We’ve heard a lot about the $PFE/ $BNTX data, but seeing this is something else. From the company briefing docs ahead of Thursday’s FDA panel. pic.twitter.com/B3G748qXMS
— Matthew Herper (@matthewherper) December 8, 2020
The above graph is part of the vaccine efficacy data that is being submitted to the FDA by Pfizer. The blue line is the number of cases over time for people in the vaccine arm. The red line is the number of COVID cases by time for people in the placebo/control arm.
Looking at the curves, it looks like vaccines provide little to no protection within the first ten days. The height of the blue line is about the same as the height of the red line.
By Day 14 there is starting to be a gap.
By Day 28 the gap is a chasm.
After Day 28, it seems like the vaccinated arm will get infections here and there, but no huge leaps.
This is an amazing curve.
And from an infection breaking perspective, this is probably good enough to break infection chains and crush the reproductive rate even if we made the completely unnatural and unsupported assumption that the immunity is very short term and fades after three or four months. This would require frequent re-vaccination/boosters and fire break strategies, but even in a fairly bad case scenario that is not supported by the data, this is very good news.
Assuming that immunity lasts longer and the news gets even better assuming that the logistics of distribution and the trust issues around vaccination are resolved. Those are huge and challenging issues.
But the take-away is that Spring 2021 has the chance to be a much more open and active season than Spring 2020. That is dependent on getting vaccines distributed and in peoples arms. That is dependent on masking up and minimizing interactions. That is dependent on minimizing the number of hospitals that are overwhelmed as well as the duration of the surge. But there is a pretty good chance that Spring 2021 is better than Spring 2020.
And a very good chance that Summer 2021 is better than Summer 2020.
WereBear
Yay! Thanks for this excellent ‘splainer.
Cheryl Rofer
I would like to see modeling of results from some modest rate of vaccinations and immunity wearing off after two months and a year. Anybody been doing that?
Wag
I agree. An amazing graph supporting significant efficacy for the vaccine. I am very pleased with this news.
Of course, we now face the fact that Trump f***ed up on this, as well, and didn’t have the vision to go long on the number of doses. Only 50 million people will get vaccinated by Spring, and everyone else will still be at risk until mid-Summer, leading to a significant slowdown for the economic recovery. If I didn’t know better, I might think that Trump knew months ago that he was going to lose the election, and decided to sabotage the incoming Democratic Administration.
dmsilev
So, ignorant question: Assuming that “day 0” is the first dose, does this mean that it is worth considering a single-dose regimen and thereby spreading the available supply across twice as many people? I assume there isn’t any data on how long immunity lasts without the second shot?
Bill K
Isn’t this a two dose vaccine? So the lack of protection in the first ten days could be attributed to the need for that second dose, right?
Also, typo – “Little to know protection”.
David Anderson
@dmsilev: I will defer to the clinicians and drug policy experts on that question, but there is already chatter about trying to design a non-inferiority trial for a 1 dose regimen.
Roger Moore
@Bill K:
I think the second dose is given at 28 days, so that’s not the answer; the reason is that it takes the immune system a while to ramp up and develop a strong reaction to the vaccination. This is part of the reason it takes a while to develop symptoms after infection. Many of the symptoms are a result of the body’s immune reaction, not of the virus itself. I think that delay in immune response is part of the reason people can become asymptomatic spreaders. Immune response is enough slower than viral replication that people are virus factories before their immune system is going strong enough to develop classic symptoms like a cough and fever.
They should also strongly consider a single dose vaccination. IIRC, most vaccination trials include a leg where the first shot is vaccine and the second is placebo. If that gives good enough results, it makes sense from a public health perspective to go with the single shot regimen. Even if the vaccine is only 80% effective with a single shot, it’s probably more valuable to get twice as many people vaccinated, especially since we don’t have enough doses to go around.
Jeffro
All I know is, I better be able to rock out with the Foos and 50,000 of my closest friends by the 4th of July – got that, team Biden??? ?
David Anderson
@Bill K: The 2nd Dose is at day 21 for Pfizer.
I think the story is that day 0 to Day 10 or so, the body is still learning to recognize and generate the needed antibodies and around Day 11, real protection is initiated with it holding through at least day 21 when the second shot is administered.
We don’t know if the 1st shot would provide pretty good protection through Day 100 without a booster. We don’t know the interactions yet.
Ken
@Bill K: It’s also due to the lag in the immune system response. It takes time for your body to generate antibodies, T-cells, etc. I don’t know if there’s a trial which would give data on the efficacy of a single dose.
Roger Moore
@dmsilev:
I think this trial included a leg with an active first shot and a placebo second shot. And frankly, there isn’t good data yet on the durability of immunity, since we simply haven’t had enough time since the trial started.
Alex
I am alarmed by the NYT report that we will only have 100M doses (for 50M people) of the Pfizer shot in the US until at least June, because the Trump administration passed up the chance to reserve 100M more. I don’t think we will break nearly as many chains of transmission with only 15% of pop vaccinated. Do we really think other manufacturers’ vaccines will be approved and ready in high enough supply by spring?
Alex
@Roger Moore: Also, people testing positive in the first 14 days are within the incubation period and may have been infected before they got the first dose
Dupe1970
@Wag: Possibly. But there is also the Moderna vaccine. And the Johnson & Johnson vaccine. Other companies are also advancing vaccines. I think it could possibly set us back but not by much.
sab
@David Anderson: Doctors have been telling me for my whole life that vaccines are only effective after a couple of weeks, after the immune response has had a chance to kick in.
sab
@Alex: We wouldn’t want to disrupt the hydrochloroquine market.
Glidwrith
@Dupe1970: Moderna can only manage 10M people. J&J is still enrolling for phase 3 trials.
Frankensteinbeck
Always remember that for everything Trump fucked up, starting January 20th a swathe of the most competent people in America will be Hell-bent focusing the power of the American government to make the curve above happen. They will be the people who not only know the limits, but know how to get around those limits and do so ahead of time. They are preparing, right now, plans where they’ll give Biden a pile of papers to say “Sign this and we’ll do the rest,” the minute Biden reaches the oval office, and maybe in the car ride on the way over. Biden knows that of all the things that need doing, this one needs the most immediate scramble.
It’s going to be a different world.
VOR
We need to explain this curve to people, otherwise some people will jettison masks the day after taking the vaccine. This clearly shows you must wait until your immune system kicks in.
And since WHO says you can still potentially transmit COVID after taking the vaccine, we need people to keep wearing masks until there is basically zero COVID left to transmit.
I am optimistic about Memorial Day BBQs.
geg6
This is such hopeful news! I can’t tell you how great this made my morning. I’ve been feeling a little down, partly because it’s typical late fall cold and gloomy and cloudy here in the ‘Burgh and partly because the media can’t seem to break their Mango Mussolini addiction. I so need to get back to normal life, or at least semi-normal life. If I can get the vaccine and be extremely careful for a week and a half or two weeks afterward, so be it. If I have to get a vaccine every six months or so, so be it. I’m fine with that.
Alex
@Dupe1970: Do we know how many doses they ordered of each?
Lacuna Synechdoche
@Bill K:
I think what we’re looking at in the first 1-2 weeks is simply a statistical artifact – by which I mean that in the first one to two weeks data, there simply haven’t been enough cases of Covid-19 that developed in the placebo group in the first two weeks for a meaningful statistical comparison.
Alex
@VOR: Yeah, I’ve seen some folks concerned that since we are going to vaccinate health care workers first (as we should), we need to have more tests to make sure they aren’t asymptomatically transmitting it until we know whether the vaccine blocks transmission.
EthylEster
NYT article yesterday (Dean Baker co-author) stated that Pfizer says it cannot produce more vax until June of this year. They predict 2021 will end with many in this country remaining unvaccinated. And more info today about Trump admin declining to buy 200 million doses initially. So I think our enthusiasm might need to be curbed a bit or at least delayed.
It’s great that the vaccine exists. Now let’s figure out how to get it to everyone in a timely fashion. After all most experts agree that manufacturing and distribution are hard the really hard parts. Let’s watch how the Brits do it and try to learn from them.
geg6
@VOR:
Or Fourth of July, more likely. That would be wonderful.
Lacuna Synechdoche
@Cheryl Rofer:
I second Cheryl’s request. Also, going forward, I’d like to see comparisons of infection rates vs. vaccination rates at the national, state, and county levels too. Specifically, it would be nice to see some data telling us at what point in vaccination rates does ‘herd immunity’ set in.
Roger Moore
@Alex:
The news is reporting they ordered 100 million doses each of the Pfizer and Moderna vaccines.
feebog
There are other vaccines that will be available during the first six months of 2021. We don’t know the efficacy of these yet, but you can bet the Biden administration will be looking at obtaining them sooner rather than later.
Matt McIrvin
This is assuming that the vaccine prevents infection and infectiousness rather than just illness, correct? I agree it’s likely that it has some such effect, but this is strictly speaking unknown.
Matt McIrvin
@Ken: I recall seeing a trial of one of the vaccines, I forget which, in which they tried both single-dose and two-dose regimens–the single-dose only gave about 70% protection as opposed to 90+% for the two-dose. It was a significant difference. (And I think the total dose given was the same for the two programs.)
Keith P.
What does this say about mRNA vaccines in general? This is a new type of vaccine, and for its first (?) rollout, it’s showing some potentially mind-blowing efficacy numbers.
Matt McIrvin
@Keith P.: If I recall correctly, the Oxford/AstraZeneca vaccine is a more traditional one based on a chimpanzee adenovirus, and it’s about as effective as the mRNA ones (with the most effective dosing regimen, which is the one they’re probably going to use–I think this was the study I was talking about above). So that may have more to do with how amenable SARS-CoV-2 is to vaccination.
Lacuna Synechdoche
David Anderson @ Top:
Maybe I’ve just become too cynical after 4 years of Trump and 40 years of conservative dominance in US politics, but my view of people in general, and Americans in particular, has become exceedingly dim and pessimistic.
So I don’t think we’ll be seeing much improvement in the US by this Spring, at least not in the first half of it. There will be bumps along the road of production, introduction, and distribution, as there always are, compounded by the more specifically American attitudes of denialism, willful ignorance, paranoia, exceptionalism, resentment, recalcitrance, and truculence.
(*Sigh*. I remember a time when optimism was seen as the defining American trait. Not anymore.)
I do expect us to see improvement by summer, though, due to a combination of increasing vaccine penetration by that point, and the improvements that come along with more light and outdoor activity in late spring and summer. That should give us time to really increase distribution of the vaccine before next fall, so we don’t get another surge again in autumn 2021.
In other words, I think we’ll be back to ‘normal’ – or whatever our post-Covid normal is going to look like – by next autumn. Maybe by the early summer. I don’t really see that happening by spring though.
I hope I’m wrong.
bluefoot
@VOR: We not only have to wait until our immune systems kick in, we should wait to go maskless after we’ve reached herd immunity. While the data show that the vaccine prevents severe disease, we don’t know what it does (yet) to infectivity. That is, can you still infect someone (non-vaccinated, immunocompromised, etc) after you’ve been vaccinated.
Still, this data is great. I was just looking through the briefing documents (I work at a biotech in medical research so have some experience) and safety looks good, efficacy great. There are of course gaps – we don’t know duration of immunity as so far there’s only been a few months of follow up, we don’t know if the vaccine confers sterilizing immunity, we don’t know efficacy in patients on immunosuppressants and other populations. I was encouraged to see that teenagers have been enrolled in the study so there will be efficacy and safety data in the 12-18 yo cohort.
One of my (many) worries with the uncontrolled spread here in the US is that it gives the virus more opportunities to mutate into something that may escape the vaccines. It’s encouraging that more than one vaccine so far shows such high efficacy. But we NEED to get the spread under control for SO MANY reasons.
BTW: The advisory committee meeting is a public forum. It will be streamed on YouTube (to accomodate the high interest) and some other platforms. You can go to the FDA website for the info.
ETA: Here’s the youtube link – https://youtu.be/owveMJBTc2I
Robert Sneddon
One thing to remember when discussing the reporting of “how many doses of vaccine X has country Y ordered” is that those are pre-orders. The big deal isn’t that those orders will magically and instantly turn into delivered packages of ready-to-dispense vaccinations, it’s that they provided a guarantee to the companies researching and making the vaccines that there would be money coming in to pay for their efforts EVEN IF A PARTICULAR VACCINE’S DEVELOPMENT FAILED. Those guaranteed pre-orders paid for a shitload of shot-in-the-dark research and development and testing over the past nine months.
Thanks to SCIENCE!!! and a lot of schmott pipple (tm Agatha Heterodyne) we lucked out and the first few vaccines seem to be very effective and probably safe to use in quantity one million but without those pre-orders the developers would still be filling in grant applications and going around cap-in-hand to funding agencies to pay for lab space, equipment, materials, Ph D students and the like. Instead they’re worrying about the transportation logistics of mass quantities of vaccine doses and how to ramp up production even more, things which are still a problem but a GOOD problem to have.
Matt McIrvin
Summer 2021 will be better, but “normal” in which people can feel reasonably comfortable doing vacation travel and indoor concerts and such is going to be 2022 at the soonest. I think a large fraction of the US population is just going to refuse to get vaccinated on the basis of conspiracy theories and scary-anecdote-based rumors that the vaccine gives you COVID, because this is what always happens. Also, the vaccines seem to have side effects about on par with the shingles vaccine (aches and fevers for about a day after the second dose), which will scare people.
Cheryl Rofer
@Lacuna Synechdoche: My guess, from having done chemical modeling that is similar in mathematical structure, is that we will start seeing the rate of spread slow down at 30-40% immune, whether from having had the disease or the vaccine. Herd immunity is generally given as 70%, which I take as a figure of merit rather than anything hard and fast.
We’re not at all close to any of those, even in the Covidakotas
ETA: for 70% coverage, we need to vaccinate 230 million people. For 30%, 90 million.
bluefoot
@Robert Sneddon: I always say that logistics is usually a solvable problem because there are few unknown unknowns. Science, not so much. :)
Roger Moore
@bluefoot:
We also know that none of the vaccines are 100% effective, so you should continue to behave as if you’re at risk even after being vaccinated. It sucks that we won’t be able to get back to normal immediately, but we’re going to have to live with that.
ColoradoGuy
I’ve been watching the Dr. John Campbell videos since the beginning of this. He provides links to original research papers, and is a medical instructor in his day job, so he’s not some random Internet guy.
He’s mentioned the true total-infection rate for the USA as a whole is somewhere between 50 and 100 million people, which is somewhere between 15 and 30% of the population. The immunity profile of SARS-Cov-2 appears to be similar to SARS-1, which is long-lasting (17 years so far). If this is so, then CV19 will be squeezed in two directions … from the already-exposed population, and from the newly vaccinated population. Re-infection, although it occurs, appears to be very rare.
In addition, there is a subtler effect. The immunity amongst the population is not evenly distributed. The virus has already swept through some regions, while others remain vulnerable due to low exposure.
Lacuna Synechdoche
@Cheryl Rofer:
That’s interesting – and hopeful. I’d been assuming that the 70% figure was low-balling it, and that the real figure would be in the 80-95% range.
To start seeing improvement by the time we get into the 30-40% range of effective vaccination (plus actual recovery among the infected) would be very good in comparison to what I feared.
P.S. Like you, I’ve been taking the 70% figure as not well-established. That’s why I’d like to see us collect more data on the overall/societal effectiveness of the vaccine as we move forward, and see if we can lock down a more data-supported answer to ‘herd imunity’ question.
bluefoot
@Roger Moore: I know – we need to be doing some serious public education/PSAs about expectations with regards to the vaccine and the pandemic and when things might be “safe.” Otherwise, people will get the first shot and think that they are protected right away. Even if we can administer the vaccine to everyone worldwide by mid-year (a pipe dream, I know), things wouldn’t be normal until fall, I don’t think.
My sister has a serious autoimmune disease and her doctors have said if she gets COVID, she’ll die. So she, her husband and daughter haven’t left the house since February. Every couple of weeks she asks me when I think it will be safe for her to be in public or her daughter back to school.
gvg
One of the more memorable facts I read is that the British Oxford/AstraZeneca vaccine was accidentally administered to some of the early enrollees at only half strength for the first dose and that that “mistake” had a 90% protection, whereas the intended full strength 2 doses was only 70% effective. They figured out that there had been a mistake because the less dosed people didn’t have as much tiredness or sore arms as expected so they went back and looked at why. Its not established why yet but now of course they plan on doing it on purpose.
Le Comte de Monte Cristo, fka Edmund Dantes
Fuck. Anticipating no second stimulus, I may as well start preparing my bankruptcy petition now.
trollhattan
@Roger Moore:
I too heard that 80% figure for the first injection, which on its own is meaningful and could factor in whether to initially give just one to more people or give the second to fewer while the vaccine is still in short supply.
Guessing with frontline health care workers their constant exposure is a compelling case for that second shot.
I sure wouldn’t want to be in the placebo group.
Matt McIrvin
@Lacuna Synechdoche:
Before there were hard numbers on vaccine efficacy, a lot of experts were trying to manage expectations about the vaccines and saying that the first generation of vaccines might only be about 60% or 70% effective (like some flu vaccines). To get significant herd immunity with that level of efficacy, you need to vaccinate much closer to 100% of the population.
Barbara
@Lacuna Synechdoche: The positive impact at 30-40% rate of vaccination will be highest if the 30-40% include people whose jobs bring them into contact with many people. IOW, the more we focus on those who are more likely to become vectors of receiving and transmitting the virus, the faster the positive impact will be. IOW, the workers at my coffee shop and grocery store should be higher in the chain than I am, even though I am much older. I don’t expect all these decisions to be made as rationally as all that, but I hope many are.
Lacuna Synechdoche
@Le Comte de Monte Cristo, fka Edmund Dantes:
Your call, but I’d probably wait to see what the results of the Georgia runoff are first.
Then again, I’m a procrastinator and lazy – so I’ll take any excuse to put off paper work.
trollhattan
Tidbit I heard this a.m. from a public health administrator is once the Pfizer vaccine comes out of the deep, deep freeze it’s viable five days, a lot better than the five hours I’d imagined.
Matt McIrvin
@Barbara: Yes–one of the surprising things about COVID transmission is that it’s very clumpy; most infected people don’t actually infect anyone else at all, and the chain is dominated by superspreaders, who might for some physiological reason be more prone to spew virus, but who also tend to be in social or work situations where they expose others. Some attempt to get those people vaccinated might help a lot, especially if/when we know the vaccine prevents asymptomatic transmission.
(I’ve seen some resistance to this on what I think are misguided moral grounds–that we shouldn’t reward people for behaving dangerously. But doctors shouldn’t act out a morality play; you can educate the public all you want but people will do what they’ll do, especially if they’ve been ordered to as a condition of employment.)
Yarrow
@EthylEster:
The Brits have the NHS so they’re kind of set up already with a way to reach people. The US has nothing like that.
Robert Sneddon
@ColoradoGuy: The proposition that’s there’s been a very large number of Americans exposed to COVID-19 and that makes things better is problematic. A mild case, even symptomatic could result in very low levels of antibodies being produced resulting in ineffective protection against a second infection later. There’s some evidence that vaccination produces much higher levels of antibodies to begin with compared to post-infection levels so a simple large-number-of-cases isn’t a defence against widespread vaccination because everyone has had it already. This proposition will be put forward by a lot of not-every-well-educated people real soon now.
Dr. Campbell (he’s not actually a medical doctor, he is a nurse trainer and nurse practitioner but he does have a medical degree) presents good explanations of the current news about COVID-19, its effects and vaccine developments news although he can be a little long-winded and repetitive at times. Don’t read the comments on his Youtube channel though, it will make you despair for humanity.
trollhattan
@Lacuna Synechdoche:
Let’s hear it for procrastination! (I would have looked up the spelling, but later.)
:-)
Matt McIrvin
@Robert Sneddon: Also, I’ve seen some speculation that some of the “reinfection” cases are really the initial infection, reactivated after a period of relative dormancy. It could be that some people who are infected can spread virus again many weeks later.
Amir Khalid
A bit off-topic, but amusing and still kind of relevant: the second person in Britain to be vaccinated against Covid-19 is named …
Roger Moore
@Lacuna Synechdoche:
A good rule of thumb is that if R0 is X, you need to get more than 1-1/X of the population immunized- either by vaccine or infection- to reach herd immunity. COVID seems to have R0 of about 3, which would mean you need to get more than 2/3 of the population immunized. This makes sense. R0 is essentially the number of people each infected person would pass the disease on to if nobody had immunity. So if you’d normally pass it on to 3 people but more than 2 out of 3 people are immune, on average you’d pass it on to less than 1 person and the disease will die out.
Of course at that point it will die out only very slowly; you need to get the effective reproductive ratio well below 1 to really crush a disease out of existence. If there are 1 million people infected and each person passes it on to 1/2 of another person on average, it will still take about 20 times the average infection life cycle to completely crush it to nothing. If on average it’s passed on to about 0.9 people, it will take an something like 100 times the average infection life cycle to completely crush it. To really wipe out COVID, we either need to get well above the minimum herd immunity level. Alternatively, we could reach that minimum herd immunity level and add public health measures to further limit spread (masks, testing and tracing, etc.). Either way, it will take way longer than people are making it sound to really wipe it out.
Roger Moore
@Matt McIrvin:
That also assumes that what makes people prone to be superspreaders is somehow immoral. If it’s either something inherent about their physiology or dependent on them working in a public setting, then that attitude is obviously counterproductive.
Yarrow
I haven’t been following the vaccine stuff all that closely. Has the US approved any vaccines yet? I keep seeing stuff about various states getting X number of doses but I haven’t heard about vaccines being approved. Where do we stand on that?
Yarrow
@Matt McIrvin: That would make sense based on what we know about how viruses behave. Herpes virus can reoccur with an active case. Chicken pox can show up again as shingles. Since this is a new virus we don’t know exactly how it might, or if it can, reoccur.
Lacuna Synechdoche
@Roger Moore:
Assuming two doses for each inoculation, that’s potentially 100 million vaccinated (minus doses lost to contamination, breakage, improper storage, inefficient distribution, going bad past ‘use-by date’, and so on).
Or about 30% of the country, probably a little less due to the above mentioned inefficiencies.
Lacuna Synechdoche
@Matt McIrvin:
Dangerously? You mean for behaving like … Conservatives?
Roger Moore
@Yarrow:
None of the vaccines have been approved in the US, but there’s no particular reason to think they won’t be. It’s frustrating that we can’t start vaccinating because the FDA wants another week or two to get all the paperwork squared away, but for logistical reasons we weren’t going to get that many people vaccinated in the next couple of weeks anyway.
Gravenstone
@Matt McIrvin: People will also incorrectly assume that once vaccinated they will no longer need to continue to take the current precautions; masking, social distancing and hygiene. It would not shock me at all to see actual localized spikes around large vaccination centers because people will be stupid and revert to their “normal life ” far too early.
Baud
@Roger Moore:
Is it paperwork or process? You can’t skimp on process given safety concerns, whether real or imagined.
Roger Moore
@Yarrow:
It seems very unlikely that SARS-CoV-2 will manage to reactivate the same way herpes viruses (which includes chicken pox) do. Herpes viruses incorporate themselves into their victims’ DNA, which is why they can remain dormant for so long. We may not have studied SARS-CoV-2 that much, but we have investigated other coronaviruses, and we have never seen one that behaves that way. OTOH, we do know that some people, especially people who mount only a weak immune response, can have living virus stay in their body for a long time even if they don’t have obvious symptoms.
Yarrow
@Roger Moore: Thanks. What you said has been my understanding – vague, “It’s going to happen in a couple of weeks,” but nothing really specific. Maybe they won’t tell us until it’s happening.
Lacuna Synechdoche
@Amir Khalid:
I like the accompanying photograph. He looks like someone who’s just dreading and weary of people making comments about his name.
Or maybe he’s just dreading the shot he’s about toget.
Roger Moore
@Baud:
I think it’s a mixture of process and paperwork. You’re right that we don’t want to skip the process to speed things up, but I think the UK had a better process. They were actively monitoring the whole trial, so they had already seen the data before the final application was made. That saved them a couple of weeks in getting their approval through.
Yarrow
@Roger Moore: There seems to be much we still don’t know about this virus. Like, why do some seemingly very healthy people, even young people, get so sick while others, even some older folks, have very little or even no symptoms. My guess is it has to do with how individuals’ immune systems respond but who knows.
Lacuna Synechdoche
@Cheryl Rofer, @Matt McIrvin, @Barbara, @Roger Moore:
Danke, danke, danke, danke for your informative responses.
Roger Moore
@Yarrow:
I think they gave specific timelines when the companies put in their applications. I found this Bloomberg article that says FDA is holding a public meeting Thursday to go over the Pfizer data. Beyond that, they don’t want to give a hard timeline because it depends on the data. If everything looks good, it could get its EUA in a few days. If there are questions about the trial results, they may need to go back and forth with Pfizer for a while to get things sorted out. If there are serious problems, there’s a chance the application could be denied. They don’t want to say “it will be approved on such and such a day” because that will make it look as if they’ve already made up their minds.
Kelly
If I recall correctly Covid super spreader is a phase of the infection some folks go thru for several days which is why the super spreader events appear random.
I really don’t want to come down the bug between now and the first of the year. Besides being, well sick and at risk of dying the illness could span two annual deductibles. The disease could hang on until June, when I transition to Medicare increasing the span to three deductibles. What a crazy system.
terry chay
@Lacuna Synechdoche: I do not think 70% herd immunity is a low ball. The Measles vaccine is under 90% effective and outbreaks occur when the vaccination rate dips below 95% which means 85% herd immunity to stop that disease. Measles has a much higher R0 than SARS-COV-2.
As Cheryl points out, curve flattening occurs at a lower number than herd immunity. In one you are talking about slowing down the spread to something manageable; in the other you are talking about eradication with no chance of another outbreak.
As for the Dakotas. I think they’re probably around 10% so the disease has to get 7x worse for them to have herd immunity. This is why the only end game for this was always a vaccine.
Redshift
@Wag:
My guess is a tossup between that scenario or that they were sure the Scott Atlas patented Herd Immunity was going to work out great (or Trump did and no one was going to contradict him no matter how many people would die.)
Barbara
@terry chay: If they are lucky, the Dakotas will end up with a death rate that rivals Massachusetts, an early locus of the virus, and if they are unlucky they could end up like New York, although it’s unlikely they will be as hard hit as New Jersey. Which is to say, that they learned nothing from what happened in the spring and Kristi Noem seems to be on an unapologetic eugenics campaign. I have been to both states and I am never going back.
Robert Sneddon
News just in, the Lancet journal has published the test results from the Oxford/AstraZeneca vaccine. This is a modified chimpanzee adenovirus unlike the two vaccine front-runners which use encapsulated mRNA to create immunity. Basically it seems all good, high levels of protection and apparent safety with some question marks around dosage levels and effectiveness.
This vaccine is a more conventional approach to inducing antibody resistance to a disease compared to the mRNA approach. The chimpanzee adenovirus can’t grow in the human body but its modified protein coat fakes the signature of the SARS-CoV-2 virus and kickstarts rejection and antibody production. It’s a lot simpler to produce than mRNA vaccines so ramping up production will less problematic, it’s easier to store and transport and it’s cheaper too per dose. The UK government has pre-ordered 100 million doses and the manufacturers intend to make three billion doses next year.
https://www.bbc.co.uk/news/health-55228422
Interestingly the Oxford vaccine was developed from a blue-sky project started several years ago after SARS-CoV-1 hit. The idea was to develop the basic materials and tools to produce a vaccine for “Disease X”, a hypothetical pandemic virus-borne disease and have everything ready to hand to create a targetted vaccine in a short timescale when the structure of the virus was characterised. Science!!!
Barbara
@Robert Sneddon: Yes, I was really disappointed that AZ/Oxford had more hiccups, because if safe and effective, this vaccine seems like it would be more accessible to more people. I believe that the most promising Russian vaccine is also based on the adenovirus methodology, which has been a tried and true methodology for some time. Whereas, no one has ever completed a true mRNA vaccine for widespread public distribution. BioNTech (a German company started by a married duo of scientists of Turkish heritage) has been working on the technology for 20 years and positively jumped on the opportunity to do so for Covid, coming up with a candidate as early as February of 2020.
Matt McIrvin
@terry chay: And now that we know there are several effective vaccines, it makes even less sense to go for herd immunity through infection.
If there were no hope at all of a vaccine, if we were doomed to get infected until the virus burned through enough of the population for the pandemic to end naturally, then one might have made a defensible argument that the best we can do is to flatten the curve enough that the health-care system doesn’t get overwhelmed–going slower than that would just be prolonging the social pain.
But if there’s a vaccine coming, which will someday provide much stronger immunity without disease, that argument doesn’t make sense at all! You want to protect as many people as you can until the day the vaccine arrives. I suppose it could be argued that protecting too many people slows down the vaccine trials, but we missed that train anyway.
Kent
Pfizer was not part of Trump’s Operation Warp Speed. I wonder if being butt hurt by not being able to take full credit for the Pfizer vaccine is one reason why they didn’t order more of it. I smell Jared’s hands in this.
trollhattan
Bwa-ha-ha
Donny, desperate to claim he invented and perfected all the COVID vaccines.
Also, in tots and sprayers news.
trollhattan
@Kent:
We know damn well Jared is hip-deep in determining state-by-state vaccine distribution. It will eerily track Trump vote margins.
Barbara
@trollhattan: It also might help to know that the White House just issued rules that Pharma and BIO are both trying to get invalidated. There is just not a lot of love lost between manufacturers and the WH at this point.
Matt McIrvin
@Matt McIrvin:
…I guess that should be “if there were no hope at all of a vaccine or of dramatic improvements in COVID treatment”, and we actually have seen significant improvement (not so much from therapeutic drugs, which have been disappointing for the most part, but improvements in medical procedure as doctors learn what works).
I’ve noticed a peculiar strain in discourse over COVID, that some people actually express disappointment that people kept on stressing or enacting precautions beyond the minimum necessary for “flattening the curve”. There’s this note of “have you forgotten what flattening the curve means?” as if it’s actually wrong to hope for any better. It seems to be connected to a conservative valorization of suffering.
bluefoot
@Yarrow: There have been some interesting reports in twins who have both gotten COVID. I just saw one where two identical twins who live and work together both got COVID and each had a very different clinical course. One had mild disease, the other was in the ICU and intubated. We really don’t know a lot about the virus yet, and why some people get mild disease and some severe.
I know the Regeneron antibody trial has an optional genetic substudy – basically studying host genetics for disease severity and response to antibody. But it will probably be a long time before the research bears fruit.
Alex
@Roger Moore: That’s a good point, elimination would require a higher vaccination rate. I’d add that R0 isn’t fixed– the number of people the average infected person transmits to depends on factors like whether karaoke bars are open, masks are required, or test/trace/isolate is effective. So those will still have a place in any elimination strategy.
bluefoot
The livestream for the FDA meeting to review the Pfizer data is in the YouTube link I posted above. it starts Thursday at 9 AM and goes all day. The agenda and briefing documents are available as of this morning. The transcripts will be available at some point afterwards. From what I hear, the target date for approval is Dec 17th if all goes well.
jonas
A bit OT, but yet another story in what I’m sure will go down as one of the great boondoggles in American history: Trump’s precious border wall. Portions of which, it’s being alleged by a whistleblower, a subcontractor hired illegal armed Mexican security guards to patrol.
The books that can and should be written about the malfeasance and corruption of this administration will occupy journalists, investigators, and historians for decades. It’s simply eye-watering.
Redshift
@Kent:
Yeah, that seems way too likely. I hope the Trumpers are as incompetent at destroying documents as they are at everything else, so the real appalling reasons for all of this come out.
(I’m reminded of Iran-Contra, where Ollie North and his crew deleted a lot of incriminating documents, but didn’t know that their system made automatic backups until the investigators came in and pulled them up.)
Alex
@Kent: Never underestimate the pettiness of the Trump admin; I bet you’re right. I’m also wondering if all of the press releases Pfizer was sending out about preliminary effectiveness results were part of a pressure campaign to try to get the Trump admin to buy more.
Kristine
@Kent:
In addition, I wonder if they planned to follow their PPE philosophy–help the red states and let the blue states fend for themselves/make their own separate deals.
Jeffro
Here’s hoping that hearings lead to investigations lead to charges lead to convictions with this crowd, over and over again.
In other news, I believe this kind of thing was discussed on BJ months ago, and it’s still a great idea: “Fireside Chats” by Biden would be a great idea (the headline sucked, so I wrote my own ;)
bemused senior
@Alex: when I was at Kaiser for my chemo on Friday the oncology nurse told me that california got half as many doses as expected, and that the initial recipients of the vaccine at Kaiser would be workers directly treating covid-19 patients. The second group would be other workers treating people in the hospital. The reduced number of doses apparently had to do with a problem detected during the cdc review.
Cheryl Rofer
@Barbara:
This is what I thought too, but a recent modeling paper in Science shows little difference in spread between this approach and vaccinating the most vulnerable first.
ETA: This is why you do modeling. Having done modeling for a system in which I could check its accuracy more easily than you can in this one, I have been surprised many times.
Kelly
Mrs Kelly tracks local political craziness on Facebook and Nextdoor. She’s just reported the Covid-19 is a hoax anti-maskers are sharing the news that the vaccine causes female sterility. Oh well, more vaccine rejectors gets me to the front of the line sooner.
Yarrow
@Roger Moore: Thanks. Appreciate your insights.
Ohio Mom
I hope that the country experiencing the pandemic abating and the economy recovering gives the Biden administration the effect of “wind in their sails” to move forward on everything else that needs doing — addressing climate change, voting rights, repairing our standing among the rest of the world, etc.
It feels to me that everything rides on Biden producing a clear end to Covid.
Matt McIrvin
@Ohio Mom: I hope so too.
The dark side is that people in Congress and in the states who want Biden to fail will have a political motivation to slow-walk vaccination, COVID control and economic relief, with the assumption that Biden will get blamed for any consequences.
MomSense
David can you recommend a good source for information about the vaccine and pregnant women/women who may become pregnant? Apparently the Covid virus affects the placenta, causing it to weaken. I haven’t seen much information about testing on pregnant women or women who become pregnant after being vaccinated.
Fair Economist
@David Anderson:
We don’t know for sure, but I can’t think of any measured immune response providing 90% protection at 2-3 weeks and then frequently fading by 6 months. We’d be far better off with a one-dose regimen for 100 million than a two-dose for 50, because of the herd effects. One-third of the population almost immune means moderate masking and distancing should quash the virus.
Fair Economist
@Kelly:
That’s kind of how I feel at this point. Given the long-term effects of COVID and the very real possibility that multiple infections over the years cause cumulative damage COVID anti-vax might serve to eliminate a large fraction of the nutcases from the population and end the anti-vax nonsense.
Barbara
@Cheryl Rofer: Interesting. Personally, I think someone who has to be in harm’s way is more deserving, whether they are otherwise apparently vulnerable or not. Identification of vulnerability is itself inexact. A fascinating New Yorker article on the history of immunology, probably Nov. 7 edition, noted that there are several attributes that might explain vulnerability among those who “shouldn’t” be at high risk, but that even these factors accounted for no more than 10% of high impact cases in populations that are on average at lower risk.
topclimber
@Jeffro: Town Halls focused on specific general issues would seem a natural for Biden. He’s got the let me hear your concerns and tell you what we are doing about it vibe much more than FDR’s great American father figure persona.
Roger Moore
@terry chay:
South Dakota is listed as having almost 80,000 confirmed cases, which is almost 10% of the population. North Dakota lists more cases in a smaller population, so they’re solidly over 10%. And that’s just confirmed positives; they’ve almost certainly had a lot more infections than that. They still aren’t at herd immunity levels- for practical reasons it’s very difficult to get to herd immunity by infection alone- but they’re almost certainly at a high enough level to start slowing the spread some.
StringOnAStick
@bemused senior: I hope your chemo is going well and effective without being difficult to tolerate. Best wishes to you.
Barbara
@Roger Moore: That’s what they said about parts of NYC in the spring, but it hasn’t worked well enough to obliterate hot spots. North Dakota does have a low density population, nonetheless, there are large areas where, literally, no one lives, not even animals, and 2/3 of the population live in the 10 largest cities. Low density isn’t preventing North Dakota from having the sixth highest death rate in the nation, in spite of not having an older than average population.
schrodingers_cat
@Roger Moore: Is this some kind of a Taylor series expansion. Is there an epidemiology 101 type book I can refer to?
David Anderson
@MomSense: Right now, there are no published studies on COVID vaccines among women who are pregnant or trying to become pregnant. I know there are a few in pipeline but no results
Dan B
@Matt McIrvin: Ypu seem as well informed as anyone here although our crowd wisdom is even stronger. I’d say the vaccine resistance of the public is because we are being sheltered from the human stories to “avoid panic”. There was a documentary maker on Amanpour last night. His doc “76 Days” was shot in hospitals in Wuhan at the start of the pandemic. The focus was on the hospital workers, primarily nurses, and patients. I’ve known that there are heartfelt and horrifying stories but seeing the elderly CP member screaming to his famiky for death to put him out of his agony, and the nurses trying to hold back the mob that was trying to break down the door to the clinic were riveting and burned into my memory.
I’ll leave the best approach to epidemiologists but the vaccine deniers will not be moved by statistics. The reason that Jenny McCarthy is so difficult is Autism is very present and visible whereas pertussis and measles generally pass by quickly.
We need a Lincoln Project type campaign to put stories like “76 Days” in front of the public. Until then our data is doomed to a Sisiphean task.
Roger Moore
@schrodingers_cat:
It’s not a Taylor series, it’s just basic math. Imagine that in a completely naive population, a sick person will spread their illness to an average of N people. This is what epidemiologists describe as R0, the reproductive ratio. Now imagine that the population isn’t completely naive and that some fraction p of the population have developed immunity by having been sick themselves. In that case, you’d expect that each sick person would spread their illness to an average of N(1-p) people instead of N people, since only (1-p) of the people can be infected. This is Reff, the effective reproductive ratio. If you set N(1-p) = 1 and solve for p, you get p = 1-1/N. So when more than 1-1/N of the population has developed immunity, the average sick person will spread their illness to less than 1 other person, and the disease will start to die out.
The part about how quickly it will die out is just a basic exponential decay function. If Reff = 0.5, then the half-life of the disease in the population will equal the generation time. Since 10^6 ≈ 2^20, that means it will take at least 20 generation times for a population of 1 million sick people to decline to fewer than 1 person. If Reff = n, then the half-life of the disease in the population will be ln(0.5)/ln(n) generation times. This is why it’s important to get Reff as far below 1 as possible. If you only get Reff down to 0.9, the half life will be about 6.5 generation times, and it will take a really long time to get case counts down.
Dan B
@Amir Khalid: Patient 2B or not 2B?
Shameless puns. Off with his head!
Dan B
@Gravenstone: The assumption that people will act like they are immune the moment they get the vaccine is undoubtedly correct, unfortunately. We see it in operation every time government announces an easing in restrictions. People go to parties or out to dinner, you name it. The issue for people who are paying attention to Covid-19 is that most people understand how pandemics unfold, or even how viruses spread.
Most people have little knowledge. Most people hear very little about the virus and there is an all to high level of misinformation. It drives me crazy every time our governor says we are easing restrictions. 90% of the public likely hears: “Covid-19 is over. Relax.”
I’d love to see a man-in-the- street video. I’ll wager good money that most people cannot describe what ‘pandemic’ means. Ponder that!
schrodingers_cat
@Roger Moore: Thanks for the explanation!
VeniceRiley
The vax with amazing tech that I am most interested in is the Imperial College one. Go have a read about it if you have the time. Seems like the big pharma players are wait and see on their cutting edge tech. They don’t have a big player partner to speed it; so not vax until summer from them, but if it proves out, then it will be the best one.
Barbara
@VeniceRiley: J&J also has a vaccination candidate in trials that would require only one dose, which is definitely a big plus.
sab
@Roger Moore: Fuck that: my stepson and his fiance both have Covid, probably because she works wirh special needs kids and she caught it from a client/ patient or co-worker and brought it home.