I find myself largely in agreement with the editors of the Washington Post, unsurprising since they’re now saying much what I’ve been saying all along:
VACCINE OPTIMISM is understandable in these days of anxiety about the virus. Almost every day, there are upbeat reports about a vaccine starting a new phase of clinical trials, and the worldwide research effort spans technologies old and new. Surely a safe and effective vaccine must arrive before too long — as promised, in “warp speed,†such as later this year or early next?
A dose of realism would be prudent. Vaccines are truly remarkable medicine and have proved effective in stopping diseases such as measles and polio. But they are not simple to discover, manufacture or distribute. Many research efforts fail. The first clinical trial for an HIV vaccine was in 1987, and there still isn’t one, despite much hard work. As Carolyn Y. Johnson reported in The Post on Monday, once a vaccine is found to be safe and effective, the process will be at the beginning, not the end. Vaccines must be manufactured to exacting standards. Distributing the vaccine fairly to people in the United States and around the world will strain health networks, the supply chain, public trust and global cooperation. This may take months or, quite likely, years.
Another reason for caution is that the vaccine timeline depends on human physiology. It may take a while to build up the antibodies to fight the novel coronavirus. A second inoculation may be required. Immunity could be short-lived or partial. Also, it is possible that the first vaccines to win approval may not be perfect, and not work all the time on everyone.
That last is one area of disagreement. I think that a vaccine whose benefits are extremely short-lived or, worse, unpredictable in its prophylactic effect would actually be worse than no vaccine at all.
They conclude:
Let’s suppose it is summer of 2022, and there is still no vaccine. What would we wish we had done today? Let’s do it.
Okay, what would that be? And should we be preparing for a vaccine at all? My speculation is that of materials and personnel personnel will be the graver bottleneck. Maybe I’m overestimating that since nowadays every Walgreens is offering flu vaccinations.
I think we should be preparing for the eventuality that a practical vaccine for SARS-CoV-2 is never developed. What would we be doing in that case? I don’t know but I know what we should not be doing. We should not be threatening to close down businesses due to a rising test positivity rate as long as the risk of a system failure in the health care system is nominal as is the case in Illinois.
‘We should not be threatening to close down businesses due to a rising test positivity rate as long as the risk of a system failure in the health care system is nominal as is the case in Illinois.’
I don’t think Los Angeles Mayor Eric Garcetti agrees with you.
https://nypost.com/2020/08/05/la-mayor-threatens-to-turn-off-water-power-after-beverly-hills-bash/
Apparently he has authorized the utility company to do exactly that people continue to flout his Kung Flu dictates. I fully expect that it will be enforced selectively depending on the political power of the host of the parties. A display of what I call negative intelligence.
Although the daily new cases of COVID-19 appear to be under control in California, the number of deaths per day due to the disease continues to increase. I can’t venture a guess as to why that might be. The situation there appears to be different than in any other state.
Lots of hispanics especially in southern Cal.
And they have a high death rate from Covid 19.
https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/Race-Ethnicity.aspx
You bring up a good point. I haven’t looked into the cases and deaths by race yet. I don’t know whether that’s relevant or not.
We should be spending a lot on upgrading hi-flo ventilation and raising filtration standards to MERV 13 at least to increase indoor safety.
Breath should go up into the filtration or exit the building and be replaced with fresh air. This is going to raise A/C and heating bills considerably but needs to be done to assure the public they are safe indoors with others.
https://news.unl.edu/newsrooms/today/article/increased-air-circulation-filtration-part-of-fall-semester-prep/
COVID 19 has been politically exploited, giving rise to unconscionable, unconstitutional restraints over people’s lives and livelihoods. We have been inundated with word redundancy, citing “science†and “safety“ as air tight reasons for the need of these lengthy draconian measures. However, frequently our lying eyes see and read data, opinions, observations which contradict standard talking points endorsed by what is becoming an untrustworthy media, CDC, Democrat mayors/governors/Congress/teacher unions.
In the meantime, where I’ve been in place during most of the lockdown, the healthcare system has not been overwhelmed by COVID. Initially, hospitals were busy. Then hospitals shifted to patient loads involving peoples’ delayed medical care. Now, hospitals seem to be over-staffed due to decreased traffic going in and out of these facilities. For instance, we have a tenant who is an ER physician. His hours have been drastically cut, leading us to reduce his rent. This is far from an isolated occurrence when reading similar stories of hospitals down-sizing their staffs.
We would have been better served, IMO, had we moderated our virus response by shortening lockdowns, focusing quarantines and guidance on those known, early-on, to being more vulnerable to COVID. People should have been given greater independence in deciding what perimeters they wanted to follow at home and in their business practices. “Testing“should have been suspended, like it was in the Obama Administration, 3 months after the first case was verified, reducing the ongoing daily injections of fear to a house-bound citizenry. Furthermore, the number of false positives, lab errors or delays in results, eventually makes relentless testing meaningless, only creating a very unreliable data base. Viral treatments, showing successful results, should be inclusive. This would include the use of HCQ – an already long approved drug by the FDA. It should have been made readily available by a person’s attending Physician, not banned or discredited by medical establishment and Pharma voices who prefer the use of more expensive drugs like remdesivir – an in hospital IV treatment costing $2000-$3000 vs HCQ + zinc costing around $12.
Finally, punishing people for not wearing masks, turning utilities off on homes and businesses not following arbitrary local/state dictates seems to go beyond emergency powers granted to elected officials. Putting fiscal tourniquets on businesses, causing them to go out of business has what benefit? Holding schools hostage under the demands of teacher unions, most of which are far afield from COVID concerns, especially in light of zero deaths from this virus in states like CA for children under 18, seems unrealistically cruel.
Basically, the mandates, limitations, shaming manufactured by “others†appears to be out of control, doing far more harm than good. But, those in charge seem deaf, dumb and blind to what is happening all around them.
I understand, CNN yesterday hammered away at the President because of state of the virus, he said “it is what it is “. Followed by repeatedly reminding us that a thousand Americans die every day and the President does not care.
So I checked. On average, eight thousand Americans die every day and CNN just pissed on seven thousand of them.
They do need to stop the daily death tally or send it to page five, but politically it’s too damn useful.
“It should have been made readily available by a person’s attending Physician, not banned or discredited by medical establishment and Pharma voices who prefer the use of more expensive drugs like remdesivir”
Once again, the world you live in is much different than mine. In the world of medicine the huge majority of people started out using HCQ. Most of us found it didnt help so we stopped making it mandatory and left it up to the individual physician whether or not to use it. There is actually a decent study which supports the use of remdesivir. There is no high quality study that supports the use of HCQ. There are several ongoing studies that should help decide if it is useful.
““Testing“should have been suspended, like it was in the Obama Administration, 3 months after the first case was verified”
Stupidest thing I have heard suggested about Covid.
Also, CA has had a child die.
“https://www.capradio.org/articles/2020/08/03/california-has-reported-the-first-teen-death-from-covid-19-heres-what-parents-need-to-know/
Steve
To make a general response I think I have given specific responses about what we should have done in the past. Going forward I think that we should continue to emphasize masks and distancing. We should do surveillance testing and set up track and trace groups where we can. We should be better prepared in case we have another outbreak this fall. The man of science here has informed me that any worries about a fall outbreak would be solely based upon politics, bout the history books show that another outbreak in the fall is not uncommon for respiratory viruses. The combination of flu and superinfection with Covid could be deadly, especially for young kids and what currently gives a 45 y/o a 5 day admission may tuen deadly or result in a prolonged ICU admission. I would push for more differentiation between indoor and outdoor activities. Outdoor risks look to be much lower than indoor.
I doubt that we totally shut down again, but we need to have plans for what we do if hospitals do get over run. Just let the excess die? Lottery those we treat? Do it by age? I know what they did in NYC.
Lets make sure we have adequate PPE and adequate testing ability. We are unable to test most of our inpatients now due to reagent shortage. Very depressing.
Steve
I have no objection to any of that, steve. I also think that President Trump has been remiss in not using his authority under the Defense Production Act to get more reagents and PPE made here in the U. S.
Needs to be based on ability to pay. Any other criteria would bankrupt hospitals.
There are charitable foundations, am I correct?
“There is no high quality study that supports the use of HCQ.”
There is also an epidemiologist at Yale with hundreds of peer reviewed papers who begs to differ. I have no dog in this fight. If it works, great. If it works selectively, great. If not, OK. But like masks, what is the real harm. Why the vociferous outcry? Politics, of course.
I agree w/ Grey about doing more about ventilation.
We Need to Talk About Ventilation
Particularly with schools mostly closed over the summer, this was the time to evaluate and mitigate. To be fair, I’m not sure we understood transmission means at the time, but its still a wish.
Two things I want to pull from the article I linked:
1. For steve, “a recent (preprint) paper showed that health-care workers in the United Kingdom—where hospitals are older and ventilation measures are poorer—were getting sick at higher rates than those in the United States where many hospital buildings come with ventilation mitigation measures.” Dave linked to a UK article that mentioned outbreaks in hospitals that steve questioned, and this appears to be the explanation.
2. The article claims that the effectiveness of air circulation and filtering inside airplane cabins is actually pretty good. The St. Louis Cardinals just experienced an outbreak on a 90 minute flight from St. Louis to Minneapolis. One or two players came onto the plane infected, resulting in a total of seven players and six staff infected, whose seats were close to each other. They wore masks, kept the middle seat empty, had the air fan above their seats turned on all the way. I do wonder if private planes might have issues that traditional commercial planes do not, but the policy is to try to avoid security theater, lines, and large airports.
I wish that people had a more nuanced view of masks; they might offer some protection, but in discussing these issues elsewhere, I am convinced that a lot of people think wearing any old mask/gator is like practicing safe sex, its moral and protects against all risks. And it encourages people to take risks.
Steve, A Yale epidemiologist, a John Hopkins cardiologist (Ramin Oskoui) and many others have vouched for the use of HCQ + Zinc, in the early stages of COVID, finding it very effective – life saving effective. Furthermore, 51 global studies have shown positive results for HCQ when used during appropriate (early) stages of the virus with zinc. 16 studies showed negative results. However, 10 of those 16 studies involved application in late stages of the virus. IMO, Fauci and “TV doctors“ have been very disingenuous in their depiction, and then deprivation, of a drug that has been used effectively by physicians around the world.
Remdesivir has been a useful anti viral too. But, it’s far more expensive than HCQ, and requires hospitalization and IV delivery.
If suspending testing isâ€stupid,†why did Obama call for the same suspension after only 3 months? Other epidemiologists and infectious disease doctors have concurred that both endless testing as well as contact tracing are of little help.
Also, that was a faulty link provided regarding one child dying from COViD in CA. However, I recall reading an earlier story about a teen reported as a COVID death, after which it was discovered he had a myriad of co-morbidities, including obesity and diabetes.
“A Yale epidemiologist, a John Hopkins cardiologist (Ramin Oskoui) and many others have vouched for the use of HCQ + Zinc, in the early stages of COVID, finding it very effective – life saving effective.”
Then they should publish a study. I actually read what the Yale guy wrote. Did you? Bet not! One of the studies he cited as proof was the Michigan study which is seriously flawed. He doesnt have much credibility on this. I also read through the database of 65 studies which claims to have mostly positive results. Should I assume you read through those also? (OK, I read through them Like I would most journal articles not reading every word but checking methods and results.) That includes studies like the early Chinese ones where they report on 40 pts and most of them were women. So there are no high quality studies supporting HCQ. We need prospective randomized studies. There are a couple of those and they show HCQ does not work but I think those also had flaws. I dont know about TV doctors but the ID folks I work with and the network of ICU doctors I work with and know, which is pretty broad, dont think it helps based upon their experience and the available literature. There may be a role for early prevention (I and my sources are hospital based) but it is likely that the effect is small since we usually pick up big changes right away.
“If suspending testing isâ€stupid,†why did Obama call for the same suspension after only 3 months?”
We dont treat every illness the same. We didnt have a new, unknown virus killing over 150,000 people in half a season under Obama. Testing and treatment should be appropriate for the illness. So if you stop all testing how would we know who has the disease and should quarantine? I think one of our goals is to get people back to work. Covid symptoms can be pretty non-specific. Everyone can just quarantine when they have a low rate race fever or they can et tested and if negative go back to work. How do we handle hospitalized pts? Lump them all on the same wards? How do we know the incidence in any given area and where we should be moving resources? I could go on but hope the picture is clear.
” Other epidemiologists and infectious disease doctors have concurred that both endless testing as well as contact tracing are of little help.”
Cite one who has said we should stop all testing. There are valid arguments about how much we should test but no one with credibility is saying we should stop all testing.
“very disingenuous in their depiction, and then deprivation, of a drug that has been used effectively by physicians around the world.”
So I dont know every hospital, but at those I do know there is no deprivation. Docs may order it if they wish. Most dont where I work and the places I know about since they didnt see any results from it. We did our own internal study also just to be sure.
PD- Thanks. Maybe a bit of inside baseball but we need a lot more space with negative pressure ventilation. It greatly reduces risk we think. Most older hospitals have no rooms with it and even newer hospitals have few if any space with negative pressure ventilation.
Steve
Omaha had a six year old boy with Covid die, but he was the recipient of a triple organ transplant previously, and so…