Corona Virus: It's a Marathon, Not a Sprint

[Kraken]

A couple of weeks ago I shut down outdoor dining for the year. Tomorrow it's going to be 75 degrees and gorgeous in the way that only New England Indian summers can be. The latest map from the state shows our brunch place in a green town, so I'm going to roll the dice one more time.

Is "Indian summer" another thing I'm not supposed to say anymore, or am I in before the ban?

As a former long time Mass-hole, I love this post. And good luck with your outdoor dining. It's a personal decision, but I say, go for it!

The Cottage Bar's picnic tables are as safe as anyplace you'll find, so I'm confident about that. Glad you know what I mean about Indian summer -- the dry air, low sun, trees shedding their last leaves, which are blowing around everywhere...it's great to be out in shorts when winter's just a breath away, and you know you can't do this again for 5-6 months. It's worth rolling one more saving throw for an Irish omelette at the Wee Pub.

Did you roll the dice and enjoy an outdoor meal? Today the family with the puppy are at Crane Beach. It's a little crowded but good social distancing and mask compliance along with a pleasant breeze.

The gentle sound of the surf is quite calming after a stressful election. Also nice to get this in before winter eventually comes and we turtle up.

Yes, we did. MA revamped its virus status tracking just the day before, so I was able to see that Weymouth is a low-risk "green" town. It was most likely our last outing until next April.

[LordMortis]

At a minimum I'd expect a national mask mandate to be ordered on 1/20/21. How that works, I'm not sure, but I guess we'll see.

After 10 months of non compliance with the courts being stacked to resist and police ignoring state mandates and people totally fatigued of isolation, not well at all I suspect, even if you ignore no small portion of the population who think that law only matters when it agrees with them and masks are against their unalienable right to freedom.

People don't even respect their employment mask wearing mandates, where their livelihood could be taken. They rail on about a business right to operate as they see fit and then ignore mask requirements. It's gonna take the hospitals going into full hazmat mode again to get areas to treat it seriously.

[Smoove_B]

The thing is, America is about to get absolutely walloped with cases. The people I follow are suggesting we're on target to hit 200K cases a day by Thanksgiving and it won't be long before we're over 2K deaths a day, possibly at some time in December. And as has been pointed out, we're likely already at 200K new cases a day *right now* but testing is still such a clusterfuck we have no idea.

Once again, it's the lag time that people always forget. Nationwide ~70% hospital capacity *right now* will absolutely collapse in the next 30 days if the projections on cases is correct. Remember, today's ~1000K daily deaths are coming from what people were doing the first week of October. NJ is back to levels we haven't seen since late April - and people aren't even blinking (at least, as far as I can tell). Lots of cars, lots of people out and about.

I don't know if the stark reality of what's about to happen is going to change the dialogue, but my experience is that humans need to overwhelmingly feel bad shit happen to them before they consider change. This might be that time; I just don't know. It frustrates me beyond words that we're at this point and we've once again put medical front-line staff in war zone activity. I'm aware of about half a dozen of my peers that are absolutely done in local public health, but they can't retire - they're too young.

I really hope all the things I'm seeing are wrong, but my gut tells me it's likely going to be worse.

[malchior]

And it isn't like we're rid of Trump. In a non-broken government we'd have the two cooperating to set a strategy. Instead I expect he'll be firing potshots at whatever messaging Biden tries to issue.

[wonderpug]

And it isn't like we're rid of Trump. In a non-broken government we'd have the two cooperating to set a strategy. Instead I expect he'll be firing potshots at whatever messaging Biden tries to issue.

How much of a voice will he have if/when Twitter neuters him on January 20?

[malchior]

And it isn't like we're rid of Trump. In a non-broken government we'd have the two cooperating to set a strategy. Instead I expect he'll be firing potshots at whatever messaging Biden tries to issue.

How much of a voice will he have if/when Twitter neuters him on January 20?

Indeterminate. He'd definitely go to Parler if cut off and I guess we'll see if people pay attention to *anyone* there.

[Smoove_B]

Buzzfeed (!) dropped a really good overview on the bigger picture stuff now that Biden will be taking the helm:

And despite winning the election, Biden will need to persuade the 70 million-plus people who voted for Trump to accept his more aggressive strategy to combat the pandemic. Any COVID relief funding he’ll want to pass to boost the economy will depend on a deeply divided Congress, with control of the Senate resting in the hands of Georgia voters in a double runoff in January.

But with Biden in charge, the country at least has a chance of containing the outbreak, according to medical experts. They expect to see a night-and-day difference between him and President Donald Trump, who told the world not to fear the virus even when he was infected with it. The Trump administration’s strategy consisted mostly of banking on a vaccine while giving up on preventing or slowing infections, flouting the guidance of his own top federal health officials.

In contrast, Biden “respects scientists, he respects doctors,” Eric Topol, a cardiologist at the Scripps Translational Science Institute, told BuzzFeed News. “That’s something that will be refreshing, for sure.”

...

Biden faces the enormous task of regaining the public’s trust after an election that spun basic medical questions, from the usefulness of masks to the dangers of prescribing unvetted drugs, into points of political tribalism. Abetted by advisors like neuroradiologist Scott Atlas, Trump flouted mask-wearing and social distancing, and expressed an openness to the controversial strategy of fully reopening society and letting the virus spread among healthy people.

“I hope that trust will come back from the general public — it’s going to be a really steep hill to climb,” said Angela Rasmussen, a virologist at Columbia University. “This is definitely not going to happen overnight even if the CDC, on night one, issues clear and consistent guidelines.”

Ideally, Topol said, a Biden administration would demonstrate a commitment to transparency by holding daily press briefings with the heads of the key health agencies and career scientists like Anthony Fauci, whom Trump sidelined and publicly berated. “On day one, we have the science and public health experts call all the shots,” Topol said.

Of note - and I cannot emphasize this enough for those saying Biden needs to work with Mitch:

At stake is a $2 trillion sequel to 2020 coronavirus stimulus funding that Senate majority leader Mitch McConnell opposed in the run-up to the election, and then said he supported earlier this week while election results were up in the air. A decade ago, McConnell blocked expanding stimulus funding, despite a deep, painful recession, and health experts fear a repeat of this scenario.

“Sen. McConnell has no real interest in ending the pandemic, addressing the social and economic crisis that has come in the virus’ wake. He’s blocked any robust efforts coming out of the House for months now,” Gregg Gonsalves, an infectious diseases expert at Yale, told BuzzFeed News. “He is all about power, amassing it for his party at all costs.”

[Unagi]

In a Pandemic / National Emergency - doesn't the President have some special abilities to tap funds?

(almost for this exact reason)

[malchior]

In a Pandemic / National Emergency - doesn't the President have some special abilities to tap funds?

(almost for this exact reason)

Whatever is allocated in the budget for emergencies/pandemic response...but nothing close to the scale required. Thinks hundreds of millions when a 2-3 Trillion dollars is probably needed.

[Ralph-Wiggum]

Didn’t the courts uphold Trump using military money for building the wall? Maybe Biden can use the precedent to divert money from the military for Covid response...

[Isgrimnur]

Didn’t the courts uphold Trump using military money for building the wall?

Narrator: They did not.

[Smoove_B]

Oy

https://twitter.com/COVID19Tracking/sta ... 4004214784

Our daily update is published. States reported 1.1 million tests, 103k cases, and 57k people currently hospitalized with COVID-19. The death toll was 462.

This is the largest number of cases ever reported on a Sunday—more than 25k more than last week—despite California not reporting by the time we published this data.

The 7-day average of deaths reported by states is now up 36% in the last 3 weeks. Here's a chart of deaths since July 1.

The number of detected cases is rising in every region. While the Midwest is at the highest level in our dataset, the West is also now at the region's highest level yet.

The number of people currently hospitalized has increased by 10k since October 30. At this rate, we'll see a record number of hospitalizations in just a few days.

[Zaxxon]

Utah getting some common sense... Thread.

https://twitter.com/UtahCoronavirus/sta ... 82593?s=19

[malchior]

https://mobile.twitter.com/JonLemire/st ... 4325496833

[Zaxxon]

https://mobile.twitter.com/JonLemire/st ... 4325496833

90%+, based on the early data. Which is better than I'd have dared hope. I guess we'll see when the trial completes in a few weeks.

Some additional details from the article: Pfizer is on track to have enough vaccine produced by EoY for 25 million people to receive it, plus another 600 million in 2021. Moderna's vaccine is using a similar approach, so presumably if Pfizer's is good, Moderna's has a decent shot, too.

Paging Smoove for more informed commentary.

[Ralph-Wiggum]

Definitely good news. I suppose the biggest question going forward with that vaccine is how long protects for.

[LawBeefaroni]

DOW futures up 1700 points, mostly on this news.

[Ralph-Wiggum]

Something to consider, assuming it turns out to be accurate, although I've kept RNA in a -20 freezer. Of course, I don't think most GPs or pharmacies likely have even a -20.

https://twitter.com/keirshiels/status/1 ... 40737?s=20

Spoiler:

This vaccine needs to be kept at below -80 ^C because it uses mRNA. Not suitable for most clinics and GP practices. My money is still on Oxford to produce a more effective and ergonomic one.

[$iljanus]

https://mobile.twitter.com/JonLemire/st ... 4325496833

90%+, based on the early data. Which is better than I'd have dared hope. I guess we'll see when the trial completes in a few weeks.

Some additional details from the article: Pfizer is on track to have enough vaccine produced by EoY for 25 million people to receive it, plus another 600 million in 2021. Moderna's vaccine is using a similar approach, so presumably if Pfizer's is good, Moderna's has a decent shot, too.

Paging Smoove for more informed commentary.

Even though the approach is novel, I’m a big geek fan of the mRNA approach just from working in an immunology lab. Being able to stably deliver RNA for protein production has come such a long way. RNA is really fragile unlike DNA but being able to use it simplifies the steps in the immune response since the necessary proteins are directly coded for by the RNA sequence and it’s the cell that’s doing the antigen production vs needing to produce antigens in large amounts in a production facility. Generating small stretches of RNA is quicker.

[Holman]

https://twitter.com/GeoffRBennett/statu ... 53856?s=20

Meanwhile, Don Jr is feeding the conspiracy that Pharma intentionally held this announcement off until after the election.

[LawBeefaroni]

Sure hope people don't give up on other measures just because we have good news about a vaccine. How many Thanksgiving/Christmas/other plans were just put back on the table? Remember a month ago when a November vaccine announcement was expected and largely derided?

We're at highest rates worldwide. Shit could still spin way out of control.

[LawBeefaroni]

https://twitter.com/GeoffRBennett/statu ... 53856?s=20

Meanwhile, Don Jr is feeding the conspiracy that Pharma intentionally held this announcement off until after the election.

They didn't get R&D money but they did get a guarantee of purchase that amounts to two billion.

[Zaxxon]

Sure hope people don't give up on other measures just because we have good news about a vaccine. How many Thanksgiving/Christmas/other plans were just put back on the table? Remember a month ago when a November vaccine announcement was expected and largely derided?

We're at highest rates worldwide. Shit could still spin way out of control.

Unfortunately, it's become quite clear that other measures are not likely to be meaningfully followed, especially before January. So I'll take what I can get, even if it is extremely preliminary.

[$iljanus]

Sure hope people don't give up on other measures just because we have good news about a vaccine. How many Thanksgiving/Christmas/other plans were just put back on the table? Remember a month ago when a November vaccine announcement was expected and largely derided?

We're at highest rates worldwide. Shit could still spin way out of control.

Unfortunately, there’s also the chance of people outright refusing the vaccine anyway. Hopefully that will be remedied by minimal or manageable side effects, adults in the White House actually talking about the science, and a good protective immune response.

But the timeline for rolling it out definitely calls for the maintaining of social distancing, masks, and testing. Instead of bragging, Pence could talk about getting America to the finish line by being responsible as we wait for these promising vaccines.

But why the fuck would this administration decide to act like adults now? They have frivolous lawsuits to file.

[Smoove_B]

Paging Smoove for more informed commentary.

I'll need the big brains to pick apart the study information to verify all the safety stuff. If they really do have ~25 million ready to go before 12/31, that first tier is going be medical staff, police, front line workers and people over the age of 65. My inbox isn't filled up this morning with specific details on distribution (where I'd come in), I've only seen the generic plans that were circulated in my state last month. Distribution (and funding of distribution) is going to be the linchpin in all this - the scale of effort here is not something anyone has seen for generations.

And yes, the much larger issues are how widespread it is now and how this vaccine gets distributed worldwide. The idea that the Trump administration could do anything at this point to further complicate how this all unfolds weighs on my mind.

Regardless, there were 94 people in the study and only a press release has been provided. Still need a ton of more information. My own bottom-rung observation is that 94 people in a vaccination study is...insanely low.

[$iljanus]

Paging Smoove for more informed commentary.

I'll need the big brains to pick apart the study information to verify all the safety stuff. If they really do have ~25 million ready to go before 12/31, that first tier is going be medical staff, police, front line workers and people over the age of 65. My inbox isn't filled up this morning with specific details on distribution (where I'd come in), I've only seen the generic plans that were circulated in my state last month. Distribution (and funding of distribution) is going to be the linchpin in all this - the scale of effort here is not something anyone has seen for generations.

And yes, the much larger issues are how widespread it is now and how this vaccine gets distributed worldwide. The idea that the Trump administration could do anything at this point to further complicate how this all unfolds weighs on my mind.

Regardless, there were 94 people in the study and only a press release has been provided. Still need a ton of more information. My own bottom-rung observation is that 94 people in a vaccination study is...insanely low.

Pfizer was wise not to pursue an emergency use authorization at this time, especially since they’re using a novel vaccine strategy. But here’s to larger clinical trials in the future!

[stessier]

Paging Smoove for more informed commentary.

I'll need the big brains to pick apart the study information to verify all the safety stuff. If they really do have ~25 million ready to go before 12/31, that first tier is going be medical staff, police, front line workers and people over the age of 65. My inbox isn't filled up this morning with specific details on distribution (where I'd come in), I've only seen the generic plans that were circulated in my state last month. Distribution (and funding of distribution) is going to be the linchpin in all this - the scale of effort here is not something anyone has seen for generations.

And yes, the much larger issues are how widespread it is now and how this vaccine gets distributed worldwide. The idea that the Trump administration could do anything at this point to further complicate how this all unfolds weighs on my mind.

Regardless, there were 94 people in the study and only a press release has been provided. Still need a ton of more information. My own bottom-rung observation is that 94 people in a vaccination study is...insanely low.

Pfizer was wise not to pursue an emergency use authorization at this time, especially since they’re using a novel vaccine strategy. But here’s to larger clinical trials in the future!

There were 43k+ people in the trial. This looked at 94 who had contracted Covid.

[Smoove_B]

There were 43k+ people in the trial. This looked at 94 who had contracted Covid.

Right - there were 40K+ in the overall study but this press release is focused on a cohort of 94 people claiming 90% efficacy. Cautious optimism. Until they release the study information to the scientific community, it's still a press release.

[$iljanus]

There were 43k+ people in the trial. This looked at 94 who had contracted Covid.

Right - there were 40K+ in the overall study but this press release is focused on a cohort of 94 people claiming 90% efficacy. Cautious optimism. Until they release the study information to the scientific community, it's still a press release.

Would have loved to have been in on the meeting between the clinical trial team, legal team, the CFO, CEO and the poor person running any power point slides as they debated whether or not to release a statement.

Also eagerly awaiting clinical data to see if there were any or minimal auto immune issues. Hopefully just cases of inflammation.

[Defiant]

I'm confused. Is it 94 got covid and ~85 of them were fine because they had had the vaccine, or was 94 the number of people where the vaccine didn't help them (and it did help ~900 or so)?

[stessier]

I'm confused. Is it 94 got covid and ~85 of them were fine because they had had the vaccine, or was 94 the number of people where the vaccine didn't help them (and it did help ~900 or so)?

The press releases I've seen haven't made any of that clear at all. And there is no paper or data to fall back on yet.

[$iljanus]

On a more mundane note, HUD secretary Ben Carson has tested positive.

[Zaxxon]

I'm confused. Is it 94 got covid and ~85 of them were fine because they had had the vaccine, or was 94 the number of people where the vaccine didn't help them (and it did help ~900 or so)?

I believe it's 94 got COVID, and 90+% of them were patients that had received the placebo rather than the actual vaccine. I could be wrong, though.

[malchior]

https://twitter.com/ishaantharoor/statu ... 6318693378

[$iljanus]

Listening to Biden now on CNN. My God, if Trump only made the same argument for wearing masks as eloquently as Biden is doing months ago.

Such a waste.

[Smoove_B]

I believe it's 94 got COVID, and 90+% of them were patients that had received the placebo rather than the actual vaccine. I could be wrong, though.

Here's a reliable quick take on what's known:

The clinical trial — run by Pfizer using a vaccine developed by BioNTech — is being conducted in nearly 44,000 people around the world. The results reported are from 94 cases of Covid-19 that have emerged among those trial participants. Presumably, the vast majority of those cases were in people who received the placebo, but details about the results are scant because Pfizer issued the preliminary findings via press release, not an academic paper. It’s unclear how many people who received the vaccine still contracted Covid-19, and if so, why.

Similarly, also unknown is whether the vaccine protected against asymptomatic infections with the novel coronavirus; the press release only mentions symptomatic cases of Covid-19. This is an important issue because people who are asymptomatic can still spread the infection.

In short - we need more information.

[Defiant]

I'm confused. Is it 94 got covid and ~85 of them were fine because they had had the vaccine, or was 94 the number of people where the vaccine didn't help them (and it did help ~900 or so)?

I believe it's 94 got COVID, and 90+% of them were patients that had received the placebo rather than the actual vaccine. I could be wrong, though.

OK, so that makes it sounds more like the first (~8-9 people with the vaccine got COVID, when you would expect 85 to).

I will say that I'm kind of surprised the number is so low for both groups. After three and a half months, I would have expected at least 1-2% to have become infected. But maybe the volunteers are people who would be cautious, anyway, and thus less likely to contract it.

[Defiant]

I'm confused. Is it 94 got covid and ~85 of them were fine because they had had the vaccine, or was 94 the number of people where the vaccine didn't help them (and it did help ~900 or so)?

I believe it's 94 got COVID, and 90+% of them were patients that had received the placebo rather than the actual vaccine. I could be wrong, though.

Yeah, it looks like that's the case:

The case split between vaccinated individuals and those who received the placebo indicates a vaccine efficacy rate above 90%, at 7 days after the second dose.

https://www.pfizer.com/news/press-relea ... te-against

[Defiant]

https://twitter.com/ishaantharoor/statu ... 6318693378

[noxiousdog]

Something to consider, assuming it turns out to be accurate, although I've kept RNA in a -20 freezer. Of course, I don't think most GPs or pharmacies likely have even a -20.

Temperature note:

Pfizer’s vaccine will almost certainly be the first to be authorized by the FDA. But it’s also going to be the hardest one to use.

The vaccine has to be shipped and stored at ultra-cold temperatures, -94 Fahrenheit (-70 Celsius). That requirement will limit where the vaccine can be used. Moderna’s mRNA vaccine must be stored at -4 F (-20 C), which is not ideal, but not quite as challenging.