SARS-CoVID-2/ CoVID-19/ CoronaVirus: Information Only from Well Informed Members

Baal · Aug 24, 2020

I agree with Dr.. Evil. My best guess is that monoclonal antibody cocktails will end up being more effective. Several are in Phase 3 trials and hopefully we find something soon. They have been carefully designed and you would know exactly what you are giving the patient. As for the plasma, there are so many variables and so hard to control. Evidence so far with that approach is not as encouraging as I was expecting. No proper clinical trials as yet and you might see very different effects depending on the donor.

What will get us back to normal is a safe and effective vaccine. Convalescent plasmas and infused monkclonal antibodies cannot provide more than transient protection, but I could imagine the antibody being administered in people who test positive on an outpatient basis.

Meanwhile, there are some very preliminary but encouraging results on a drug that mimics vasoactive intestinal peptide (VIP). This peptide seems to have a pretty strong effect on lung cells and lung blood vessels and it has been used in critically ill Covid-19 patients. Nothing
peer reviewed yet, so not to get too excited, but several patients on death's door here at Houston Methodist Hospital recovered after receiving it.

Brs · Aug 25, 2020

What about the one and only confirmed case of reinfection with a different strain. Just a freak thing, or not so much?

Dr Evil · Aug 25, 2020

Brs said:
What about the one and only confirmed case of reinfection with a different strain. Just a freak thing, or not so much?

Not a freak thing. Reinfection will happen, but how common it is and how long after initial infection it becomes more likely are open questions. We'll need to track many patients for a long time to get answers. A single case report won't do it. Interesting that the patient had no symptoms the second time around. Could be that he's effectively immune to getting sick but doesn't have sterilizing immunity. If this turns out to be typical, the virus may become endemic but mostly harmless like most other coronaviruses we know about. On the other hand, more than six months into the pandemic there have been notably few reports of reinfection, so it may turn out to be uncommon. We'll just have to wait and see.

Baal · Aug 25, 2020

I was encouraged by th e lack of symptoms rhe second time. But not surprised that it is possible.

allencorn · Aug 26, 2020

I have a question about vaccine efficacy. The US FDA has stipulated that for approval of a vaccine, it must be at least 50% effective. That means that infection rates in a vaccinated group would be 50% less than the rates in a placebo control group. So if 1% of a population is typically infected, with vaccination only .5% would be infected. In a region of 100,000 people, that is still a lot of infections in a vaccinated group (.5% x 100,000 = 500 people) if everyone was vaccinated, which is not likely.

From a public health perspective, this is good, as I assume the incidence of the virus will gradually continue to decrease, reducing risk for everyone, but from an individual perspective, how does that change my risk initially? If I get vaccinated, that does not mean I am automatically immune from the virus, it just means my chances of getting it have been reduced. So once a vaccine has been developed and I get it, is there a way to see if I am one of the lucky 50% who develop immunity?

And all these vaccine efficacy studies will be conducted in an environment where masks and social distancing are recommended or required. Do those results translate to a society that then relaxes these restrictions?

After reflecting on this, I am more interested in seeing effective treatments for COVID-19 rather than vaccines, as this would seem to be more helpful from an individual comfort level, knowing if I get infected, I can get treatment that will mitigate some of the seriousness of the infection.

UpSideDownCarl · Aug 26, 2020

zeio said:
.....

Zeio, is there a question with your link? I have deleted your post. If you have a question to add to the link for these guys to answer, I can undelete it. If I don't here from you at a certain point, I will just delete this post as well since it contains your link. [edit: I decided to remove the link without removing this post. I decided a reminder about the rules of this thread was fine to keep up here.]

I am sure you already know the rules of this thread. But, here they are for anyone who does not know them:

UpSideDownCarl said:
So, I just want this to be clear. I closed the last 2 threads on the Novel CoronaVirus Pandemic as it seemed that each, at some point went off into unsubstantiated territory. Nevertheless, with this global crisis, I still feel, having useful information on the subject available to our members will be valuable.

UpSideDownCarl said:
So, we are going to try something different here.

The rules of this thread are not the rules of most threads.

Baal, RainNeverEver, Dr Evil, and Passifid will be the well informed members or "Experts" on the thread since they all have science and medical related backgrounds. They can post as they see fit to provide information and to answer questions.

Other members can ask questions but cannot simply post thoughts, opinions, answers.

I will HEAVILY MODERATE the thread so that, if a member, unaware of the rules for this thread, posts content rather than a question, I will delete and inform that member of the special rules for this thread.

Thank you for you understanding and cooperation in this endeavor. I am looking forward to seeing how this thread turns out.

Dr Evil · Aug 30, 2020

allencorn said:
I have a question about vaccine efficacy. The US FDA has stipulated that for approval of a vaccine, it must be at least 50% effective. That means that infection rates in a vaccinated group would be 50% less than the rates in a placebo control group. So if 1% of a population is typically infected, with vaccination only .5% would be infected. In a region of 100,000 people, that is still a lot of infections in a vaccinated group (.5% x 100,000 = 500 people) if everyone was vaccinated, which is not likely.

From a public health perspective, this is good, as I assume the incidence of the virus will gradually continue to decrease, reducing risk for everyone, but from an individual perspective, how does that change my risk initially? If I get vaccinated, that does not mean I am automatically immune from the virus, it just means my chances of getting it have been reduced. So once a vaccine has been developed and I get it, is there a way to see if I am one of the lucky 50% who develop immunity?

And all these vaccine efficacy studies will be conducted in an environment where masks and social distancing are recommended or required. Do those results translate to a society that then relaxes these restrictions?

After reflecting on this, I am more interested in seeing effective treatments for COVID-19 rather than vaccines, as this would seem to be more helpful from an individual comfort level, knowing if I get infected, I can get treatment that will mitigate some of the seriousness of the infection.

A vaccine that's 50% effective by FDA standards wouldn't necessarily reduce your personal risk by the same amount. It would depend on many factors including your age, health, the prevalence of the virus where you live, etc. What it would do is reduce the effective reproduction number (the average number of new cases generated by each case) by a roughly predictable amount in populations matching the clinical trial population. A good vaccine might be able to get R below 1 without any social distancing measures. Of course enough people would have to get vaccinated, and the required number would be higher with a less effective vaccine. I agree that a good treatment, especially one that keeps people out of the hospital, could be as much of a game changer as a vaccine.

Baal · Aug 31, 2020

Clearly we need both: effective treatments and an effective vaccine. Of course the word effective is vague. However a vaccine that makes someone asymptomatic or mildly symptomatic instead of critically ill or dead is effective by my way of thinking but maybe hard to tease out of clinical trials. Dr. Evil has pointed out the cricial population effect on R.

Regarding drugs, a lot of effective drugs fail on some patients. Look at any randomized clinical trial for anything and you can see that.

An effective orally bioavailable small molecule antiviral would be ideal and from what I can discern we are nowhere near that for any coronavirus.

I remain optimistic that vaccines will eventually provide some definite protection but there are people who know more than I do on both sides of that prediction and we will just have to see.

NextLevel · Sep 16, 2020

Right, Hype, or Tripe?

https://www.upmc.com/media/news/091420-mellors-dimitrov-covid-ab8

Baal · Sep 16, 2020

Not tripe and almost certainly right. Might be useful. It's an antibody fragment, an unusually small one, but it can neutralize the virus. Anything that can do that is worth looking at. The idea is (I think) that small pieces can get to more places (which is probably good). It might be safer because it doesn't form aggregates. Probably a lot cheaper to produce. Stil, needs intravenous infusion. I'm not sure how big a breakthrough this is (for example compared to antibody cocktsils) but I might be missing something. University PR units like to put out press releases. But the editors of Cell were convinced, and they are not easy to persuade and this article was extensively peer reviewed by people more knowledgeable than I am. Also the data in the animal model are a lot more convincing than experiments done in a culture dish. Still, it's not yet in even a Phase 1 tfial. Maybe slightly hyped.

souza13alex · Sep 21, 2020

I have noticed that today almost every day there are some "brilliant" discoveries, but careful research turns out to be only remote assumptions from real products.

Baal · Sep 21, 2020

You noticed correctly.

The reality is that biomedical research, especially the kind of lab research I do, always takes awhile to lead to a new therapy (if it does at all, and when it does it is from a lot of work by many labs, never just one study). And even then there are a few years or a decade wherein there are many new clinical trials to really confirm that it IS an advance. I'm still hoping that what I do could lead to a drug. Its a cool idea, might lead to nothing.

But then there is the hype aspect. I personally have come to dislike it intensely. My very old school mentor used to say don't ever do it. Publish your articles and move on. Like I said, old school British style or so I figured. But later a clinician colleague who works on ALS once explained to me why he would never hype his own research, since it leads to false hopes. His comment had a big impact on me. It actually came after the university released something about one of my papers. It was a a nice paper (he told me), but come on, get real. He was right. I felt properly chastised and a bit embarrassed.

But university PR departments ALWAYS have another agenda. They are all about (1) attracting philanthropic gifts or other $$$ and (2) convincing young people they think are the best students to enroll. So every paper in a high visibility journal generates a press release (they constantly want us to send them content) and newspapers pick it up uncritically. Science journalism is sometimes excellent, but too often just reprints these PR blurbs. And even within a university, different colleges compete for limited funds. One college at my university would appear to be on the verge of solving EVERY problem afflicting humanity -- if you believe their press releases.

I personally think it is damaging to science and medicine at a lot of levels. So I'm actually glad you made that comment. My opinion on this might make me a bit of a dinosaur, I'm not sure. I haven't discussed it with younger colleagues. But anyway, that is what drives this.

Press releases from drug companies are often much closer to an actual product (before that secrecy is the rule) but again, they have multiple agendas (which vary depending on many considerations such as size of company, stock price etc.).

UpSideDownCarl · Sep 21, 2020

souza13alex said:
I have noticed that today almost every day there are some "brilliant" discoveries, but careful research turns out to be only remote assumptions from real products.

I see you are newer to the forum and have not made too many posts. So, I just want to remind you (maybe inform you): this thread has different rules than all other threads. Baal, Dr Evil, Passifid and RainNeverEver can post content as they choose and can answer questions.

All other forum members, if they post in this thread need to be asking questions.

Now, Baal responded in a way that makes your post fine. But, in the future, please pose questions in this thread rather than statements or information meant as useful content.

Feel free to read the OP from the thread with the information on how this particular thread is supposed to work which I am including below.

UpSideDownCarl said:
So, I just want this to be clear. I closed the last 2 threads on the Novel CoronaVirus Pandemic as it seemed that each, at some point went off into unsubstantiated territory. Nevertheless, with this global crisis, I still feel, having useful information on the subject available to our members will be valuable.

So, we are going to try something different here.

The rules of this thread are not the rules of most threads.

Baal, RainNeverEver, Dr Evil, and Passifid will be the well informed members or "Experts" on the thread since they all have science and medical related backgrounds. They can post as they see fit to provide information and to answer questions.

Other members can ask questions but cannot simply post thoughts, opinions, answers.

I will HEAVILY MODERATE the thread so that, if a member, unaware of the rules for this thread, posts content rather than a question, I will delete and inform that member of the special rules for this thread.

Thank you for you understanding and cooperation in this endeavor. I am looking forward to seeing how this thread turns out.

UpSideDownCarl · Oct 8, 2020

souza13alex said:
Unfortunately, yesterday there was a new anti-record for the number of illnesses worldwide, based on today's tendency, I think the world will get used to the new reality of life - in permanent quarantine. What do you think?

MaLin2.0 said:
Seems like that, no social gatherings on the cards for a while, even Christmas looks like few direct family members. Until number is contained think we need to adjust.

Wonder how Table Tennis looks like moving forward, is the future of the sport in jeopardy? Sure they are having hubs however feel one of the sports that relies on players touring the world where they generate audiences and TV ratings and sponsorship. Right now these hubs are a kinda bandaid for a bullet wound. Don't think empty crowds is sustainable for long periods of time.

Is Olympics in jeopardy? Not sure logistically can introduce 11,000 athlete plus trainers and coaches and world wide media and spectators safely, number just too big to carry out safe passage to the country, to village to venues etc

Guys, please read the rules of this thread. They are posted over and over. Rhetorical questions are not questions that you need someone who is an expert to answer. You both have been warned about this before. Therefore, I am deleting your posts.

UpSideDownCarl said:
So, I just want this to be clear. I closed the last 2 threads on the Novel CoronaVirus Pandemic as it seemed that each, at some point went off into unsubstantiated territory. Nevertheless, with this global crisis, I still feel, having useful information on the subject available to our members will be valuable.

So, we are going to try something different here.

The rules of this thread are not the rules of most threads.

Baal, RainNeverEver, Dr Evil, and Passifid will be the well informed members or "Experts" on the thread since they all have science and medical related backgrounds. They can post as they see fit to provide information and to answer questions.

Other members can ask questions but cannot simply post thoughts, opinions, answers.

I will HEAVILY MODERATE the thread so that, if a member, unaware of the rules for this thread, posts content rather than a question, I will delete and inform that member of the special rules for this thread.

Thank you for you understanding and cooperation in this endeavor. I am looking forward to seeing how this thread turns out.

NextLevel · Oct 8, 2020

Forbes had two articles both concerned about how the vaccine trials were structured to exclude the high risk groups afflicted by the disease, which means the trials are likely to be more successful than they should be given the nature of the high risk groups for the disease. Are these concerns valid?

https://www.forbes.com/sites/willia...-trials-are-designed-to-succeed/#462b1d525247

https://www.forbes.com/sites/nextav...ials-are-excluding-older-adults/#737964db1dbb

Baal · Oct 8, 2020

NL, Based on my somewhat limited knowledge, i would say these critiques are absolutely valid, and the people writing them are experts (William Haseltine was a heavy hitter in the world of pharmacology for a long time). The information in those Forbes pieces is new to me and I'm actually quite shocked by it, along with the small size of the trials. I don't have much that is illuminating to say since designing clinical trials is not what I do (and as I noted upthread, trials for vaccines present special challenges, different from most drugs). But having read those pieces, I'm concerned.

From what I've seen, the science journalism in Forbes is some of the best anywhere, often because the pieces are written by scientists in the field. I have no idea about other things they write.

MaLin2.0 · Oct 8, 2020

UpSideDownCarl said:
Guys, please read the rules of this thread. They are posted over and over. Rhetorical questions are not questions that you need someone who is an expert to answer. You both have been warned about this before. Therefore, I am deleting your posts.

Hey do apologise, yes been warned, slipped my mind but will be extra careful moving forward on the thread. Don't want create friction as do enjoy browsing on this forum.

UpSideDownCarl · Oct 9, 2020

MaLin2.0 said:
Hey do apologise, yes been warned, slipped my mind but will be extra careful moving forward on the thread. Don't want create friction as do enjoy browsing on this forum.

Thank you. It is just that, two earlier versions of this thread really did get off onto conspiracy theories and needed to be closed down. So I don't want this thread to slip into that again since it is a subject that is not TT and it is very emotionally charged since we are all, dealing with this to some extent everywhere on the planet.

Dr Evil · Oct 10, 2020

NextLevel said:
Forbes had two articles both concerned about how the vaccine trials were structured to exclude the high risk groups afflicted by the disease, which means the trials are likely to be more successful than they should be given the nature of the high risk groups for the disease. Are these concerns valid?

https://www.forbes.com/sites/willia...-trials-are-designed-to-succeed/#462b1d525247

https://www.forbes.com/sites/nextav...ials-are-excluding-older-adults/#737964db1dbb

The trial protocols seem entirely reasonable; for a quick overview see Derek Lowe on The Vaccine Protocols. You can trust Lowe on this subject matter. I'd ignore the Haseltine article even though he is a big name. There's appropriate skepticism and then there's petulance and nit-picking. For example, he makes the provocative claim that "prevention of infection is not a criterion for success for any of these vaccines." But all the trials test for prevention of infection. He knows this, and his complaint turns out to be that this is only a secondary objective. This is immaterial, since the relevant data will be collected, and everyone including the agencies responsible for authorization will have access to it. He goes on to make a number of bizzare criticisms, including that the numbers required for interim reporting seem very small. But these numbers aren't chosen by the researchers; they're generated by standard statistical calculations and are precisely sufficient to answer the questions being asked. If you want fast preliminary results for emergency authorization -- which are not guaranteed, only hoped for -- then these are the right numbers.

The other article is much better, and makes a reasonable case that older people are being inappropriately excluded from some trials. By most accounts the big phase III trials are making serious efforts to enroll people in the 65+ age group, as well as from hard hit minority communities, but they haven't been as successful as they'd like so far. It's difficult given the higher prevalence of pre-existing/disqualifying medical conditions in those communities, as well as skepticism about vaccine safety. They'll get it done eventually, but (as with everything concerning this pandemic) not as soon as we'd like. But if you want a vaccine in less a year, the perfect is the enemy of the good enough.

Baal · Oct 10, 2020

Dr. Evil makes good points and he knows more about vaccine clinical trials than I do. Recruitment is always hard in certain groups, especially okder oeople. I just hope these trials have sufficient statistical power.

His last sentence is pretty much how I feel about this upon thin,ing about it some more.

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