Coronavirus

[Jeff N]

Compare and contrast HIV and C19 mitigation in the US.
~1.2 million people have HIV in the US today. We could have wiped it out at any time by testing and quarantine but choose not to.

HIV remains the only politically 'protected' disease in our nation.

If we had the same attitude about C19 as we do about HIV, the C19 body count would be far higher.

That’s an absurd suggestion but I’ll respond to it seriously.

I hope your not suggesting doing that today. It would be pointless since almost every HIV patient on drug therapy today has a near-zero viral load which means they can’t transmit the virus to others. People are now put on therapy, or should be, as soon as they test positive. We should focus on fully-funding voluntary testing and making treatment available to everyone infected.

Even back in the 80s and 90s without effectively suppressive anti-viral therapy, putting someone with HIV in quarantine would mean isolating many patients for years. As a practical matter, people would have avoided testing. Frequent mandatory testing of everyone would have been unrealistically expensive at the time. Not to mention the cruelty of following down this road. HIV is relatively hard to transmit even from an untreated person.

In contrast, COVID is very easily transmissible through respiration and quarantining for COVID is 7 to 10 days. New antigen rapid tests could be brought down to $1 or $2 per day through volume production and done at home or the workplace. Unlike HIV and AIDS, COVID can be readily cured if treated with monoclonal antibodies within days after infection exposure and many recover without treatment. Even so, many people would still resist mandatory testing and quarantine today.

 

[scottf200]

Sidebar -
Apparently it was called the Spanish Flu because that was the only country broadcasting accurate news about the disease.

Sidebar response -
This WNYC RadioLab podcast was great on that subject: Dispatches from 1918 | Radiolab | WNYC Studios

 

[MXLRplus]

That’s an absurd suggestion but I’ll respond to it seriously.

I hope your not suggesting doing that today. It would be pointless since almost every HIV patient on drug therapy today has a near-zero viral load which means they can’t transmit the virus to others. People are now put on therapy, or should be, as soon as they test positive. We should focus on fully-funding voluntary testing and making treatment available to everyone infected.

Even back in the 80s and 90s without effectively suppressive anti-viral therapy, putting someone with HIV in quarantine would mean isolating many patients for years. As a practical matter, people would have avoided testing. Frequent mandatory testing of everyone would have been unrealistically expensive at the time. Not to mention the cruelty of following down this road. HIV is relatively hard to transmit even from an untreated person.

In contrast, COVID is very easily transmissible through respiration and quarantining for COVID is 7 to 10 days. New antigen rapid tests could be brought down to $1 or $2 per day through volume production and done at home or the workplace. Unlike HIV and AIDS, COVID can be readily cured if treated with monoclonal antibodies within days after infection exposure and many recover without treatment. Even so, many people would still resist mandatory testing and quarantine today.

Now that there is effective treatment, HIV is no longer the threat it used to be. But it did kill half a million Americans before there was any serious treatment. Today we have ~700,000 dead and another 15,000+ a year. We refuse to test people for HIV at the most basic checkpoint, our adult schools. While you must take an sexual assault prevention class each year in college, and mandatory vaccinations, even for online classes, there is no requirement for HIV testing, nor will there ever be.

The concept that we should remove people's civil rights in the name of public health is being discussed as we speak. So removing HIV patients civil rights could be next if we decide that we want to live like the Chinese.

PS - Recommended quarantine is 14d.

 

[Jeff N]

PS - Recommended quarantine is 14d.

Technically that remains true, but CDC guidance allows states to lower it to 10 days in many cases and even 7 days with testing.

California’s rules, where I live, say:

Guidance on Isolation and Quarantine for COVID-19 Contact Tracing

DURATION OF QUARANTINE

For most individuals who have had close contact (less than 6 feet for at least 15 minutes) with a person who is COVID-19 positive, CDPH recommends the exposed person self-quarantine and stay home for a period of 10 days from the last day of exposure.

 

[bkp_duke]

A number of developed countries around the world have very few cases and deaths or had a surge and were able to near-fully suppress community spread of the virus.

A few examples include Norway (and to a lesser extent Denmark and Finland), Japan, Taiwan, Australia, Singapore and New Zealand. Other countries include China, and Vietnam. Germany was doing well until the European fall wave.

The Asian countries had more severe recent experience with the original SARS and learned from that experience to aggressively test, contact trace and isolate effectively. Most countries including the US have had lethargic and uneven reactions that allowed the virus to spin out of control.

You can do this when you are smaller and control your border. Not possible in the US. Remember, this country "values Freedom above all else". Not a good mix for a pandemic.

 

[AlanSubie4Life]

Post-lockdown SARS-CoV-2 nucleic acid screening in nearly ten million residents of Wuhan, China

Interesting article describing the voluntary PCR testing of the entire city of Wuhan, China. They got 92.7% participation.

Probably you got WeChat demerits for not participating or something (WeChat is used for everything in China!), but no idea, and the article does not mention it. If does discuss why some people may not have participated.

Anyway, it’s interesting from the perspective of false positive rates (or they could have been old undetected infections) demonstrating basically zero prevalence in the community, etc.

Anyway, with a bit of quality social engineering, I’m confident we could do better, and have greater community commitment to victory, in the US. One of the interesting things about this pandemic to me is how we have apparently turned into a nation of whiners and selfish losers. I have never heard so much loser talk and handwringing as I have when it comes to how “we simply cannot be successful” against the “fearsome and undefeatable” COVID-19. It’s very strange, and I don’t think it represents the true American spirit. I think someone pulled a fast one on these people. Propaganda can be surprisingly demoralizing when cleverly implemented! The interesting thing is that I can’t quite identify how this happened...which just speaks to the cleverness of the propaganda, I suppose.

Anyway, it’s now time for America to counter. Fighting back against the defeatism will have benefits beyond COVID as well.

 

[hill]

Today my first patient received the Moderna vaccine. She was chosen randomly given age > 75 as we have vaccinated or offered all health care workers with direct patient care. As of 12/30 7AM UCHealth has delivered 22,900 first doses.

any data yet on Anaphylaxis between the 22.9K? seems to be (at least) some are having varying reactions.
.

 

[AlanSubie4Life]

any data yet on Anaphylaxis between the 22.9K? seems to be (at least) some are having varying reactions.
.

I guess we’ll see what he says. But so far it seems like these reactions are quite rare. Not clear how much of this is due to avoiding administration to those who are known to be susceptible (probably a big part of the reason!).

 

[dhanson865]

So the building I work in has had 3 positive cases in a 5 month period. The first one didn't mention contact tracing (which is disappointing considering the location of the employee), the second one said no contacts were exposed, this third event quarantined 7 people on top of the confirmed infected.

I redacted some company names and suite numbers. And generally skipped 90% of the details about the clean up and whatnot, just wanted to put together the timeline/number of people.

-----

Dec 2020 1st batch Timeline of Events
The employee was last onsite on Dec. 18, and tested positive on Dec. 23. XXXX was notified Dec. 24.

Dec 2020 1st batch Occupied Space
This facility is a multi-tenant building with shared common areas.

Dec 2020 1st batch Contact Tracing
Contact tracing is complete. Seven employees have been identified as required to self-quarantine

-----

Nov 2020 Timeline of Events
The person who tested positive was last onsite on Nov. 22, and tested positive on Nov. 24. XXXX received notification of the positive test on Nov. 25.

Nov 2020 Occupied Space
This facility is a multi-tenant building with shared common areas. The person who tested positive was in their own cubicle on the third floor, in Suite 3200.

Nov 2020 Contract Tracing
Contact tracing is complete. No one has been identified as needing to self-quarantine.

-----

Aug 2020 Timeline of Events
The person who tested positive was last onsite on Aug. 11 and tested positive on Aug. 14. XXXX received notification of the positive test earlier today. We immediately alerted the property owner.

Aug 2020 Occupied Space
This facility is a multi-tenant building with shared common areas. The person who tested positive had access to the 4th floor reception desk, but did not access XXXX office spaces.

Aug 2020 no mention of contact tracing

I just got the email about the latest occurrence 3 hours ago. I guess the good news is I didn't get contacted as part of the tracing effort.

make that 4 cases in 5 months / 2 cases in the last month.

Dec 2020 2nd batch Timeline of Events
The employee was last onsite on Dec. 21, and tested positive on Dec. 30. XXXX was notified Dec. 30.

Dec 2020 2nd batch Occupied Space
This facility is a multi-tenant building with shared common areas.

Dec 2020 2nd batch Contact Tracing
Contact tracing is underway. All other employees were sent home as a precaution while its being determined who may have come into close contact with the individual.

I guess the good news is I'm still in the office, contact tracing hasn't contacted me. Bad news is the 1st and 2nd positive in Dec 2020 overlap (last day in office and tested positive day overlap between the two cases), so it seems like we are in a situation that is growing faster than they can respond to it.

my county is doing phase 1a1 and 1a2 at the same time right now and I don't expect to be given a vaccine until 2b (by role) or possibly 3 (by age not role) which on this timeline is summer of 2021.

 

[AlanSubie4Life]

I guess the good news is I'm still in the office

This seems like it is actually bad news. I don’t quite follow why anyone is in the office. If it’s essential work, I figure everyone would be wearing P100 two-way respirators or better, at this point.

 

[jerry33]

This seems like it is actually bad news. I don’t quite follow why anyone is in the office.

Two reasons. Many mangers feel that working from home is just a paid vacation--regardless of all the studies showing just the opposite. The other reason is that working from home requires less supervision, so the manager is only a coordinator and can coordinate a lot more people (at least double). This means fewer jobs, so managers fear it.

 

[dhanson865]

This seems like it is actually bad news. I don’t quite follow why anyone is in the office. If it’s essential work, I figure everyone would be wearing P100 two-way respirators or better, at this point.

I don't have daily contact with anyone, I come into the office for the secure connection because when VPN goes down I'm one of the people that gets called and it helps if I'm already in the office. Just the way it rolls when you support tens of thousands of users.

I wear masks and I don't touch the door handles or elevator buttons with my bare skin.

I'd be happy to wear something better than a n95 but I don't have access to anything like that and I need to be able to talk on a phone to do my job.

They do allow me to work from home but 1. I'm not willing to install the company software on my home PC. 2. I wouldn't be able to support anyone during outages (seems counter productive for a support role).

as an example we had a VPN outage today and they had people driving in from home to the office because of it. I sat at my desk working normally on a hardline connection that never even hiccupped.

 

[AlanSubie4Life]

Two reasons. Many mangers feel that working from home is just a paid vacation--regardless of all the studies showing just the opposite. The other reason is that working from home requires less supervision, so the manager is only a coordinator and can coordinate a lot more people (at least double). This means fewer jobs, so managers fear it.

Weird. Seems misdirected. Getting corona cases to zero solves this problem more directly.

 

[AlanSubie4Life]

I'd be happy to wear something better than a n95 but I don't have access to anything like that and I need to be able to talk on a phone to do my job.

3M Ultimate FX FF-402 Respirator - Medium H-4727 - Uline

Don’t forget to get filters too (floppy P100 ones are fine). And you’ll need to rubber band a surgical on tightly to the two exhaust ports to protect others.

Everyone can have one. I am not sure why these are not free. But here we are.

Talking on the phone would indeed be a challenge. Could wear selectively when not in an enclosed office where only you reside.

 

[jerry33]

Weird. Seems misdirected. Getting corona cases to zero solves this problem more directly.

Agreed, but I can assure you that virtually every large corporation works this way. In the one I used to work for I was asked by my manager if I wasn't resentful of the people who worked from home. Denise's office changed work from home to work from the office a couple of weeks ago. They really believe that if you are not warming an office chair, you are not working.

 

[jerry33]

3M
Talking on the phone would indeed be a challenge.

That's what texting is for.

 

[madodel]

Agreed, but I can assure you that virtually every large corporation works this way. In the one I used to work for I was asked by my manager if I wasn't resentful of the people who worked from home. Denise's office changed work from home to work from the office a couple of weeks ago. They really believe that if you are not warming an office chair, you are not working.

When my wife took a job here in the Poconos I knew I wouldn't be able to work at my then latest profession ( Hospital Clinical System developer) since they barely had computers here 30 years ago, let alone a mainframe. But my then employer wanted me to continue to work for them so they hired me as a consultant to work from my home about 100 miles away. They weren't comfortable with an employee working from home, but could sell it to administration as a "consultant". My long distance telephone bills ran between $600-$800 a month dialing into the mainframe. That lead to my getting other contracts from IBM clients. So for almost 5 years it was great. Then IBM torpedoed their hospital system (they didn't kill it outright they spun it off which everyone knew was a deathknell) And then I had almost 5 years of being paid even more money to sit home and help clients get their data off of IBM's system so it could be loaded onto whatever they replaced it with. Anyone remember Y2K? By 2001 all that work dried up. Around that time I sold my IBM stock since I didn't like their exiting the software market and killing my golden goose and bought a couple thousand shares in what was rumoured to be a computer company on the verge of bankruptcy. It didn't go bankrupt. So I retired and have been watching the stock market everyday since. Real estate here is now actually booming because of COVID. All the thousands of foreclosed houses from the 2008 housing collapse are gone. Now with COVID there are thousands of people flocking to where I live to get out of the congested cities of NY and NJ and work from home. Houses here are selling within days of going on the market for really good prices. Strange it took a killer pandemic to get people to be allowed to do what I was doing 20-30 years ago.

 

[NikolaACDC]

Seen discussions about going with only one vaccine dose for a while longer,
here in an opinion-piece in the NYT (by Drs Zeynep Tufekci and Michael Mina)
Opinion | Can We Do Twice as Many Vaccinations as We Thought?

"Both vaccines are supposed to be administered in two doses, a prime and a booster, 21 days apart for Pfizer and 28 days for Moderna. However, in data provided to the F.D.A., there are clues for a tantalizing possibility: that even a single dose may provide significant levels of protection against the disease.
If that’s shown to be the case, this would be a game changer, allowing us to vaccinate up to twice the number of people and greatly alleviating the suffering not just in the United States, but also in countries where vaccine shortages may take years to resolve.
But to get there — to test this possibility — we must act fast and must quickly acquire more data.
For both vaccines, the sharp drop in disease in the vaccinated group started about 10 to 14 days after the first dose, before receiving the second. Moderna reported the initial dose to be 92.1 percent efficacious in preventing Covid-19 starting two weeks after the initial shot, when the immune system effects from the vaccine kick in, before the second injection on the 28th day."
-----------------------------------
and also in articles in the UK and Germany.
The UK is planning to extend the time to the second shot from the recommended 21 days.

Guess it's worth pursuing with studies with volunteers, until enough doses for regular applications are available.

But...
"we must act fast and must quickly acquire more data" - yeah.

And
Pfizer: "No data" to show single dose of vaccine offers protection after 21 days

 

[wdolson]

There are BOTH memory B cells, AND memory T cells. The have different, but complimentary functions (B cells become plasma cells and produce a @#$% ton of antibodies, T cells work to coordinate much of the inner machinery of the secondary immune response). But for coronaviruses and fighting off repeat infections or infections you have already built artificial immunity to, B Cells are the FAR more important component.

This is a good review article covering the three primary memory cells of the immune system:
Immunological memory cells

This article is basically the same information, but in a more lay format, and re-written specifically related to SARS-CoV-2:
Not just antibodies: B cells and T cells mediate immunity to COVID-19 (Figure 1 sums up everything nicely, and I have attached it below).

There are very good, documented for decades, cases of individuals that cannot produce either T or B cells. They have very specific phenotypes, and both kinds of individuals would be highly susceptible to infection and have difficulty clearing it.

Also, all bets are off on any memory working if SARS-CoV-2 mutates substantially (UK variant is likely covered under the current vaccines, but there is GREAT concern that a new variant out of South Africa is NOT).

View attachment 622636

Thank you, that was interesting. The article states that from the SARS research it looks like people who had recovered from SARS did not have memory B-cells after 6 years, but still have the memory T-cells. Though if someone has SARS-CoV-2 specific CD4+ and CD8+ T-cells, it sounds like their immune system has some kind of memory for the disease and if they do get sick again it might not be as severe.

I have read that in the 1918 flu pandemic people over 30 tended to get sick less often and if they did get sick they got milder cases and it's believed it was because there was a related strain of the flu that went around the world in 1890. Rural areas in 1918 had everyone hit because the 1890 strain was mostly isolated to cities and the 1918 pandemic went everywhere. By 1918 travel was becoming more common and with the war on, there were a lot of people from rural areas in the military who returned home after the war and brought the flu with them.

I've been following the new European and new South African strains. The European strain is dangerous because it could result in a lot more people being infected and because of that a lot more people ending up needing a hospital. But the South African strain appears to be more deadly and more deadly to younger people.

I would not be surprised if the South African variant was loose in the US already. If it's resistant to existing immune memory and vaccines, that could be very bad.

Post-lockdown SARS-CoV-2 nucleic acid screening in nearly ten million residents of Wuhan, China

Interesting article describing the voluntary PCR testing of the entire city of Wuhan, China. They got 92.7% participation.

Probably you got WeChat demerits for not participating or something (WeChat is used for everything in China!), but no idea, and the article does not mention it. If does discuss why some people may not have participated.

Anyway, it’s interesting from the perspective of false positive rates (or they could have been old undetected infections) demonstrating basically zero prevalence in the community, etc.

Anyway, with a bit of quality social engineering, I’m confident we could do better, and have greater community commitment to victory, in the US. One of the interesting things about this pandemic to me is how we have apparently turned into a nation of whiners and selfish losers. I have never heard so much loser talk and handwringing as I have when it comes to how “we simply cannot be successful” against the “fearsome and undefeatable” COVID-19. It’s very strange, and I don’t think it represents the true American spirit. I think someone pulled a fast one on these people. Propaganda can be surprisingly demoralizing when cleverly implemented! The interesting thing is that I can’t quite identify how this happened...which just speaks to the cleverness of the propaganda, I suppose.

Anyway, it’s now time for America to counter. Fighting back against the defeatism will have benefits beyond COVID as well.

A lot of the attitude in the US is generational. GenX specifically, but Boomers to some extent too got the attitude that everyone was on their own. The idea that everyone needed to pull together for a common cause which the WW II generation had in spades is rarer in the post war generations. GenX specifically had a larger number of single parent households with latch key kids than previous generations. The latter half of the generation came of age in a time when they had to figure out how to make a living on their own. Things like the gig economy has flourished since.

There is also a political attitude that has grown from this generation that the US is not capable of doing these things anymore.

Fortunately a lot of those attitudes are not there in most of the Millennials and later generations. They are much more community based and are reinventing the idea of community. Unfortunately they have very little political power today.

Agreed, but I can assure you that virtually every large corporation works this way. In the one I used to work for I was asked by my manager if I wasn't resentful of the people who worked from home. Denise's office changed work from home to work from the office a couple of weeks ago. They really believe that if you are not warming an office chair, you are not working.

I think managers who are self secure have little trouble with their people working from home, but managers with a lot of self doubt want to see the bodies in chairs.

For the last 10 years I've been contracting with a company in California and have only been in the office about a dozen times. I have consistently been far more productive than I ever was in an office.

 

[NikolaACDC]

Some more confidence on long-term immunity
Great News: Latest Research Shows Immunity to COVID-19 Lasts at Least 8 Months

"In a collaboration between Monash University, The Alfred Hospital, and the Burnet Institute in Melbourne, researchers analysed blood samples taken from 25 volunteers diagnosed with COVID-19.
Each sample provided a snapshot of the immune system's status, from just four days after infection to as long as eight months.
A further 36 individuals with no history of the disease also provided one or two blood samples for comparison.
The COVID-positive samples suggest concentrations of free-floating SARS-CoV-2 antibodies begin to fade just 20 days after symptoms appear, a finding that falls in line with previous studies suggesting antibody levels drop quickly, especially in mild cases of COVID-19.
...
The key to this antibody-printing service are white blood cells called memory B cells. Formed during an infection to print out antibodies specific to an invader, these cells can hide away for decades once the heat dies down, ready to generate a fresh supply of antibodies at a moment's notice if the pathogen were to reappear.
To see whether a COVID-acquainted immune system still had sufficient B cells to do the job after just a few months, the researchers introduced fluorescently labelled pieces of SARS-CoV-2 to the once-infected blood samples.
The analysis not only revealed a significant response in each of the COVID-19 blood samples, but allowed the team to determine which kinds of B memory cells were reacting to which particular chunk of the virus's body.
"These results are important because they show, definitively, that patients infected with the COVID-19 virus do in fact retain immunity against the virus and the disease," says van Zelm.

And since the proteins analysed by the study are considered prime sites to target, we can expect most vaccines will also convey a good level of immunity for at least eight months.
---------------------------------
Link to paper:
Rapid generation of durable B cell memory to SARS-CoV-2 spike and nucleocapsid proteins in COVID-19 and convalescence | Science Immunology

Excellent.