a couple of young friends of mine who got Covid in March. One of them (<30) couldn't do a thing until October. If my parents get the flu it's extremely likely they'll be fine in a week or two. Covid would be a completely different story.


That's such an excessively tired, debunked, and often (but not always, and not necessarily in your case) bad-faith contrarian talking point that this far into the pandemic I can't be bothered to get worked up about it any more.


Who said I was afraid? I'm literally locked in my house in England, and all of the pubs are shut, and I'm banned from hanging out with my friends or my family. I want all that to end. I want to get back to seeing the world and going to festivals and for everyone to be able to do the same. I want my elderly grandmother to be able to see us again without worry. It's nothing to do with me being afraid.


[flagged]


Oh bugger off, I'm not getting into the ins and outs of the safety protocols I've been observing my for seeing my grandmother on hacker news. I'm relieved about the vaccine. You do you.


I am as happy about the progress as you are, don't let these people bother you. I would also not endanger anyone else by giving in to my impulses for the instant gratification of having a beer with some buddies. This is going to be over one day and all we need to do is not make things worse in the meantime.

(Behaviour in these times seems to be a good indicator who has got some self-control and who has not, I think)


Why shouldn't I be afraid? If my parents get infected there's a close to 100% chance that they'll die, due to their existing conditions. And I have to visit them, so do others. There's a real risk of infection there.


Maybe you should be, but if they are in bad shape, the 100% figure will apply to many diseases. On a long enough time line, they will of course die, just like you and everyone else.


Just like the planets and the stars and the universe itself. How is this relevant in any way to the discussion at hand?


I see my parents regardless. They are happy to see me. There are always a risk of some kind regardless of covid. My parents are old too, they have high chance of death and likely also have some kind of existing condition. Covid or not they have high chance of death at anytime.


This is what a subtle misunderstanding of risk and probability looks like. "It has not affected me so it probably doesnt affect anyone"


Where is the misunderstanding ?

>It has not affected me so it probably doesnt affect anyone

I didn't say it won't affect me or it won't affect anyone.


Covid isn't a particularly pleasant way to die though...


>I wake up long time ago when I realized the virus is not as dangerous as the media reported it. You too should wake up right now and live your life. Stop being afraid.

This is really exciting news. How did you find out? Shouldn't we alert the public?


How dangerous did you assess it to be?


Vast majority of the cases are asymptomatic or only have mild symptoms.


The vast majority of single rounds of Russian Roulette are won too.


Only 83.3%.


I don't think anybody disputes this.

But each new person who gets it is a potential spreader, which increases the likelihood of an at-risk person getting it. Someone who may be elderly or immunocompromised, who can be seriously hurt or killed by it.


Sure but how about the risk/damage due to lockdown?


Given the level of lockdowns we've seen so far, that is minimal. Especially if the government is smart enough to simply pay the wages of people who are forced to not work (which would also give a massive boost to the economy).


So what? 1% IFR is very, very high. If 90% of world population gets sick with it, 70 000 000 will die. Compare that with 700 000 flu death every year.


here cdc estimate of ifr https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scena...

0-19 years: 0.00003 20-49 years: 0.0002 50-69 years: 0.005 70+ years: 0.054

I wouldn't consider it high at all.

I'm not againts vaccine, I'm againts lockdown.

At least for me I consider the cost/risk from lockdown is greater than the cost/risk from covid.


Do you understand that it is not percents? Those are ratios? Do you realize that for 70+ IFR is 5%, and for 50-69 is 0.5%? You can consider anything I cannot force ypu to tyhink otherwise, but something that kills 1 in 18 senior citizen is something of extreme public health concern.


Of course the number seems high if you focus on a particularly vulnerable group. All that matters is the IFR across the entire population, as the entire population is being harmed by lockdowns.