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

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There is a lot of news and to start with I need to some of the studies on the the duration of antibody responses (either in people who get the disease or people who get the vaccine). Bottom line, that tells very little about the duration of immunity. Antibody responses always go down at some point after an initial infection (or exposure to a vaccine) This is just how it works. What matters is what happens if the person is exposed to the virus a second time after this (this is called the secondary immune response). Because the immune system has "memory" usually the antibody response peaks again and a lot of cellular immune responses are triggered too. But not always, and in the case of SARS-CoV-2 we just don't know. There are reports of second infections in people but I'm not convinced, these may be people who never entirely eradicated the virus from their body. Time will tell, it could go either way (and it may be different in different people). Keep that in mind as we discuss vaccines.

The biggest news lately has been from (1) the Moderna RNA vaccine, and (2) the Oxford University/AstraZeneca vaccine, which uses an engineered chimpanzee adenovirus to deliver SARS-Cov-2 proteins into human cells to evoke an immune response (3) The CanSino Biologics vaccine from China, which uses an engineered human adenovirus. All three have evoked very strong immune responses based on being able to increase blood antibodies that neutralize SARS-CoV 2 proteins. So far they all seem safe. The Oxford vaccine was tested in healthy adults, all under age 55. In addition to inducing production of neutralizing antibodies, it also induced cellular immune responses, which is pretty interesting and important. A much stronger response appeared in a subset of patients who received a second booster shot. The CanSino Biologics also reported both antibodies and cellular immune responses. At first glance the responses to that vaccine seemed a bit weaker but it really is hard to compare directly since things were not evaluated the same way, and they didn't report responses to a booster injection. It is possible that some humans have antibodies against the human adenovirus vector, which can cause mild colds, and which could conceivably reduce effectiveness of that vaccine. This has also been published in the Lancet.

Finally I should mention that Pfizer/BioNTech have released results of a much smaller Phase 2 trial of their own RNA vaccines, actually two of them (similar to the Moderna one in principle). They have two additional ones in development. There vaccines required a second booster and resulted in strong antibody and T-cell responses (they say) but nothing published so far. If what they say is true, their responses are a bit better than the Moderna one.

So what do we know and not know? Well these are all Phase 1/2 trials of various sizes, which I explained earlier on this thread. We don't know if any of these will actually protect someone from getting Covid-19. That can only be ascertained from Phase 3 trials, which by their nature take a lot longer. But those will now proceed.

However there is reason to be cautiously optimistic. For the mean time, really try your best to not catch this virus!!!!
 
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Another paper I saw amazed me and underscored how unpredictable Covid-19 is. 41 kidney transplant outpatients with known or suspected COVID-19 were treated at Columbia University Medical Center in NYC, and only 13 of them required hospitalization. They were hospitalized a median of 8 days from symptom onset but as late as 16 days after onset. Bear in mind that these patients take a whole cocktail of immunosuppressive drugs to keep them from rejecting the transplant. So you might predict that these people would be especially sensitive, it is a pretty striking comorbid state. Well I certainly would have.

But they did ok, certainly better than I would have predicted. It will take a lot more time to tease out why Covid-19 didn't immediately cause massive problems.
 
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There is a lot of news and to start with I need to some of the studies on the the duration of antibody responses (either in people who get the disease or people who get the vaccine). Bottom line, that tells very little about the duration of immunity. Antibody responses always go down at some point after an initial infection (or exposure to a vaccine) This is just how it works. What matters is what happens if the person is exposed to the virus a second time after this (this is called the secondary immune response). Because the immune system has "memory" usually the antibody response peaks again and a lot of cellular immune responses are triggered too. But not always, and in the case of SARS-CoV-2 we just don't know. There are reports of second infections in people but I'm not convinced, these may be people who never entirely eradicated the virus from their body. Time will tell, it could go either way (and it may be different in different people). Keep that in mind as we discuss vaccines.

The biggest news lately has been from (1) the Moderna RNA vaccine, and (2) the Oxford University/AstraZeneca vaccine, which uses an engineered chimpanzee adenovirus to deliver SARS-Cov-2 proteins into human cells to evoke an immune response (3) The CanSino Biologics vaccine from China, which uses an engineered human adenovirus. All three have evoked very strong immune responses based on being able to increase blood antibodies that neutralize SARS-CoV 2 proteins. So far they all seem safe. The Oxford vaccine was tested in healthy adults, all under age 55. In addition to inducing production of neutralizing antibodies, it also induced cellular immune responses, which is pretty interesting and important. A much stronger response appeared in a subset of patients who received a second booster shot. The CanSino Biologics also reported both antibodies and cellular immune responses. At first glance the responses to that vaccine seemed a bit weaker but it really is hard to compare directly since things were not evaluated the same way, and they didn't report responses to a booster injection. It is possible that some humans have antibodies against the human adenovirus vector, which can cause mild colds, and which could conceivably reduce effectiveness of that vaccine. This has also been published in the Lancet.

Finally I should mention that Pfizer/BioNTech have released results of a much smaller Phase 2 trial of their own RNA vaccines, actually two of them (similar to the Moderna one in principle). They have two additional ones in development. There vaccines required a second booster and resulted in strong antibody and T-cell responses (they say) but nothing published so far. If what they say is true, their responses are a bit better than the Moderna one.

So what do we know and not know? Well these are all Phase 1/2 trials of various sizes, which I explained earlier on this thread. We don't know if any of these will actually protect someone from getting Covid-19. That can only be ascertained from Phase 3 trials, which by their nature take a lot longer. But those will now proceed.

However there is reason to be cautiously optimistic. For the mean time, really try your best to not catch this virus!!!!

Thank you Baal. It is great to read this.
 
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Another paper I saw amazed me and underscored how unpredictable Covid-19 is. 41 kidney transplant outpatients with known or suspected COVID-19 were treated at Columbia University Medical Center in NYC, and only 13 of them required hospitalization. They were hospitalized a median of 8 days from symptom onset but as late as 16 days after onset. Bear in mind that these patients take a whole cocktail of immunosuppressive drugs to keep them from rejecting the transplant. So you might predict that these people would be especially sensitive, it is a pretty striking comorbid state. Well I certainly would have.

But they did ok, certainly better than I would have predicted. It will take a lot more time to tease out why Covid-19 didn't immediately cause massive problems.

And that is really really interesting.
 
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People who want an easy to understand summary of immunology sufficient to understand a lot of the issues in Covid-19 should see this extensive thread from an actual (and quite famous) immunologist, Dr. Akiko Iwasaki from Yale University. It is really well done, a whole lot better than I could do. I know some readers here will like this. By the way, she is one of the world's top experts on interferons in Immunology, which play a big role in responses to SARS-COV-2.

https://twitter.com/VirusesImmunity/status/1285944893085491204
 
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A paper came out in Nature showing WHY hydroxychloroquine (HQ) doesn't work against Covid-19. The original cell culture study showing an anti- viral effect was done in a non-human cell line called Vero (from a monkey kidney originally). Its convenient to work with and widely used. The SARS-COV-2 virus needs a protease to replicate and in Vero cells it uses a type of cathepsin protein that only works in acidic compartments in those cells. HQ has long been known to deacidify those compartments so the cathepsin is inactivated and so the virus can't replicate.

The problem is that human lung cells have a different protease the virus can use that doesn't need an acidic environment so the virus can replicate even in the presence of HQ.

https://www.nature.com/articles/s41586-020-2575-3
 
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I need to back and review some of what he is citing. I have definitely not read all of it. Again, the scientific rationale -- how it is supposed to produce an anti-viral effect -- is weaker than it was before.

There was a double blind placebo controlled study of HQ as a preventative treatment in 821 people exposed to SARS-COV2 that showed no effect. It appeared in NEJM. So if HQ doesn't work as a prophylactic, and it doesn't work later in the disease, why should it work earlier in the disease?

Supposedly there is a good clinical trial of HQ in early Covid-19 coming out in September. Until then I remain skeptical. But if it works that would great news.

I will say this though, I think the potential dangers of HQ in terms of arrythmias have been overstated.
 
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I read about an outbreak in Hong Kong traced to a table tennis club, and the club was apparently using some pretty sophisticated disinfecting procedures out of Japan (Japanese medical-grade nano silver ion and photocatalyst technology). The article is here - https://www.dimsumdaily.hk/3-covid-...ry-table-tennis-sports-centre-in-san-po-kong/. No mention of what type of social distancing practices were in place.

Does this undermine a bit the focus on disinfecting over social distancing and masking practices? It would be great to hear more details of this specific outbreak, and any others traced to table tennis, so we can learn from them.
 
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My reply is based on an incomplete knowledge of the literature but for what it's worth, the consensus that seems to be emerging is that preventing spread through the air is crucial and that unexpected things can happen indoors because of how air flows. With that in mind, surface cleaning of some sort is certainly a good thing, probably even necessary, but by itself is insufficient. All existing evidence on masks points in the same direction-- they help, they probably help a lot. Now consider some other factors that contribute to overall environment that might facilitate transmission: 1. Average distance between people, 2. Duration of people in proximity, 3. Breathing patterns of the people (singing, shouting, exercising), 4. Room size and ventilation relative to number of people.

Factors 1, 2 and 3 would tend to promote transmission between unmasked TT players (if someone has the virus). 4 maybe not so bad at a lot of clubs around the world, but Hong Kong is famous for cramped real estate so it wouldn't surprise me if a TT club there had more humans oer cubic meter than most places. And like I said, it can depend on patterns of air flow you can't easily see. The picture in your article shows tables closer together than where I play, and we can't see the ceiling. The article also says one player was infected by the person he was playing with. I'm satisfied that their surface cleaning was good because these viruses are pretty easy to kill on surfaces.

It is a complex problem but personally there is no way I would play without a mask no matter what a club did to surfaces between sessions. The problem is finding a mask you can still use when you sweat.

By the way, lots of materials can block a virus particle and respiratory droplets while still allowing O2 and CO2 to move freely --- if they are dry.

I may have found a solution but I need to try it a few more times on my bike to be more sure and it's been rainy last two days.
 
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My reply is based on an incomplete knowledge of the literature but for what it's worth, the consensus that seems to be emerging is that preventing spread through the air is crucial and that unexpected things can happen indoors because of how air flows. With that in mind, surface cleaning of some sort is certainly a good thing, probably even necessary, but by itself is insufficient. All existing evidence on masks points in the same direction-- they help, they probably help a lot. Now consider some other factors that contribute to overall environment that might facilitate transmission: 1. Average distance between people, 2. Duration of people in proximity, 3. Breathing patterns of the people (singing, shouting, exercising), 4. Room size and ventilation relative to number of people.

Factors 1, 2 and 3 would tend to promote transmission between unmasked TT players (if someone has the virus). 4 maybe not so bad at a lot of clubs around the world, but Hong Kong is famous for cramped real estate so it wouldn't surprise me if a TT club there had more humans oer cubic meter than most places. And like I said, it can depend on patterns of air flow you can't easily see.

It is a complex problem but personally there is no way I would play without a mask no matter what a club did to surfaces between sessions. The problem is finding a mask you can still use when you sweat.

By the way, lots of materials can black a virus particle and respiratory droplets while still allowing O2 and CO2 to move freely if they are dry.

I may have found a solution but I need to try it a few more times on my bike to be more sure and it's been rainy last two days.

I think this virus is too smart, just keeps spreading regardless of anything
 
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I think this virus is too smart, just keeps spreading regardless of anything

Not at all. The virus is a particle of a few macromolecules that spreads by airborne movement from one person to another. That's all. The problem is that people are not always smart, many are quite stupid, and for many different reasons do things that cause it to spread, and fail to do things that prevent it from spreading. That's why the virus has been controlled in some places and not in others.

Sadly, nowhere is this more true than where I live, Texas (well except Florida, Georgia and Arizona). Some people are forced into proximity to other people because their livelihoods depend on it, others don't believe they can get sick or they think it's a hoax, or they don't want to wear a mask for political or religious reasons, or they really don't understand how to adequately protect themselves (like the right way to wear a mask).

Watch Houston over the next month, you will see. We were doing ok. Then the governor overruled the mayor, opened up everything including bars and gyms, refused to enforce mask orders. Things then shot completely out of control so that in some places in Texas doctors are forced to decide who lives and who dies based on available rooms (in the Rio Grande valley, not Houston, there is more hospital infrastructure per capita here). Finally the governor backtracked a little, closed bars, ordered mask use (still no penalties for noncompliance). But people here are mostly doing it and the numbers are slowly looking a little bit better (maybe even the beginnings of a trend), and like I said, the next month will make or break. I think it will make for an interesting epidemiological case study.
 
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I watch plenty of news situation in Texas and Florida has been terrible, I wish....... [removed content because of controversial nature].

I see on news hospitals are over capacity, hospital workers exhausted and limited supplies, hopefully......[removed content].....turn things around.

.....[Removed content].....

MaLin2.0, I am sorry that I had to delete your post but the content removed was political in nature and some content mentioned the name of a political figure that would likely cause controversy.

You CAN ASK QUESTIONS about policies like masking or surface cleaning. You can ask questions about medical information. But you cannot make comments that are not questions for one of the experts (Baal, Rain, Dr Evil and Passifid) or a response to an answer to those experts. And you cannot simply make comments that don't pertain to information presented by one of the experts in this particular thread, and mentioning specific political figures by name is also not okay.

Thanks for sticking to the rules of this particular thread when posting here. I know it is a drag. But there is a reason. There were 2 previous CoVID threads that were closed because people going off the rails on political issues. There was a third CoVID thread started about the politics that I also had to close. I want people to have access to good information on the science of the virus. With access to that information, there should be no need for banter about the politics or the trolling that invites.

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.
 
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MaLin2.0, I am sorry that I had to delete your post but the content removed was political in nature and some content mentioned the name of a political figure that would likely cause controversy.

You CAN ASK QUESTIONS about policies like masking or surface cleaning. You can ask questions about medical information. But you cannot make comments that are not questions for one of the experts (Baal, Rain and Dr Evil) or a response to an answer to those experts. And you cannot simply make comments that don't pertain to information presented by one of the experts and in this particular thread, and mentioning specific political figures by name is also not okay.

Thanks for sticking to the rules of this particular thread when posting here. I know it is a drag. But there is a reason. There were 2 previous CoVID threads that were closed because people going off the rails on political issues. There was a third CoVID thread started about the politics that I also had to close. I want people to have access to good information on the science of the virus. With access to that information, there should be no need for banter about the politics or the trolling that invites.

Understood
 
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On a lighter note, let it never be said that Texans are not adaptable. Here in Houston, one of the global centers of the Covid-19 pandemic, bars are now closed by order of the governor. That hasn't deterred the geniuses who run the Vivid Gentleman's Club, who have set up a drive through strip club. According to KPRC News, you pay up front, like you were ordering a burger (they also offer pizza, nachos and chicken sandwiches) and then drive around, and watch the girls through a window (the news report notes that the girls wear masks, which should set a good example for all of you). You get two songs and then have to move on so as to keep the line from getting too long.

It is that kind of out of the box thinking that will get us through this crisis.
 
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Only three days into the Major League Baseball season in the US 14 members of the Miami Marlins team, including 2 players, have tested positive for the coronavirus. MLB players are tested every other day. Baseball is probably a relatively safe sport on the field in terms of virus transmission (players are generally not too close to each other for long and it is played outdoors in most places), but of course locker rooms are another matter. Problem may be that several of the players who tested positive were on the field in a game against the Phillies. My gut feeling is that the odds of spread from that are not huge, but still, it has to be pretty scary for players and I wonder if some will opt out as a result of this.

I doubt it will be too long before Covid-19 runs rampant through an NBA team (they are trying to play all their games in Florida, which is probably not the greatest choice right at the moment), and that is a sport where transmission between players is a lot more likely. The NFL is going to be a disaster I predict.

The main point I am making here is not intended to be political, although it could easily seen that way by some. The point is that people in much of the US especially need to be really careful right now. Don't let up your guard. This is not politics, it's pure biology.
 
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It will save lives, and if deployed intelligently (e.g., temporary immunity for essential workers) may push us in the direction of normal. But it won't get us there because of some inherent limitations. It has to be harvested from donors, so it's a limited resource. Some donors will be better than others (higher concentration and/or better quality antibodies), some will be useless for this purpose even though they test positive, and for now we have no established quality control standards. It's usually administered over an hour or two by IV; this can be done in a doctor's office or outpatient clinic, but it's more cumbersome than just taking a pill or getting a shot. Serious side effects are rare but possible. This kind of therapy usually works better the earlier it's administered, but at least for now the focus has been on already hospitalized and often very sick patients. We still lack proper clinical trial results to guide us in designing effective treatment protocols. So many questions remain that it's really not ready for deployment except that this is an emergency. Even best case this won't be a magic bullet, and it's still too early to predict how much it will help.
 
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