Coronavirus

[y66]

Let us not again forget knowledge of exponentials. New variants may change everything. They’ll be 1% of all cases by end of next week, with hot spots in Florida and Southern California. But doubling every week, they’ll be about 30% of all cases in 5 or 6 weeks. It’ll be harder to hide from them, schools will be more vulnerable.

 

That is from Scott Gottlieb at https://twitter.com/ScottGottliebMD/status/1350808526390767618. And much of what you thought you knew about this pandemic may soon be obsolete.

[shyams]

I love how officials in the UK responsible for managing the pandemic allow themselves to describe mundane acts as though they just moved mountains. Case in point:

 

A headline on BBC (link here) reads Covid-19: England delivering 140 jabs a minute, says NHS chief executive

 

The NHS Chief Exec didn't define how they are deriving the statistic. Presumably this is based on minutes in a working day (8 hours?) which translates to 67k jabs per day. If one allows for the lunch hour (i.e. proper workday of 7 hours), the number is even lower at 59k per day.

 

The article goes on to talk about setting up vaccination centres that will operate 24x7 within the next 10 days. This suggests that the vaccination programme currently operates only during the day time and that the "140 a minute" calc is probably is based on working hours only.

 

The vaccination rate is much lower than one would have thought possible or necessary. Yet, somehow the Govt. can spin it to make it look like success!

[cherdano]

shyams- the daily vaccination figures are on the dashboard. It's currently around 300.000 a day. https://coronavirus.data.gov.uk/details/healthcare#card-people_who_have_received_vaccinations_by_report_date_daily

Per capita, the number of doses given in the UK is the 4th highest in the world. https://ourworldindata.org/covid-vaccinations

 

It's no secret that I don't hold our government, or its respone to covid-19, in high esteem. But on vaccines, they got it right - they bought more doses than almost any other country, MHRA was quicker than anyone else in approving them, and the NHS is fairly efficient at administering them. I think even the controversial delay of 2nd doses was probably the right call. And they might be able to vaccinate everyone over 18 who wants to by this summer.

[barmar]

shyams- the daily vaccination figures are on the dashboard. It's currently around 300.000 a day.

It seems that the article was probably giving an average over some unspecified time period (maybe since vaccinations started?), during which the rate of immunization has been ramping up. 300K/day is the peak this past Saturday.

 

300K/day is about 200/minute around the clock, or 625/minute if only 8 hours/day.

[shyams]

shyams- the daily vaccination figures are on the dashboard. It's currently around 300.000 a day. https://coronavirus.data.gov.uk/details/healthcare#card-people_who_have_received_vaccinations_by_report_date_daily

Per capita, the number of doses given in the UK is the 4th highest in the world. https://ourworldindata.org/covid-vaccinations

 

It's no secret that I don't hold our government, or its respone to covid-19, in high esteem. But on vaccines, they got it right - they bought more doses than almost any other country, MHRA was quicker than anyone else in approving them, and the NHS is fairly efficient at administering them. I think even the controversial delay of 2nd doses was probably the right call. And they might be able to vaccinate everyone over 18 who wants to by this summer.

Thank you for this information and the links. I was unaware that we really were doing so many vaccinations a day.

 

The dashboards are quite useful to track progress... and I intend to do so periodically. Well, at least until it's my turn to get vaccinated :)

 

At this rate, hopefully the entire Covid situation could turn around quickly within 2-3 month. I assume it is reasonable to assume that R0 for Covid will drop to insignificant levels once about 50%-60% of the country has been vaccinated. That is something I eagerly look forward to.

[pilowsky]

Thank you for this information and the links. I was unaware that we really were doing so many vaccinations a day.

 

The dashboards are quite useful to track progress... and I intend to do so periodically. Well, at least until it's my turn to get vaccinated :)

 

At this rate, hopefully the entire Covid situation could turn around quickly within 2-3 month. I assume it is reasonable to assume that R0 for Covid will drop to insignificant levels once about 50%-60% of the country has been vaccinated. That is something I eagerly look forward to.

 

According to the Mayo clinic, it needs to be at 70%+

[Cyberyeti]

According to the Mayo clinic, it needs to be at 70%+

 

Ignoring the complications around k vs R, the percentage you need depends on how infectious the disease is. For the old strain where R was a little over 2.5 anything better than 40% (hence the 50-60% figure) will get R below 1 and the epidemic will fizzle. The new strains are more infectious (but less so than measles) so require a higher figure, but not as high as the 94% measles does.

[pilowsky]

Ignoring the complications around k vs R, the percentage you need depends on how infectious the disease is. For the old strain where R was a little over 2.5 anything better than 40% (hence the 50-60% figure) will get R below 1 and the epidemic will fizzle. The new strains are more infectious (but less so than measles) so require a higher figure, but not as high as the 94% measles does.

 

Are you making a different point?

1. The Mayo clinic reference is specifically about sars-cov-2

2. All RNA viruses mutate and change their infectivity. Normally they get more infective and less dangerous.

3. Point number 2 is called the 'Theory of Evolution' - quite popular amongst Biologists north of the Mason-Dixon line - in this situation it means that the virus will likely become (simultaneously) more infective and (slightly) less dangerous.

4. Trump - surprisingly given his opinions about climate change in general - seems to believe that everything will get better when the climate changes - hmm, maybe his belief system is internally coherent after all.

[Cyberyeti]

Are you making a different point?

1. The Mayo clinic reference is specifically about sars-cov-2

2. All RNA viruses mutate and change their infectivity. Normally they get more infective and less dangerous.

3. Point number 2 is called the 'Theory of Evolution' - quite popular amongst Biologists north of the Mason-Dixon line - in this situation it means that the virus will likely become (simultaneously) more infective and (slightly) less dangerous.

4. Trump - surprisingly given his opinions about climate change in general - seems to believe that everything will get better when the climate changes - hmm, maybe his belief system is internally coherent after all.

 

I was responding to both the Shyams quote:

 

At this rate, hopefully the entire Covid situation could turn around quickly within 2-3 month. I assume it is reasonable to assume that R0 for Covid will drop to insignificant levels once about 50%-60% of the country has been vaccinated. That is something I eagerly look forward to.

 

Where the 50-60 figure came from, it WAS reasonably accurate but out of date, and explaining why the Mayo clinic figure is higher.

[cherdano]

shyams, let us know when you get an appointment so that we can figure out your age ;)

At this rate, hopefully the entire Covid situation could turn around quickly within 2-3 month. I assume it is reasonable to assume that R0 for Covid will drop to insignificant levels once about 50%-60% of the country has been vaccinated. That is something I eagerly look forward to.

 

I am afraid it's not quit that easy. For one thing, we don't quite know to what extent vaccines prevent transmission - e.g. there is a good chance that it's extremely high after two doses of the Pfizer vaccine, but seems unlikely to be as high after one dose of the Astrazeneca one. For another, I am afraid we will only find out over the coming year whether we have already created a mutation that happens to escape the immune response created by the vaccines.

 

Finally. I have young kids in pre-school/school. I am sure I am not the only in that situation whose social life pre-covid consisted to a large part of meeting other parents and their kids. Well, none of us will get vaccinated any time soon, and there aren't even trials at this point for young children. (Pfizer is running a trial for 12+ year olds I think.) So vaccinating everyone over 50 might make less of a dent to R than you might expect just based on the simple numbers game.

On the other hand, those under 50 are more likely to have been infected already.

 

I think what it comes down to is that as long as Her Majesty's government insists on playing this "Let's aim for R = 1 - epsilon" game, they will find ways to stay in shooting range (and thus just a stretch of bad weather or bad luck away from another emergence of cases) until a very large part of the adult population is vaccinated with two doses.

 

Meanwhile, we are 11 months into this and we still don't have widespread use of FFP2/N95/KN95 masks (you see them a lot in Germany), don't have serious sick pay for those who have to stay home because of a positive test/contact tracing, and have given up on backwards tracing. Even if each of these would just reduce R by 0.03, together they would roughly half the number of cases every 6 weeks. Would seem worth doing, no?

[pilowsky]

Here is a rather old reference (it's a fast-moving field) that explains why sars-cov-2 is mutating so rapidly.

how sars changes its infectivity.

I'm happy to explain SNP's etc, I note that the 452 mutation is now causing severe problems.

[thepossum]

I think I may have made this quip about the thread's sub-title last year but when talking about ignoring history I think it wasn't the pandemic history that people ignored. Sadly it is now bein repeated and possibly irreversible. Everyone allowed the pandemic to take over absolutely everything and we are headed for total control of the planet, maybe forever. However people have been believing what they are fed from all sources for so long now etc

[Zelandakh]

I think I may have made this quip about the thread's sub-title last year but when talking about ignoring history I think it wasn't the pandemic history that people ignored. Sadly it is now bein repeated and possibly irreversible. Everyone allowed the pandemic to take over absolutely everything and we are headed for total control of the planet, maybe forever. However people have been believing what they are fed from all sources for so long now etc

I believe that over 2 million people are dead. Are you suggesting that those corpses are fictional creations of the media?

[hrothgar]

I believe that over 2 million people are dead. Are you suggesting that those corpses are fictional creations of the media?

 

Note: That death toll occurred despite a lot of efforts to restrict the spread of the virus.

 

Its remarkable to compare how successful various parts of the world have been in controlling the spread. (Yes, there have been confounding effects like the age of the population. Yes, there has been a lot of luck at play. However, it also seems clear that some countries such as Japan, New Zealand, etc. have been much muhc more successful than others at controlling the spread)

[Zelandakh]

I certainly understand that and do not disagree; at the same time, I am (and probably always will be) still skeptical about measurements of pain, a really non-quantifiable expression. I am not in a position to challenge genuine experts in this field, I know. But I would like to question someone about things like this:

The whole placebo debate goes well beyond potentially subjective measure such as pain. One of the reasons why placebo became a mainstream research topic rather than a dirty word in medicine relates to a trial about the effects of altitude. It turns out that taking a placebo actually causes the blood to mimic the effects of taking oxygen, a purely physical response. The fact that this result was robust and contradicted everything supposedly known at that time about the placebo caused a burst of research. That research has turned up a number of such physical responses, with one key area indeed being pain, where natural pain killers can be detected in the body after application of a placebo (thus making it a confirmed physical effect).

 

Trials suggest that these natural pain killers are often at least as effective as commercially available ones. As an example, a recent major Oxford study (published in The Lancet) found that a fake shoulder surgery was just as effective at reducing pain as the real thing. As I wrote before, this is a really interesting area of research and it is good to put aside your preconceptions from decades of media telling you that "the placebo effect" is purely psychological and of no importance. Research is obviously ongoing but as far as I know, pretty much every team working in the field is producing results that back up these effects, with the emphasis now on working out how to use the effect rather than questioning whether it is real or not.

[Winstonm]

The whole placebo debate goes well beyond potentially subjective measure such as pain. One of the reasons why placebo became a mainstream research topic rather than a dirty word in medicine relates to a trial about the effects of altitude. It turns out that taking a placebo actually causes the blood to mimic the effects of taking oxygen, a purely physical response. The fact that this result was robust and contradicted everything supposedly known at that time about the placebo caused a burst of research. That research has turned up a number of such physical responses, with one key area indeed being pain, where natural pain killers can be detected in the body after application of a placebo (thus making it a confirmed physical effect).

 

Trials suggest that these natural pain killers are often at least as effective as commercially available ones. As an example, a recent major Oxford study (published in The Lancet) found that a fake shoulder surgery was just as effective at reducing pain as the real thing. As I wrote before, this is a really interesting area of research and it is good to put aside your preconceptions from decades of media telling you that "the placebo effect" is purely psychological and of no importance. Research is obviously ongoing but as far as I know, pretty much every team working in the field is producing results that back up these effects, with the emphasis now on working out how to use the effect rather than questioning whether it is real or not.

I would be interested in any study of true physical findings such as improved oxygenation - have you links? Btw, It's not the media but my experience as a nurse that makes me take these findings with a grain of salt, most notably in pain management. Correlation is not causation, and finding endorphins (which pain causes to be released) is not a strongly valid argument.

 

There are many patient biases to overcome with pain studies. This abstract pretty well sums up my thinking about the placebo effect.

[pilowsky]

I believe that over 2 million people are dead. Are you suggesting that those corpses are fictional creations of the media?

 

No, he isn't - your thinking has become a little concrete.

[y66]

Israel serostudy: 98% have sterilizing immunity after second Pfizer shot; they cannot infect others.

 

https://www.ynetnews.com/health_science/article/H1jaK7mkd

[Zelandakh]

I would be interested in any study of true physical findings such as improved oxygenation - have you links? Btw, It's not the media but my experience as a nurse that makes me take these findings with a grain of salt, most notably in pain management. Correlation is not causation, and finding endorphins (which pain causes to be released) is not a strongly valid argument.

 

There are many patient biases to overcome with pain studies. This abstract pretty well sums up my thinking about the placebo effect.

Unfortunately I have long ago given up my link to the academic research database so it is not so easy for me to pinpoint the current research papers. What I can tell you is that leading expert in this area is Fabrizio Benedetti - a recent paper that came up for him via Google is this one but he has published many so do look around for more information. For a general overview of placebos from a few years back presented in an informal, entertaining way, you could also check out this BBC documentary.

[Winstonm]

Ok, thanks

[pilowsky]

Ok, thanks

 

I think there is a slight misunderstanding of what is meant by the 'Placebo effect' and the opposite the 'Nocebo effect'.

Just to begin, the terms are derived from Latin.

Doctors use foreign language words so that they can speak freely in front of patients - believing that the patient will not be able to understand them.

 

The idea of using foreign words is sometimes credited to Rene Laennec (inventor of the stethoscope).

Laennec coined the terms Craptitations and Rhonchi to describe the breath sounds that are known in English as crackles and wheeze.

 

Placebo comes from the Latin and simply means to make acceptable - it's also the root for placate.

Nocebo comes from the same Latin root as noxious.

 

The 'effects' associated with these words have absolutely nothing to do with causation.

 

So looking for a physiological reason for them is not sensible. They are not really 'effects' they are phenomena.

 

Both placebo and nocebo effects are a problem in clinical research because they contaminate the data. In any trial (even 'n of 1' trials - similar to when you see a Doctor) a person my coincidentally get better or worse.

The change in state can be due to many things.

 

I have high blood pressure (ironically). I get it checked by my GP so that adjustments to my medication can be made if needed.

Yesterday I had it checked - it was a bit high - 5 minutes later normal.

This could be 'white coat hypertension' (unlikely) or just because when I arrived I was in a hurry. The placebo effect can be better characterised as a falling away of some previously active process. Maybe a better term is 'Apobo', but that sounds a bit silly.

 

The nocebo effect is the opposite. A person taking a compound becomes unwell in some way while taking an active ingredient. The unwellness has nothing to do with the treatment.

 

In both cases, there can be false positives and negatives. A person may get better because of a previously unidentified effect of the treatment and so on.

 

non deus ex machina - neither placebo nor nocebo has a physiological basis.

 

They are a bothersome statistical artefact, not a basis for management.

[shyams]

There is an interesting article on the NFL website on Covid transmission. (Link)

 

Some points from this report that I found interesting (only selective text shown below - the entire article can be accessed using the link):

... the NFL found that transmission of the virus that causes COVID-19 occurred in less than 15 minutes of cumulative contact between individuals -- the timeframe the CDC initially used in its definition of close contact.

 

What was gleaned from the season suggest recommendations that could be useful in other settings.

 

1. 
    
   
2. "It's important to recognize that the most impactful intervention was not testing or tracking devices," said Dr. Allen Sills, the NFL's chief medical officer. "The most impactful interventions were universal use of facemasks, holding meetings outside and minimizing in-person meetings, closing dining rooms -- those all have broad applicability outside of football."
    
   
3. Also important were the quality of the masks being used, and air flow and ventilation. That is why in-person meetings were eventually forbidden in the NFL, even if people were able to be 6 feet away in a room, and why all meals at team facilities had to be grab and go -- eating together was an area of vulnerability.
    
   
4. And the paper showed the importance of isolating and quarantining people who were deemed high-risk close contacts of an infected person. That mid-season adjustment in the NFL protocol was designed to limit the spread of the virus. To date, 37 individuals who were isolated after being a high-risk close contact later tested positive.
    
   
5. The intensive protocol -- which included virtual meetings, mask-wearing at all times, including during practice, and elimination of group meals -- was put in place at the start of October for any team that had a positive case.

 

 

Edit: The CDC "Early Release" article on the above subject can be found here

[barmar]

So looking for a physiological reason for them is not sensible. They are not really 'effects' they are phenomena.

Electromagnetism is also a phenomenon. But it occurs reliably and we can quantify it, which allows us to make use of it in technology.

 

So it's not unreasonable to research whether the placebo effect is also reliable enough to be used clinically. And also to try to determine how much the effectiveness of "real" treatments is due to physiological processes versus psychological ones.

 

And on the other side, we can reasonably wonder how much of the fatality rate of COVID-19 is due to the psychological effects of being isolated in ICU wards.

 

It's very difficult to measure this, so what we mainly get are anecdotes, and they'll almost certainly be biased.

[pilowsky]

Electromagnetism is also a phenomenon. But it occurs reliably, and we can quantify it, which allows us to make use of it in technology.

 

So it's not unreasonable to research whether the placebo effect is also reliable enough to be used clinically. And also to try to determine how much the effectiveness of "real" treatments is due to physiological processes versus psychological ones.

 

And on the other side, we can reasonably wonder how much of the fatality rate of COVID-19 is due to the psychological effects of being isolated in ICU wards.

 

It's very difficult to measure this, so what we mainly get are anecdotes, and they'll almost certainly be biased.

 

You are splitting hairs, Barry. I don't want to get into a tedious debate about the difference between effects and phenomena.

Perhaps I made the wrong choice of word, but my intent was clear.

 

The placebo effect is not a 'positive' state. It is something that is attributed to an outcome when all real-world explanations are ruled out.

 

Doctors do not chat amongst themselves and say "hmm I wish we had some placebo to offer this person". Although there was a Band at the med school I went to that was called 'Placebo' - their music would not have effectively treated anyone.

 

No physicist will say "I can't work out why that happened, it must be electromagnetism!".

 

You are absolutely correct about the psychological effects of confinement in ICU. My daughter is doing her PhD on this topic. She has just published her first paper about it. I'm a little bit proud.

[shyams]

I have noticed over the past week or two that every article on Covid vaccine effectiveness seems to top the "most read article" list on the BBC website. I would have thought the a single-number for effectiveness (e.g. today's headline --- "Janssen single dose Covid vaccine 66% effective") provides no informational value to the average (i.e. non expert) citizen.

 

The Covid vaccination centres are unlikely to offer people a choice, right? And even if they did, would the recipient be in able to make an informed choice? In other words, is the fixation on the percentages a needless distraction?

 

Would love to hear opinions.