Coronavirus - are you afraid?

[stormwyrm]

I'm very interested in the developments with the Sputnik vaccine, but even the scientific community here had a knee-jerk reaction to it and it's difficult to get information not tainted by a Cold War agendas.

We're going to need vaccines which are effective in immunocompromised individuals, and unfortunately Pfizer's vaccine does not fill that role.

It's not a knee-jerk reaction. Vaccine scientists initially took a look at the phase II clinical trial data that was made available and found it to be incomplete, which does not inspire a lot of confidence. The data were finally released last September, but this is data for only a very small (76 subjects) phase II clinical trial, which offers at most scant evidence that it is probably not going to cause severe adverse reactions, i.e. it might be reasonably safe. It doesn't answer the trillion-dollar question of whether it will be effective. And there are lingering questions about how the clinical trial data seem to be suspiciously uniform, which raises a lot of red flags. The Russians appear to be granting regulatory approval to the vaccine without bothering to do a larger-scale phase III clinical trial that could actually establish just how effective it is, which is reckless and foolish. So why on earth should anyone trust it? The suspicion comes from the Russians not following proper scientific procedure in testing their vaccine for safety and effectiveness, not because of any lingering biases held over them from the Cold War.

Frankly, I'd be fine with any vaccine if it passed the phase III randomised clinical trials which show how it is safe and effective, even if it's made by the Russians. But I for one am not planning on paying for the privilege of becoming an unregistered, uncontrolled guinea pig with an incompletely tested vaccine though. At this point no one has a vaccine that has completed phase III trials yet. Several are undergoing these phase III trials as we speak, including the Pfizer/BioNTech one that everyone's talking about, and some should be complete around the middle of next year. I am hopeful that at least one of these will succeed, but until then all we can do is wait.

How would a vaccine work for immunocompromised people? The immunocompromised are generally given exemptions from vaccination precisely because they can't be safely vaccinated. This is why mass vaccination is done: to make sure that as many people who can be safely vaccinated are vaccinated, providing herd immunity that will stop a disease from spreading and protect those who have such medical conditions that preclude them being vaccinated. Based on the R₀ of COVID-19, which is variously estimated between 3 and 4, that means something like 60-75% of a population has to be vaccinated for herd immunity to kick in. It's not as ridiculously contagious as measles, with a R₀ of 18, requiring upwards of 94% to be vaccinated.

Corona viruses are a form of influenza, so the population will need a vaccine shot every year, maybe in this case more than once a year.

No, coronaviruses are not a form of influenza. They're a completely different class of virus altogether. Several more benign types of coronavirus cause the common cold though. It is true though that infection with these coronavirus strains tends not to grant lasting immunity, which is why the common cold remains as common as it is. The same might be true of SARS-CoV-2.

[Dhi]

How would a vaccine work for immunocompromised people? The immunocompromised are generally given exemptions from vaccination precisely because they can't be safely vaccinated. This is why mass vaccination is done: to make sure that as many people who can be safely vaccinated are vaccinated, providing herd immunity that will stop a disease from spreading and protect those who have such medical conditions that preclude them being vaccinated. Based on the R₀ of COVID-19, which is variously estimated between 3 and 4, that means something like 60-75% of a population has to be vaccinated for herd immunity to kick in. It's not as ridiculously contagious as measles, with a R₀ of 18, requiring upwards of 94% to be vaccinated.

With a subunit vaccine. Novavax and Sanofi have a good track record with subunit vaccines specifically safe for immunocompromised individuals, and both are currently working on subunit Covid vaccines. That's why I mentioned them specifically by name.

[Dashenka]

The Russians appear to be granting regulatory approval to the vaccine without bothering to do a larger-scale phase III clinical trial that could actually establish just how effective it is, which is reckless and foolish. So why on earth should anyone trust it? The suspicion comes from the Russians not following proper scientific procedure in testing their vaccine for safety and effectiveness, not because of any lingering biases held over them from the Cold War.

That's a bold claim to make without any evidence to back it up.

[stormwyrm]

That's a bold claim to make without any evidence to back it up.

If you can find the peer-reviewed scientific paper describing the results of the Phase III clinical trial for Sputnik V, please link it. Oh wait, it really doesn't exist yet:

https://clinicaltrials.gov/ct2/show/NCT04530396

They're still doing the trial. It won't be complete until at least May 2021. So why then is the vaccine already approved for widespread use in Russia?

https://www.nature.com/articles/d41586-020-02386-2

Russian President Vladimir Putin announced on 11 August that the country’s health regulator had become the first in the world to approve a coronavirus vaccine for widespread use — but scientists globally have condemned the decision as dangerously rushed. Russia hasn’t completed large trials to test the vaccine’s safety and efficacy, and rolling out an inadequately vetted vaccine could endanger people who receive it, researchers say. It could also impede global efforts to develop quality COVID-19 immunizations, they suggest.
...
“This is a reckless and foolish decision. Mass vaccination with an improperly tested vaccine is unethical. Any problem with the Russian vaccination campaign would be disastrous both through its negative effects on health, but also because it would further set back the acceptance of vaccines in the population,” said Francois Balloux, a geneticist at University College London, in a statement distributed by the UK Science Media Centre.

[Dashenka]

So why then is the vaccine already approved for widespread use in Russia?

I have a few reasons why but those will almost certainly offend people so I'll keep them for myself :)

[Oniya]

As I mentioned, I've got some familiarity with this sort of thing.  A 'phase III clinical trial' is important to determining the safety of a new medication.

There's a larger, more varied group of people involved in a phase III.  Some receive the drug, others receive another effective treatment.  The people taking the drug are carefully monitored to ensure that the new drug is actually as effective as the current treatments, and that it doesn't have side effects that out-weigh the benefits.  The larger group of patients also ensures that the drug is going to be effective over a greater percentage of the population. 

So, for example, one might find that a drug that looks promising after the phase II trials is actually not effective on a certain group of people.  Or it causes a terrible side effect.  Or it's not as effective as the current treatments.

Approving a drug before it's even made a token pass at a phase III is just turning your entire population into test subjects, without informed consent. 

[Dhi]

To my mind we are witnessing phase III in these multi-national trials, which are being characterized as widespread release for political reasons. I don't consider 180 volunteers in India widespread release with any intellectual honesty. I consider that a component of Sputnik 5's phase III trial. Some of this is posturing to elevate Sputnik's position in the global race to vaccine, which is what I meant by Cold War agendas. And some of what Gameleya Research Institute are guilty of are also regulations Pfizer at least debated skirting. The difference is that Pfizer, under the same timetable, is being heralded as humanity's savior and GRI are being condemned as monstrous. I  oughtn't have used loaded words like knee-jerk when I could have more accurately said inconsistent.

So yes, I'm looking forward to the full data from the phase III trials or grossly negligent widespread release, whichever way one chooses to frame it. I'd like to see cooperation so the data can be analyzed without this secrecy. It would help that aim not to accuse Russia of something nefarious while they're undergoing largely the same process as every other country.

[Oniya]

The problem is that a phase III is usually double-blind.  The participants and doctors don't know if they are getting the new product or the previously approved product.  That way, the data that I mentioned earlier doesn't have an expectation bias attached to it.  Assuming that any such data is even being collected.

[Dhi]

It is, have a look at the link stormwyrm provided above. All of the other studies I could find details on are also double-blind.

[Mechelle]

Boris Johnson is self-isolating after coming into contact, for 35 minutes, with MP Lee Anderson who has subsequently tested positive.

However, I thought he had already survived quite a nasty attack of Covid-19, so should have some immunity (I know there have been very rare cases when people have caught it twice). He is well and not exhibiting any symptoms.

[elone]

This initially looks like good news and refrigerations or freezing at extremely low temperatures is not necessary.

https://www.cnbc.com/2020/11/16/moderna-says-its-coronavirus-vaccine-is-more-than-94percent-effective.html

[Dashenka]

Boris Johnson is self-isolating after coming into contact, for 35 minutes, with MP Lee Anderson who has subsequently tested positive.

However, I thought he had already survived quite a nasty attack of Covid-19, so should have some immunity (I know there have been very rare cases when people have caught it twice). He is well and not exhibiting any symptoms.

Only dumb people get it twice... Makes him extra suseptible :)


Seriously though, there have been plenty of cases of people getting it twice

[gaggedLouise]

Boris Johnson is self-isolating after coming into contact, for 35 minutes, with MP Lee Anderson who has subsequently tested positive.

However, I thought he had already survived quite a nasty attack of Covid-19, so should have some immunity (I know there have been very rare cases when people have caught it twice). He is well and not exhibiting any symptoms.

I'm really not sure if immunity always means that you can't spread the disease on to others, by acting as a carrier for a limited time, while not getting sick again yourself. Remember how Europeans spread chicken-pox and stuff to the western hemisphere in the 16th century - illnesses most grown-up white people had been immune to for generations, but which killed many native Americans? Not sure how the immunity/transfer equation plays out in such cases.

[TheVillain]

Plus, one of the reasons CoVID is such a big deal is that it seems to be the case that if you've had it you're only immune to it for a few months and then can get it again.

[CrownedSun]

https://youtu.be/WicsWfTm1ZI?t=70

[Haibane]

While millions die, greedy people get rich. This is obscene.

https://www.bbc.co.uk/news/uk-54974373

[Haibane]

The UKs official C-19 death toll of ~50,000 is probably short by ~20,000 with over ~70,000 being the "excess morbidity" figure.

https://www.bbc.co.uk/news/health-54976362

Disparities such as this between official/reported deaths and actual deaths are probably uniform across the globe meaning that the C-19 pandemic has been considerably more lethal than official figures indicate.

[Dhi]

The state health figures I've seen in the US suggest this is only about 10%, but because of our numbers that's still more than 20,000.

[Dashenka]

While millions die, greedy people get rich. This is obscene.

https://www.bbc.co.uk/news/uk-54974373

That's the NHS for you. Eventually they'll run out of other people's money :)

[Haibane]

The NHS is amazing, or at least it was until the Tories royally screwed it over with the Trusts system, even now it still excellent. Now they waste half their money on managers and e-mail pushers. But in terms of the medical service it provides its second to none in the world and I'm immensely proud of it.

The issue here is one or more of those stupid managers just pressing "send" on an e-mail contract and not properly policing things, not properly working through the decision making process. Though that argument can be levelled at a lot of modern organisations. My view is that far too many contemporary corporations think their raison d'etre is to make money whereas in fact it ought to be to manufacture useful goods and /or to provide a service.

Anyhow... rant over. Back to the pandemic...

[Fox Lokison]

The NHS and other such systems are helping countries avoid the pitfalls America is stumbling into. We can't afford time off from work or medical care. So people have to go to their jobs sick or risk their livelihood to protect their community and themselves. When you can't even afford basic medical care on your country because of skyrocketing prices, pandemics are a nightmare. So is the lack of other social programs and safety nets for society. It basically ensures that only those with enough money can access proper medical care, and a virus doesn't care if you're rich. As much as the NHS definitely has some shortfalls, from what I've heard of it, it's still a better system than America's to handle this. Which really says something about America, tbh.

There's always going to be someone trying to take advantage of the system, or some red tape screwups, but honestly I see it as a prototype for bigger and better systems, whereas America is just... "if you're poor you might as well just die now, or we can bleed you dry over a few years if you're feeling masochistic". Surviving only to face an insurmountable mountain of medical bills is not the testament to a "free country" I'd like, to say the least.

[Fox Lokison]

Basically if you put the health and wellbeing of the population behind a giant paywall, there's sliiiiight issues when a pandemic hits. As we're learning the hard way.

[Skynet]

As an American, trust me when I say that you don't want privatized healthcare unless you're making a six-figure salary. Even my own plan doesn't cover eye-related care, and it's still a significant cut out of my monthly paycheck.

[Lexandria]

besides how crazy-not-okay our whole system is; it's also extra bonkers that you have to get separate insurance for vision and for dental than from the other health insurance.

[Fox Lokison]

besides how crazy-not-okay our whole system is; it's also extra bonkers that you have to get separate insurance for vision and for dental than from the other health insurance.

Ah yes, the luxury bones. Because sight and teeth aren't at all critical to health for... reasons.

I've had the same glasses for 9+ years now and my eyesight has changed significantly since then, but I haven't been able to afford a vision appointment. I'm legally blind. -.- It's completely mind-blowing that it's that expensive for me to go get my eyes retested and get a new prescription, yet here I am... Blind as a bat...