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Are vaccines the light at the end of the tunnel?


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12 hours ago, TeeRick said:

I can only tell you my perspective here and sure I will not change your mind.  But I know from personal experience that a very large number of people working in every aspect of drug and vaccine development, manufacturing, distribution, etc. at Pharmaceutical companies enjoy what they do and think they have a noble profession contributing to the betterment of the human condition.  These folks have no control on pricing and many do not make a huge amount of money.  But they are dedicated.  If they develop a COVID vaccine in record time they will be extremely proud to have done it.  Maybe you can object to very senior management making enormous salaries but that happens in most large public companies too.

And one day when we're cruising again and by chance meet one of these vaccine "behind the scenes" heros, my DW and I will feel quite privileged to have meet one of them and thank them profusely!!!

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17 hours ago, TeeRick said:

I can only tell you my perspective here and sure I will not change your mind.  But I know from personal experience that a very large number of people working in every aspect of drug and vaccine development, manufacturing, distribution, etc. at Pharmaceutical companies enjoy what they do and think they have a noble profession contributing to the betterment of the human condition.  These folks have no control on pricing and many do not make a huge amount of money.  But they are dedicated.  If they develop a COVID vaccine in record time they will be extremely proud to have done it.  Maybe you can object to very senior management making enormous salaries but that happens in most large public companies too.

I think you are correct that many/most people work for more than money and want to do some good for the world (or at least their community, their state or their country).  

 

Unfortunately however, the system is set up for profit making - not only the senior managers but also the shareholders.  There seems to be no apparent way to moderate the people more concerned with trying to make money than global health.  I am seriously concerned about how much is going to be charged for a vaccine.  

 

I am in Australia, where I am certain there will be negotiation and subsidy to ensure everyone who needs it (eventually) gets the vaccine (if there is one).  We have a Pharmaceutical Benefits Scheme, run by the federal government and paid for in our taxes, to negotiate drug prices.  (For example, I pay $16.99 for 100 Hydroxychloroquine tablets if I go to the cheapest discount pharmacy).   https://www.pbs.gov.au/info/about-the-pbs    This causes some problems with some new drugs as it takes time to get them listed on the PBS and desperate parents or cancer patients lobby hard to get them on the scheme before their loved ones succumb to whatever illness or condition they have.  Whatever the difference is between the price charged by the drug company and what we get charged, we will pay for it (willingly) in our taxes - but we will expect strong negotiation. 

 

I hope that there will be a global effort to get any effective vaccine to the people who need it - not just the rich.    

 

 

 

 

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5 hours ago, lucymorgan said:

Unfortunately however, the system is set up for profit making  

 

I hope that there will be a global effort to get any effective vaccine to the people who need it - not just the rich.    

lucymorgan, I am taking a couple of your statements from your post #177.  Folks can refer to it for all of your thoughts many of which I do agree with.  In particular I do wish drug and vaccine prices (in particular in a free market health system like the US) were lower and more affordable.  Even people with Health Insurance and Medicare struggle at times. I absolutely understand the mistrust of Pharma companies.  Every country like yours (Australia) has a different way of doing things.  Yes agree that the private companies are in it for profit.  They are not government agencies.     No other vaccine has been produced "just for the rich".  Influenza vaccine is free for a lot of people or maybe $25-50 for others.  See my previous post on how governments tender and set the prices.  Let's just get a COVID vaccine as a  first step and then see how the world gets access and what are the prices charged.  Would people here pay $5000-10000 USD for a cruise or $15 for a martini or $50 extra pp for premium dining but then object to maybe $100 for a vaccine shot that allows then to travel and cruise and perhaps save their lives?

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1 hour ago, lucymorgan said:

I agree.  

This is a global pandemic.  We need to hope that public sentiment influences people to think more about lives than about profit 💝

We need to require governments to think more about lives than about profits.  Left on their own Pharma will set the price as high as it can.  No question.  A huge concern is the 90-day life of the antibodies.  That suggests quarterly booster shots to stay current.  Not only expensive, but difficult to manage and track.

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1 hour ago, Ride-The-Waves said:

We need to require governments to think more about lives than about profits.  Left on their own Pharma will set the price as high as it can.  No question.  A huge concern is the 90-day life of the antibodies.  That suggests quarterly booster shots to stay current.  Not only expensive, but difficult to manage and track.

Not really they have been left on their own. You do have some wild card like the wacko that was put in prison for fraud that was buying up small market drugs and raising the price 1000X.  The major calculation for price is based upon medical benefit.  For example if the lifetime treatment for Hep-C is X hundred of thousands of dollars.  The list price for the first product that cures Hep-C will be priced at some percentage of what is currently being spent prior to its introduction.  As such while the drug is expensive, the cost for treatment is still less than existed prior to it being brought to market (plus the additional benefit in life expectancy)  The actual price, after discounting will be another percentage lower.  The drug will only have that pricing power until the second drug hits the market, That drug will generally get its list price set at about 70% of the first to market.

 

Then keep in mind that the brand pricing power only exists on average about 6-7 years, then its patents will expire and generics will come.  Pretty much eliminating any pricing power.

 

Keep in mind that the average drug development cost runs about 1.3 billion with the median cost being a bit lower near 1 billion. The highest cost for a single drug that I know about being in the 5 billion dollar range.  Cheaper to develop small oncology drugs, that large market chronic therapies.  Of course those numbers do not include all of the drug failures that are also a part of development.  Keep in mind that a little less that 1 out of 10 drugs that make it into phase 1 actually end up making it to market.  Half of all of the drugs that make into into the very expensive phase III process succeed.  A lot of money goes into paying for the failures.

 

So one out of 10 in phase one makes it to market, then unless it is truly innovative, it must compete in that market, and then it only has a limited life span before its patent life ends.

 

So go start a business where you spend over a billion, have success out of 1 in 10 once it goes into humans (about 1 in 30 for pre-clinical), have to compete, and know that the investment must be recouped in 7-8 years.  There is a reason why very few companies survive for long (Take for example Glaxo-Welcome who over the years has absorbed Wellcome, Smith Kline Beecham, Sitari, Tesaro, GlycoVaxn, Human Genome Sciences, Cellzome, Laboratorios Phoenix, Stiefel Laboratories, CNS, Block Drug, and 15 other companies.  All of which have been absorbed over the years by Glaxo or the companies it has acquired.  The reason why is because this is a very difficult business to survive in.  To survive you must have a pipeline of new drugs being constantly discovered (aver difficult task).  If you don't you fail and become part of another company who will acquire you for your cash flow for remaining market drugs or if you are a small company your technology.  All of the major survivors have a similar history of acquisition to survive.

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I find it interesting that the States have already suffered high infection and death rates are now under fairly good control, while the States that were under fairly good control early-on are now suffering high infection rates.  I realize that there are multiple possible explanations for this, but have you considered this highly optimistic POSSIBLE explanation???

 

MAYBE the infection rates in the States hit early and hard are much much higher than anyone realizes.  MAYBE the reason they are not experiencing a new infection surge like the rest of the country is because they have achieved a degree of herd immunity there.  MAYBE after this surge in the rest of the country, other States will also achieve a degree of herd immunity and there will finally be a light at the end of the tunnel. 

 

It's not a totally unreasonable possibility.  Sure differences in mask compliance and social distancing (reopening) may account for things, but ask yourself, people being people, are people in New York really that much better at wearing masks than those in California?  Maybe there's something else at play.  If some experts say the infection rate may be 10 times higher than reported, might it be even higher than that?

 

Just an hypothesis, but if accurate it may be the fastest way to get back to normal 🤔

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19 minutes ago, mnocket said:

Just an hypothesis, but if accurate it may be the fastest way to get back to normal 🤔

 

Unlikely, I'm afraid. Spain did a very thorough seroprevalence study, recently published in Lancet and only found 5-6% seropositive individuals. And they were one of the most impacted countries. That's well below the 50-75% you'd need for any form of herd health.

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5 minutes ago, markeb said:

 

Unlikely, I'm afraid. Spain did a very thorough seroprevalence study, recently published in Lancet and only found 5-6% seropositive individuals. And they were one of the most impacted countries. That's well below the 50-75% you'd need for any form of herd health.

Probably true, but as I understand it neutralizing antibodies are only one of several factors (e.g. T cells) that may convey immunity and contribute to herd immunity.  There is just so much still unknown about this virus that it's hard to rule anything out - although I agree my hypothesis is a long shot.

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1 hour ago, mnocket said:

I find it interesting that the States have already suffered high infection and death rates are now under fairly good control, while the States that were under fairly good control early-on are now suffering high infection rates.  I realize that there are multiple possible explanations for this, but have you considered this highly optimistic POSSIBLE explanation???

 

MAYBE the infection rates in the States hit early and hard are much much higher than anyone realizes.  MAYBE the reason they are not experiencing a new infection surge like the rest of the country is because they have achieved a degree of herd immunity there.  MAYBE after this surge in the rest of the country, other States will also achieve a degree of herd immunity and there will finally be a light at the end of the tunnel. 

 

It's not a totally unreasonable possibility.  Sure differences in mask compliance and social distancing (reopening) may account for things, but ask yourself, people being people, are people in New York really that much better at wearing masks than those in California?  Maybe there's something else at play.  If some experts say the infection rate may be 10 times higher than reported, might it be even higher than that?

 

Just an hypothesis, but if accurate it may be the fastest way to get back to normal 🤔

Infection timing.  The initial outbreaks  Washington, New York and California were simply the areas that got hit first.  Not surprising that they are major travel hubs from Europe and Asia.  Then you started to see Chicago, Atlanta, Dallas.  Again major travel hubs.  The initial group happened when many parts of the country were locked down.  

 

Many of the states that are now seeing outbreaks were not so much under control, as initially not hit.  They started opening, prior to ever really getting their first wave.

 

Also if you look at many of the hot spots.  For example look at Montana the area where it is worst is Yellowstone county. Gee what would one expect in the summer in Yellowstone County.  One of the reasons you are seeing problems in many areas is due to more people traveling.  Where I am at in Oregon we have started to get increases in our counts.  Most of which are tied to people traveling to the area from out of state.

 

Also since some areas were not hit many people took the relaxing of restriction to mean to go back to normal.  No distancing, gather together for parties, etc. One of the reasons New York is doing relatively well now is because of how hard it was hit.  Gave people incentive to continue distancing, wear masks, etc.  Even now some of the "hard hit" areas are only dealing with 3-5% of the population compared to NYC 10 to 20%.

 

As long as interstate travel is not restricted people will travel and carry the virus from one hot spot to another.  What is one criteria that people use for selecting a place to travel to, from high count areas,  low case counts. So it flows from one area to another.

Edited by npcl
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51 minutes ago, markeb said:

 

Unlikely, I'm afraid. Spain did a very thorough seroprevalence study, recently published in Lancet and only found 5-6% seropositive individuals. And they were one of the most impacted countries. That's well below the 50-75% you'd need for any form of herd health.

Couple that with apparent short term life of the antibodies and it will make herd immunity a pipe dream.

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40 minutes ago, mnocket said:

Probably true, but as I understand it neutralizing antibodies are only one of several factors (e.g. T cells) that may convey immunity and contribute to herd immunity.  There is just so much still unknown about this virus that it's hard to rule anything out - although I agree my hypothesis is a long shot.

The problem is that Corona viruses due not have a track record of effective t cell based immunity either.

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2 hours ago, npcl said:

The problem is that Corona viruses due not have a track record of effective t cell based immunity either.

I'm not sure of the track record (although there were some studies that showed T cell response during the SARS outbreak), but it is an active area of interest for COVID. It's seems a mistake to write it off.  It's even been speculated that T cell response may explain why COVID reinfections aren't evident even after antibody levels have waned.  Let's agree that there is much more that is unknown about this virus than is known.

https://blogs.sciencemag.org/pipeline/archives/2020/07/15/new-data-on-t-cells-and-the-coronavirus

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3 minutes ago, mnocket said:

I'm not sure of the track record (although there were some studies that showed T cell response during the SARS outbreak), but it is an active area of interest for COVID. It's seems a mistake to write it off.  It's even been speculated that T cell response may explain why COVID reinfections aren't evident even after antibody levels have waned.  Let's agree that there is much more that is unknown about this virus than is known.

https://blogs.sciencemag.org/pipeline/archives/2020/07/15/new-data-on-t-cells-and-the-coronavirus

Oh its an area of interest, but not one with a high potential for creating long lasting natural immunity.  We have already been getting some evident reinfections.  Including at least one where the second infection was worse than the first.

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13 minutes ago, npcl said:

Oh its an area of interest, but not one with a high potential for creating long lasting natural immunity.  We have already been getting some evident reinfections.  Including at least one where the second infection was worse than the first.

You seem very willing to write off T cells as having a high potential in fighting COVID.  I'm glad researchers disagree and are pursuing this avenue.

 

As for reinfections.....  I've heard anecdotal evidence of reinfections, but as far as I'm aware there is no conclusive scientific evidence that reinfections occur.  Here's the CDC's position on reinfection.......

 

The immune response, including duration of immunity, to SARS-CoV-2 infection is not yet understood. Patients infected with other betacoronaviruses (MERS-CoV, HCoV-OC43), the genus to which SARS-CoV-2 belongs, are unlikely to be re-infected shortly (e.g., 3 months or more) after they recover. However, more information is needed to know whether similar immune protection will be observed for patients with COVID-19.

 

One thing is clear, reinfection is rare if it occurs at all (in the time-frame  we have).  The exact nature of the immunity conveyed to those infected is not understood.  It is premature to attribute this immunity exclusively to antibodies.  There is much to learn and it's a good thing researchers keep an open mind.

Edited by mnocket
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2 hours ago, mnocket said:

You seem very willing to write off T cells as having a high potential in fighting COVID.  I'm glad researchers disagree and are pursuing this avenue.

 

As for reinfections.....  I've heard anecdotal evidence of reinfections, but as far as I'm aware there is no conclusive scientific evidence that reinfections occur.  Here's the CDC's position on reinfection.......

 

The immune response, including duration of immunity, to SARS-CoV-2 infection is not yet understood. Patients infected with other betacoronaviruses (MERS-CoV, HCoV-OC43), the genus to which SARS-CoV-2 belongs, are unlikely to be re-infected shortly (e.g., 3 months or more) after they recover. However, more information is needed to know whether similar immune protection will be observed for patients with COVID-19.

 

One thing is clear, reinfection is rare if it occurs at all (in the time-frame  we have).  The exact nature of the immunity conveyed to those infected is not understood.  It is premature to attribute this immunity exclusively to antibodies.  There is much to learn and it's a good thing researchers keep an open mind.

The best evidence for T-Cells having an impact also found the same T-cells in individuals that had not been infected.

 

I am more concerned about the potential for T-cell involvement in COVID-19 autoimmune and inflammatory responses, based upon the papers I have read.

 

There is a growing body of evidence about reinfections.  Have seen several papers going through peer review expect them to start getting published in early to mid August.  Considering the time frames to see any reinfections at all with the numbers that have been infected and the time frame, is concerning.

 

We will see.  In either case I do not think that natural immunity (antibodies or T-Cell) will be sufficient.

Edited by npcl
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8 hours ago, npcl said:

Infection timing.  The initial outbreaks  Washington, New York and California were simply the areas that got hit first.  Not surprising that they are major travel hubs from Europe and Asia.  Then you started to see Chicago, Atlanta, Dallas.  Again major travel hubs.  The initial group happened when many parts of the country were locked down.  

 

Many of the states that are now seeing outbreaks were not so much under control, as initially not hit.  They started opening, prior to ever really getting their first wave.

I agree with this.  To get away from the bushfire smoke here in Australia I went on a last minute cruise from Sydney (another travel hub) in late January.  I am almost certain I caught the virus from a northern hemisphere traveler (waiting to get an antibody test at some stage).   My doctor told me that she thought I had developed 'pneumonia secondary to flu' caught from someone from the north of the globe but all my flu swab tests were negative.  Couldn't get a covid test at the time.  Two cruises after mine there were confirmed cases on the ship.

 

Our government started publishing the origins of the virus cases here and they were approximately 1/3 from Europe, 1/3 from the US and 1/3 from cruise ships with actually few from Asia.  The numbers are not available any more - there seems to have been pressure applied to remove the detail (which is concerning). 🤔

 

 

 

    

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We will need a combination of B-Cells (Antbodies) and T-Cells.  Let's forget about natural herd immunity for the time being.  Let's concentrate on acquired immunity (vaccine) and hopefully herd immunity from that vaccine if widely used.  What one might generate for vaccine-acquired immunity might be protective, albeit different than from natural infection.  There is confusion here.  Just because an antibody response wanes from natural infection does not mean that a vaccine will be ineffective.  Remember that all T-Cells are not created equal.  Most refer to CTL's or Killer T-Cells but the response of Helper T-Cells and cytokines greatly aid the antibody response.  So everything needs to be measured in the clinical trials.  We do not yet know the required immunity formula yet for a vaccine.

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7 hours ago, lucymorgan said:

 

I agree with this.  To get away from the bushfire smoke here in Australia I went on a last minute cruise from Sydney (another travel hub) in late January.  I am almost certain I caught the virus from a northern hemisphere traveler (waiting to get an antibody test at some stage).   My doctor told me that she thought I had developed 'pneumonia secondary to flu' caught from someone from the north of the globe but all my flu swab tests were negative.  Couldn't get a covid test at the time.  Two cruises after mine there were confirmed cases on the ship.

 

Our government started publishing the origins of the virus cases here and they were approximately 1/3 from Europe, 1/3 from the US and 1/3 from cruise ships with actually few from Asia.  The numbers are not available any more - there seems to have been pressure applied to remove the detail (which is concerning). 🤔

 

 

 

    

lucymorgan- I think over time there will be a lot of retrospective studies published on the origins and genetic deviations of this virus and you will see great details of where it came from, how and when it mutated, and its virulence.  I think this is an area of very active ongoing study.  It actually will be quite fascinating to some of us geeks! 

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1 hour ago, TeeRick said:

lucymorgan- I think over time there will be a lot of retrospective studies published on the origins and genetic deviations of this virus and you will see great details of where it came from, how and when it mutated, and its virulence.  I think this is an area of very active ongoing study.  It actually will be quite fascinating to some of us geeks! 

Yes.  I am a different type of geek (IT and statistics - not medical) but personal (and scary) experience leads you to explore the worlds of the the other geeks 🙂

  

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6 hours ago, BigAl94 said:

Beginning to look like certainly initially the plan will be vaccination for higher risk groups only http://news.sky.com/story/coronavirus-uk-secures-early-access-to-90-million-covid-19-vaccine-doses-12032251

 

Good for the UK, in the US I expect a complete and utter cluster____ when it comes to the vaccine here.

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6 hours ago, BigAl94 said:

Beginning to look like certainly initially the plan will be vaccination for higher risk groups only http://news.sky.com/story/coronavirus-uk-secures-early-access-to-90-million-covid-19-vaccine-doses-12032251

Yes that is a very good bet that higher risk groups, health care workers and first responders will get the vaccine first in most countries.  I do not believe that regular folks taking cruises will be a high priority for limited initial doses of a vaccine.

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On 7/18/2020 at 1:10 AM, lucymorgan said:

What is your view about Vitamin D? 

 

I have been watching Dr John Campbell's youtube videos since February and he believes that one reason that the virus seems to be more dangerous to some people is because their Vit D levels are lower. 

 

 https://www.youtube.com/channel/UCF9IOB2TExg3QIBupFtBDxg

 

I have recently read about this.  But it seems that about 40% of the population in the US is VitD deficient.  It helps a bit in summer in the sun to improve these numbers.  Or taking Vitamin D3 daily.  But it is very hard to say if VitD normal levels are helpful against coronavirus unless you could just reason that getting normal levels of VitD will give you a more healthy immune system.  It is quite often that "studies" correlate one effect with something else.  Pretty easy to do.  You are a statistician so I think you know more than I do about correlations.  You can make a case for almost any correlation if you want to do so.  But these things are rarely proven and are mostly impossible to prove one way or another.

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