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Are vaccines the light at the end of the tunnel?


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2 hours ago, TeeRick said:

You are of course right on target with your entire post.  But I think the last sentence is truly the issue in particular in the USA.  Even with highly effective vaccines there is continued misinformation, resistance, and outright lack of education.  All we can hope for is that a lot of our population will rise above this if we have a new COVID vaccine.  But highly unlikely that it will be mandatory.  Maybe it will be an easier task to convince people to get a 1 or 2 vaccine shot series than to convince them to wear masks. 

Unfortunately it will probably be impossible to convince people that they should continue to wear masks even after they get the vaccine, until the level of virus cases reduce dramatically. Too many will have the attitude of I got my shot I don't have to worry about it any more, lets party.

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5 minutes ago, npcl said:

Unfortunately it will probably be impossible to convince people that they should continue to wear masks even after they get the vaccine, until the level of virus cases reduce dramatically. Too many will have the attitude of I got my shot I don't have to worry about it any more, lets party.


Probably true, but every for every point the use of masks drops the effective R value in the population, you need fewer people vaccinated, and can accept a less effective vaccine, and still stop transmission. 
 

It’s actually pretty simple math. 

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There is the issue of surviving, which is getting better every day as more is learned about how to deal with COVID-19 and the potential for new therapies such as Lilly's antibody product that is in Clinical trials.  Then there is the issue of hidden long term damage.  One of the recent papers I have read has indicated that 70% of the patients they tested (which included those with both serious cases requiring hospitalization, and minor cases which did not) indicated detectable levels  of heart damage weeks after the symptoms resolved. Another paper has found lasting kidney damage.  You have numerous reports of people (many under 40) with minor symptoms experiencing problems impacting their ability to do normal daily activities.

 

I suspect that there will be long term impacts to health that will be showing up in the medical community for years after the virus itself is no longer an issue.

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56 minutes ago, npcl said:

Unfortunately it will probably be impossible to convince people that they should continue to wear masks even after they get the vaccine, until the level of virus cases reduce dramatically. Too many will have the attitude of I got my shot I don't have to worry about it any more, lets party.

Given the difficulty in trying to get people to wear masks without a vaccine, I can't imagine how difficult it will be once a vaccine arrives.

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54 minutes ago, markeb said:


Probably true, but every for every point the use of masks drops the effective R value in the population, you need fewer people vaccinated, and can accept a less effective vaccine, and still stop transmission. 
 

It’s actually pretty simple math. 

i’ll concede the ‘in the population’ reduction of R, but if the situation is reduced to ‘on a cruise ship’, I don’t believe the math and risk management calculations are quite as simple.

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6 minutes ago, d9704011 said:

i’ll concede the ‘in the population’ reduction of R, but if the situation is reduced to ‘on a cruise ship’, I don’t believe the math and risk management calculations are quite as simple.

So you're thinking if everyone is required to have proof of taking the vaccine prior to boarding, you still think folks should have to wear masks in public areas?  

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2 minutes ago, Ken the cruiser said:

So you're thinking if everyone is required to have proof of taking the vaccine prior to boarding, you still think folks should have to wear masks in public areas?  

I did not read back very far in the thread and did not have anything in mind about proof of vaccination prior to boarding when I commented on the notion of simple math around viral reproduction when comparing a huge swath of ‘the population’ to a relatively tiny sample of cruisers.

 

To answer your specific question, I think masks in public areas on cruises where everybody has proved vaccination should not be necessary.  From a slightly different angle, I would not not go on any cruise where mask wearing would be required.  To me, this is a signal that cruising is still too risky for me, even though we’re all vaccinated.

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I'm just curious how the state and local governments are going to get the word out to their local "working" populations AFTER the initial guidelines are released for those deemed most in need, especially if you don't live in a metropolitan area.

 

For example, since most folks don't get newspapers anymore and many don't watch the local news for whatever reason, are state and local government agencies allowed to advertise on TV for free during prime time and/or to targeted locations on other applicable medias such as FB if it's a public service announcement defining where you can specifically go to get the vaccine in your local area?

 

Right now I see notices on local TV about calling a 1-800 number if you think you have COVID symptoms and need to get tested. However, they also say you will be turned away if you have not made a reservation. Like folks have said, it will be interesting to see how this all unfolds, especially when it comes to the rest of us who are healthy, whether you're in your 20s or late 60s, and don't live in a metropolitan area.

Edited by Ken the cruiser
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1 hour ago, d9704011 said:

i’ll concede the ‘in the population’ reduction of R, but if the situation is reduced to ‘on a cruise ship’, I don’t believe the math and risk management calculations are quite as simple.

 

Honestly, I'm not even thinking "on a cruise ship". I don't think the math will apply, and until you've reduced or stopped transmission outside of a closed environment, I don't see how you do it in a closed environment. Vaccines should be good, but they are not going to be that good.

 

And, yeah, there are a lot of assumptions in R values. You can actually model interactions and get a decent idea, but on a cruise ship, you've really got one population in the thousands intermingling with way too much frequency for that to matter. And the goal of reducing the R is stop sustained transmission (R <1), not transmission...

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1 hour ago, Ken the cruiser said:

So you're thinking if everyone is required to have proof of taking the vaccine prior to boarding, you still think folks should have to wear masks in public areas?  

Depending upon the efficacy of the vaccine.  If it is less than 90% then yes. Probably even if it is above 90% but it would depend upon too many other conditions. That will still leave 300 potential cases on a ship of 3000 (crew and passengers).  As long as there is transmission taking place in the population the people that are cruising (crew and passengers) than distancing measures should still be used. The vaccine will reduce spread, not eliminate it.

Edited by npcl
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6 hours ago, TeeRick said:

I just recently got the new Shingles vaccine Shingrix.  Unlike the previous vaccine, this one is not "live".  But my arm was sore for a day or two.  And I will need a second dose in 2-6 months.  Small price to pay to avoid getting a shingles outbreak- for me anyway.  But I am curious.  Why do you believe that because you have not had a sick day off in 20 years that somehow correlates with you thinking you are safe from becoming sick with COVID if you are exposed?  

 I just got the first Shingrix vaccine on Thursday.  The injection itself hurt, but my arm wasn't as sore as it is when I get my annual flu vaccine.  As you say, TeeRick, small price to pay.

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3 hours ago, Ken the cruiser said:

I'm just curious how the state and local governments are going to get the word out to their local "working" populations AFTER the initial guidelines are released for those deemed most in need, especially if you don't live in a metropolitan area.

 

For example, since most folks don't get newspapers anymore and many don't watch the local news for whatever reason, are state and local government agencies allowed to advertise on TV for free during prime time and/or to targeted locations on other applicable medias such as FB if it's a public service announcement defining where you can specifically go to get the vaccine in your local area?

 

Right now I see notices on local TV about calling a 1-800 number if you think you have COVID symptoms and need to get tested. However, they also say you will be turned away if you have not made a reservation. Like folks have said, it will be interesting to see how this all unfolds, especially when it comes to the rest of us who are healthy, whether you're in your 20s or late 60s, and don't live in a metropolitan area.

I expect the initial doses will be to institutions that will be tasked with vaccinating the priority candidates in their area (hospitals and clinics for their staff), County Health departments for first responders, assisted and independent living institutions for their populations, and so on military health departments, Indian health service, etc.  Once you get past the institutions then it will become more widely available, but limited with the instructions to doctors and other care providers to vaccinate patients that meet certain requirements (however at that point you will see it start to break down  and see people not prioritized starting to get shots based upon their relationship with their physician or if a given clinic might be able to get extra out of their distributor.

 

Once it is generally available I expect that you will see signs at pharmacies advertising that they have the vaccine available.

 

I have been on the producer end in dealing with distribution issues of a very limited availability product.  No matter how you try and keep a lid on the channels to keep the product flowing to most in need, you find people are most creative in trying to figure out ways to go around the allocation controls.

Edited by npcl
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2 hours ago, npcl said:

Depending upon the efficacy of the vaccine.  If it is less than 90% then yes. Probably even if it is above 90% but it would depend upon too many other conditions. That will still leave 300 potential cases on a ship of 3000 (crew and passengers).  As long as there is transmission taking place in the population the people that are cruising (crew and passengers) than distancing measures should still be used. The vaccine will reduce spread, not eliminate it.

I'm not so sure about everyone having to wear masks if a vaccine is 90% effective. Probably even less. If all of the 300 cases mentioned above materialize then the downstream cases would be reduced by at worst 90% with a few possible exceptions. The transmission rate would drop dramatically. The people capable of transmission would have to interact with someone capable of being infected which would be dropping every day. The herd immunity thing. There will of course be people who cannot get the vaccine and they will have to be very careful. Just like they are now for other infectious diseases. Unleashing a small number of people into a population largely immune will not be a problem. I really believe that for travel to get back to normal in the mid-term then proof of vaccination will be required. I think that will be the real new normal. At least for travel. Many will not take a cruise or a long haul flight while wearing a mask. Someone will have to figure out a way around that.    

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45 minutes ago, npcl said:

Once it is generally available I expect that you will see signs at pharmacies advertising that they have the vaccine available.

We just went for our daily walk and my DW also mentioned when the vaccine is widely available, we'll probably see signs going up at our local grocery store, which of course has a pharmacy. After all, everyone has to eat. We're also retired military and usually go to the nearby base to get any necessary vaccine required for a cruise, so we'll be probably be checking there too.

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1 hour ago, JL87 said:

I'm not so sure about everyone having to wear masks if a vaccine is 90% effective. Probably even less. If all of the 300 cases mentioned above materialize then the downstream cases would be reduced by at worst 90% with a few possible exceptions. The transmission rate would drop dramatically. The people capable of transmission would have to interact with someone capable of being infected which would be dropping every day. The herd immunity thing. There will of course be people who cannot get the vaccine and they will have to be very careful. Just like they are now for other infectious diseases. Unleashing a small number of people into a population largely immune will not be a problem. I really believe that for travel to get back to normal in the mid-term then proof of vaccination will be required. I think that will be the real new normal. At least for travel. Many will not take a cruise or a long haul flight while wearing a mask. Someone will have to figure out a way around that.    

The issue is not the number into a population mostly immune, the problem on board a ship is if you have a case on board it can spread to non-protected percentage fairly quickly.

 

 

The answer to the pandemic is to drop the number of cases as quickly as possible which will require both the vaccine as will as continued social distancing.

 

Let me talk about the story of another vaccine.  Prior to the Polio vaccine in 1956 it impacted between 15-50,000 people per year. When the polio vaccine was announced to be safe and effective you had people celebrating in the streets because polio was considered to be that much of a scourge.  Even with active programs to vaccinate as many as possible it takes a while. It was not until 1960 that the number of cases in the US dropped below 3,000. It was not considered to be eliminated in the US until 1979. With no transmission taking place in the US since that date.

 

While many in the US will want to drop social distancing and masks the second a vaccine were to come out and declare the crisis over, the driver to policy should be 1 thing and 1 thing only the number of new cases and the rate of infection.  Otherwise you could have a vaccine and find counts going up.

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@npcl @TeeRick This was in Science today.  Pretty inside baseball for the forum, so apologies. 

 

From the abstract:   Using human blood samples derived before the SARS-CoV-2 virus was discovered in 2019, we mapped 142 T cell epitopes across the SARS-CoV-2 genome to facilitate precise interrogation of the SARS-CoV-2-specific CD4+ T cell repertoire. We demonstrate a range of pre-existing memory CD4+ T cells that are cross-reactive with comparable affinity to SARS-CoV-2 and the common cold coronaviruses HCoV-OC43, HCoV-229E, HCoV-NL63, or HCoV-HKU1.

 

For most of the folks on the forum, if you're not really seriously up on molecular immunology, this isn't going to tell you anything. I'm not sure how you'd try to correlate this to clinical outcomes, positive or negative, but that's the obvious extension of this study. The LinkedIn poster who posted the link to the article suggested data that we're seeing more of a booster response from infection and immunization, which I hadn't heard before. Inappropriate immune response has been a feature of most coronaviruses, but this doesn't say that's the case, and it's equally likely to be a good thing. Lasting T cell immunity could offset the rapid decline in antibody activity seen in a lot of recovered patients. It's just another datapoint for those of us who are holding our breaths a bit as the clinical trials proceed.

 

Another part of that strategic communication prep  that I really hope is happening. Totally outside the realm of cruising or vaccines, but for those who've only minimally read history, in World War II, Eisenhower wrote a handwritten note before each major amphibious landing, apparently accepting blame for failure. He tore them up after each successful landing, with one exception. A very eloquent statement written on the 4th or 5th of June, 1944, stating that he had withdrawn the D Day invasion force due to their inability to establish a successful foothold in Normandy. He never had to use it, but he had it...

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4 hours ago, markeb said:

@npcl @TeeRick This was in Science today.  Pretty inside baseball for the forum, so apologies. 

 

From the abstract:   Using human blood samples derived before the SARS-CoV-2 virus was discovered in 2019, we mapped 142 T cell epitopes across the SARS-CoV-2 genome to facilitate precise interrogation of the SARS-CoV-2-specific CD4+ T cell repertoire. We demonstrate a range of pre-existing memory CD4+ T cells that are cross-reactive with comparable affinity to SARS-CoV-2 and the common cold coronaviruses HCoV-OC43, HCoV-229E, HCoV-NL63, or HCoV-HKU1.

 

For most of the folks on the forum, if you're not really seriously up on molecular immunology, this isn't going to tell you anything. I'm not sure how you'd try to correlate this to clinical outcomes, positive or negative, but that's the obvious extension of this study. The LinkedIn poster who posted the link to the article suggested data that we're seeing more of a booster response from infection and immunization, which I hadn't heard before. Inappropriate immune response has been a feature of most coronaviruses, but this doesn't say that's the case, and it's equally likely to be a good thing. Lasting T cell immunity could offset the rapid decline in antibody activity seen in a lot of recovered patients. It's just another datapoint for those of us who are holding our breaths a bit as the clinical trials proceed.

 

Another part of that strategic communication prep  that I really hope is happening. Totally outside the realm of cruising or vaccines, but for those who've only minimally read history, in World War II, Eisenhower wrote a handwritten note before each major amphibious landing, apparently accepting blame for failure. He tore them up after each successful landing, with one exception. A very eloquent statement written on the 4th or 5th of June, 1944, stating that he had withdrawn the D Day invasion force due to their inability to establish a successful foothold in Normandy. He never had to use it, but he had it...

 

The million dollar question right now, as you alluded to, is if these crossreactive CD4 T-cells make the disease more, or less severe (or possibly both depending on context).

 

There is some evidence either way, why no one is really willing to predict.

 

Edited by UnorigionalName
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21 hours ago, Esprit said:

I don't TeeRick

I just try to stay healthy, eat well, but over imbibe with alcohol perhaps!

I try to think positively and love my job.

For my Shingles I was prescribed Aciclovir for a week. Got a funny look from the Pharmacist. Then I looked up the stuff. Turns out it's prescribed for STI's too! :classic_biggrin:

Ok be well!   Yes acyclovir was put into use as an anti-viral back in the 1980's against Herpes viruses.  There are several types and everybody knows about the STD type.  And a type that causes cold sores.  But the virus that causes Chickenpox that later in life manifests as Shingles is also a Herpes virus.

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On 8/3/2020 at 8:27 PM, Covepointcruiser said:

It was announced today that  Russia  will be vaccinating all citizens for COVID 19 in October 2020.    Guess we will have loads of Russians competing for cruises as they will have the vaccine first.

If the Russian vaccine is not tested and approved in other parts of the world then it is entirely possible that countries outside of Russia will not accept the results.  And not allow Russians to enter and travel.  But I hope for the sake of the great people in Russia that their vaccine efforts are successful.

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20 hours ago, npcl said:

There is the issue of surviving, which is getting better every day as more is learned about how to deal with COVID-19 and the potential for new therapies such as Lilly's antibody product that is in Clinical trials.  Then there is the issue of hidden long term damage.  One of the recent papers I have read has indicated that 70% of the patients they tested (which included those with both serious cases requiring hospitalization, and minor cases which did not) indicated detectable levels  of heart damage weeks after the symptoms resolved. Another paper has found lasting kidney damage.  You have numerous reports of people (many under 40) with minor symptoms experiencing problems impacting their ability to do normal daily activities.

 

I suspect that there will be long term impacts to health that will be showing up in the medical community for years after the virus itself is no longer an issue.

Sadly have to agree.

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From the Canadian Chief Public Health Officer - "even if there is a vaccine, the pandemic may persist for years to come"

 

https://www.ctvnews.ca/health/coronavirus/even-if-there-s-a-vaccine-pandemic-may-persist-for-years-to-come-tam-1.5050584

 

One quarter of Canadians polled were skeptical a vaccine would be effective.

 

For cruising, guess it comes down to a risk / reward tolerance.

 

 

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11 hours ago, markeb said:

@npcl @TeeRick This was in Science today.  Pretty inside baseball for the forum, so apologies. 

 

From the abstract:   Using human blood samples derived before the SARS-CoV-2 virus was discovered in 2019, we mapped 142 T cell epitopes across the SARS-CoV-2 genome to facilitate precise interrogation of the SARS-CoV-2-specific CD4+ T cell repertoire. We demonstrate a range of pre-existing memory CD4+ T cells that are cross-reactive with comparable affinity to SARS-CoV-2 and the common cold coronaviruses HCoV-OC43, HCoV-229E, HCoV-NL63, or HCoV-HKU1.

 

For most of the folks on the forum, if you're not really seriously up on molecular immunology, this isn't going to tell you anything. I'm not sure how you'd try to correlate this to clinical outcomes, positive or negative, but that's the obvious extension of this study. The LinkedIn poster who posted the link to the article suggested data that we're seeing more of a booster response from infection and immunization, which I hadn't heard before. Inappropriate immune response has been a feature of most coronaviruses, but this doesn't say that's the case, and it's equally likely to be a good thing. Lasting T cell immunity could offset the rapid decline in antibody activity seen in a lot of recovered patients. It's just another datapoint for those of us who are holding our breaths a bit as the clinical trials proceed.

 

Another part of that strategic communication prep  that I really hope is happening. Totally outside the realm of cruising or vaccines, but for those who've only minimally read history, in World War II, Eisenhower wrote a handwritten note before each major amphibious landing, apparently accepting blame for failure. He tore them up after each successful landing, with one exception. A very eloquent statement written on the 4th or 5th of June, 1944, stating that he had withdrawn the D Day invasion force due to their inability to establish a successful foothold in Normandy. He never had to use it, but he had it...

Thanks for posting this.  I have been following the T-Cell data but had not seen this. 

 

As far as communications, it has to be at a very high level and very simple for most of the population.  Not a criticism here, but many many people do not even understand the basics of science and medicine - but of course believe what the lay press throws at them as absolute truth. This is the case for most of my family and friends too.   So a lot of people know perhaps white blood cells and red blood cells but have no idea what they actually do.  Forget T-Cells (and subtypes) and B-Cells and helper responses and cytokines.  Forget explaining the details of vaccines and how they work (or not).  So we need very simple communication materials for pretty much a science-uneducated population.  That is the challenge.

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The first phase 1 clinical results from a more traditional vaccine technology (purified SPIKE protein in adjuvant) were just released and are said to be encouraging.  This tried and true vaccine approach if successful might be the easiest to get approved across multiple groups and will likely have no unexpected side effects except injection site soreness.  We shall see!

 

https://www.cnn.com/2020/08/04/health/novavax-phase-1-vaccine/index.html

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There were 6 strains identified of SARS-CoV-2 by a major genomic sequencing study.  The good news for a vaccine is that the virus does not diverge very much.  Over 48,000 viral genomes analyzed from all over the world.  Published in the journal Frontiers in Microbiology by scientists from the University of Bologna.

 

https://www.eurekalert.org/pub_releases/2020-08/udb-tss080320.php

 

https://www.theweek.in/news/health/2020/08/04/Strains-of-the-novel-coronavirus-show-little-variability.html

Edited by TeeRick
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