How long will this go on?

[chuckbear]

“To argue with a person who has renounced the use of reason is like administering medicine to the dead.” —Thomas Paine (1737-1809)

[docj]

15 hours ago, RV_ said:

If we make it mandatory and people do wear them, it will still be a year or two barring an amazing vaccine.

There has never been an amazing instant vaccine, it takes stages and testing. Then a year to manufacture after learning the best production methods, then the long line with health pros and first responders first.

Unfortunately, because of the nonsense that people are hearing from some politicians, I don't think the majority of the country (or the world for that matter) fully appreciates that we are going to be stuck with masks and restricted activities for that length of time.  The economic disruptions this will bring about will be huge.  For example, how many people will want to go on a cruise before this is under control?  Even though Disney World opened yesterday, do you seriously want to crowd onto a ride or do you really believe every seat in every ride is going to be wiped clean every time?  Most restaurants aren't profitable if they can't open past the 50% point.  Etc, etc, the list goes on.  

[2gypsies]

7 hours ago, Barbaraok said:

Even if they determine one of the vaccines starting trials is the magic bullet and they have the factories ramped up that is still Billions of doses the world needs.   We tend to lose sight of the fact that everyone in the world will be vying for the vaccine and we won't get it all.    It will take probably a  couple of year or more just to get it out to all of the people who want it (about 25% of people in this country will say no way until someone in their family dies) to get the needed doses and then how will it be allocated?   Health care workers, first responders, etc., will be first, and then high risk (ie us 'golden oldies') and then general population?   And what about costs?   Assume Medicare will include it as a NEED Preventative care for those over 65, will health insurance cover the rest?

I just assume we will be in this state for a couple of more years, at least.   And then we can all get ready for the next one - there are several other animal viruses that have been identified as ones that could possibly jump species.

Totally agree on all you said!

[Zulu]

7 hours ago, Barbaraok said:

Even if they determine one of the vaccines starting trials is the magic bullet and they have the factories ramped up that is still Billions of doses the world needs.   We tend to lose sight of the fact that everyone in the world will be vying for the vaccine and we won't get it all.    It will take probably a  couple of year or more just to get it out to all of the people who want it (about 25% of people in this country will say no way until someone in their family dies) to get the needed doses and then how will it be allocated?   Health care workers, first responders, etc., will be first, and then high risk (ie us 'golden oldies') and then general population?   And what about costs?   Assume Medicare will include it as a NEED Preventative care for those over 65, will health insurance cover the rest?

And then there’s how effective the vaccine will be, and probably not 100%.
 

Here are the past vaccine effectiveness rates for the flu from the CDC — nothing to write home about.

 

 

[docj]

39 minutes ago, Zulu said:

Here are the past vaccine effectiveness rates for the flu from the CDC — nothing to write home about.

The influenza virus mutates often and, therefore, it is a guessing game to decide what version of the virus will be prevalent during the winter flu season.  The "guess" has to be made long before the actual flu season to allow enough time to ramp up production for the millions of doses that are used each year.  As a result, how close the guess is to the actual virus strain varies each year.  Some years the vaccine provides more benefit than in others.

The flu is not a coronavirus and, therefore, there is little one can extrapolate from our experience with it.  From the data we have to date it appears that its rate of mutation may be less than that of the flu but there definitely has been a change from the version that was first seen in Asia and that which swept through Europe and the US.  The bottom line is that we won't know how effective the vaccine is until we have one (or more of them) to try.

One fact to keep in mind is that because COVID-19 is considered to be a lethal disease, the Phase 2 tests of vaccine candidates will not include intentional infection of volunteers.  Rather, a test group of subjects will be inoculated and after several months their incidence of catching the virus will be compared to that of a control group.  That's a much less direct way of determining efficacy than would be intentional infection.  So it will be even harder to determine how effective any vaccine really is.

Edited July 12, 2020 by docj

[Zulu]

1 hour ago, docj said:

The bottom line is that we won't know how effective the vaccine is until we have one (or more of them) to try.

So we have no reason to believe a COVID-19 vaccine will be any more (or less) effective than flu vaccines, right?

[Jaydrvr]

22 minutes ago, Zulu said:

So we have no reason to believe a COVID-19 vaccine will be any more (or less) effective than flu vaccines, right?

"The flu is not a coronavirus and, therefore, there is little one can extrapolate from our experience with it."

[Randyretired]

1 hour ago, docj said:

The influenza virus mutates often and, therefore, it is a guessing game to decide what version of the virus will be prevalent during the winter flu season.  The "guess" has to be made long before the actual flu season to allow enough time to ramp up production for the millions of doses that are used each year.  As a result, how close the guess is to the actual virus strain varies each year.  Some years the vaccine 

One fact to keep in mind is that because COVID-19 is considered to be a lethal disease, the Phase 2 tests of vaccine candidates will not include intentional infection of volunteers.  Rather, a test group of subjects will be inoculated and after several months their incidence of catching the virus will be compared to that of a control group.  That's a much less direct way of determining efficacy than would be intentional infection.  So it will be even harder to determine how effective any vaccine really is.

There was an interview on 60 minutes with a woman that will be intentionally  infected with covid after receiving a vaccine.  She said she is risking herself to save lives.  She is in her 20's as I recall.

[docj]

3 hours ago, Randyretired said:

There was an interview on 60 minutes with a woman that will be intentionally  infected with covid after receiving a vaccine.  She said she is risking herself to save lives.  She is in her 20's as I recall.

You aren't going to get statistically significant data from a test involving one person.   From what I've read you won't get reputable researchers to intentionally expose a person to a potentially fatal disease in order to test a vaccine.

[Jaydrvr]

On 7/12/2020 at 8:11 PM, Randyretired said:

There was an interview on 60 minutes with a woman that will be intentionally  infected with covid after receiving a vaccine.  She said she is risking herself to save lives.  She is in her 20's as I recall.

 

20 hours ago, docj said:

You aren't going to get statistically significant data from a test involving one person.   From what I've read you won't get reputable researchers to intentionally expose a person to a potentially fatal disease in order to test a vaccine.

My impression from the clip I saw was that she was part of a larger study, but who knows. These "news" clips are always heavily edited to present someone's desired perspective in a small amount of air time, so it's difficult to get a compete picture. Jay

Edited July 14, 2020 by Jaydrvr

[Randyretired]

10 hours ago, docj said:

You aren't going to get statistically significant data from a test involving one person.   From what I've read you won't get reputable researchers to intentionally expose a person to a potentially fatal disease in order to test a vaccine.

Challenge tests as these intentional exposure test are called are being debated by a number of researchers.  From what I have read it is still being debated and in some instances researchers are preparing for it as the 60 minutes news clips suggests.  In one case they already have thousands of volunteers.  Certainly there are some ethical issues and the US may not be involved but it seems to be to early to rule these challenge trials out.

[DanZemke]

Challenge tests would get us answers about efficacy much more quickly than random trials.  And the economist in me favors them.  But they are ethically dicey. 

IMO, given the likely Covid1-19 impact on all people on this planet, I favor them.  If we ("every" country) were to offer huge rewards (without any wiggle room about paying) we could dramatically accelerate the testing of vaccines and therapeutics.  In my mind, its similar to going to war.  But there would be no conscription, only voluntary service.

https://en.wikipedia.org/wiki/Human_challenge_study

Edited July 14, 2020 by DanZemke
clarity

[sandsys]

2 hours ago, DanZemke said:

Challenge tests would get us answers about efficacy much more quickly than random trials.  And the economist in me favors them.  But they are ethically dicey. 

IMO, given the likely Covid1-19 impact on all people on this planet, I favor them.  If we ("every" country) were to offer huge rewards (without any wiggle room about paying) we could dramatically accelerate the testing of vaccines and therapeutics.  In my mind, its similar to going to war.  But there would be no conscription, only voluntary service.

https://en.wikipedia.org/wiki/Human_challenge_study

I have participated in a drug study but NOT one that might give me the disease. Only people who really need cash would likely do that which means they may not be the healthiest to start with if they need money that badly.

[DanZemke]

1 hour ago, sandsys said:

Only people who really need cash would likely do that which means they may not be the healthiest to start with if they need money that badly.

I agree that could be a danger of a poorly implemented program.  But just like serving in a war, there would need to be some screening criteria.

It's a very difficult decision.  If 10,000 thousand people participated in a challenge test and all lost their lives (very unlikely), that ended up saving the lives of 20,000 people, which would you choose?

The least ethical case, IMO, would be to do all the testing in 3rd world countries.

p.s. A slow path to protection and remediation also results in more misery and lost lives.

 

Edited July 14, 2020 by DanZemke
clarity

[Zulu]

 

13 hours ago, sandsys said:

I have participated in a drug study but NOT one that might give me the disease. Only people who really need cash would likely do that which means they may not be the healthiest to start with if they need money that badly.

 

 

12 hours ago, DanZemke said:

I agree that could be a danger of a poorly implemented program.  But just like serving in a war, there would need to be some screening criteria.

I'm guessing the "danger" you're talking about is the possibility of getting unhealthy volunteers and not "people who really need cash".

Regardless, volunteers for money means you won't be getting any 1 percenters. So, yes, like wars, the poor will be dying, not the rich.

 

12 hours ago, DanZemke said:

It's a very difficult decision.  If 10,000 thousand people participated in a challenge test and all lost their lives (very unlikely), that ended up saving the lives of 20,000 people, which would you choose?

It's not a difficult decision for me. One person is too many.

 

12 hours ago, DanZemke said:

The least ethical case, IMO, would be to do all the testing in 3rd world countries.

The fact that you even mention this speaks volumes.

Hell, as long as we're at it, let's be thorough and reinstitute Aktion T4.

[Randyretired]

There are 2 sides to this.  One of course is the danger trial participants face but the other is the deaths and suffering of covid.  The woman on 60 minutes made it clear she is doing it to try and stop the covid suffering and save lives.  She said she was willing to risk everything so she may be able to save many.  There are many variables that go into these trials and I think I would need to hear specifics before I could form an opinion.  There maybe some future heroes and I pray for their health and thank them for their courage.  I think it is also to early to try and segment and prejudge these volunteers by income or any other criteria.

[2gypsies]

15 hours ago, DanZemke said:

The least ethical case, IMO, would be to do all the testing in 3rd world countries.

 

I can't believe someone would say that!!!

[sandsys]

54 minutes ago, 2gypsies said:

I can't believe someone would say that!!!

Why? Do you not remember Nestle convincing third world women that their formula was better for babies than breast milk? But the women couldn't afford the formula so they watered it down. And babies starved. Why would drug development companies have any more conscience?

[docj]

1 hour ago, 2gypsies said:

I can't believe someone would say that!!!

The Tuskegee syphilis study ran from 1932-1972. Are we naive enough to think the world has changed all that much in 50 years?  

[DanZemke]

7 hours ago, Zulu said:

It's not a difficult decision for me. One person is too many.

One extra person dying from Covid-19 or one dying in a trial?

No one dying is a non sequitur.

My desire, and I assume that of most others, including you, is to minimize the total amount of suffering and death from Covid-19.  Challenge trials accelerate the process of insuring that a vaccine or drug is safe and effective.  Faster availability would save many lives and much misery.

If you haven't read this short description of challenge trails, please do.

https://en.wikipedia.org/wiki/Human_challenge_study

Edited July 14, 2020 by DanZemke
more information

[DanZemke]

4 hours ago, Randyretired said:

I think I would need to hear specifics before I could form an opinion. 

As would I.  Well said. 

[Barbaraok]

Lots of drug studies use to be done on prison inmates, often without their knowledge.

 

[Zulu]

2 hours ago, DanZemke said:

My desire, and I assume that of most others, including you, is to minimize the total amount of suffering and death from Covid-19.  Challenge trials accelerate the process of insuring that a vaccine or drug is safe and effective.  Faster availability would save many lives and much misery.

Challenge trials do this by putting people at risk, possibly forfeiting their lives. The rationale, as you explained, is that a few may die in order to protect society.

I think human challenge studies are unethical. To me, they are the embodiment of the ends justify the means.

Also, I don't think using "volunteers" necessarily make human challenge studies any more ethical. It is standard practice in these studies to pay volunteers, sometimes a great deal of money. This can result in a disproportionate number of people who are poor or jobless.

I suggest you get beyond Wikipedia -- Human Challenge Studies for Covid-19 Vaccine: Questions about Benefits and Risks

[Pieere]

I lightly read a video on Vanderbilt University Hospital that has some hope of a vaccine for CUVID-19. Hopefully it will shed some light on it! 

[DanZemke]

15 hours ago, Zulu said:

I suggest you get beyond Wikipedia -- Human Challenge Studies for Covid-19 Vaccine: Questions about Benefits and Risks

The link you cited was a republished opinion piece originally posted on May 15 in "The Doctor's Tablet Blog".
    http://blogs.einstein.yu.edu/human-challenge-studies-for-a-covid-19-vaccine-ethical-quandaries/
    
Here's a more recent posting of an opinion piece on the subject from the same source you cited:
    https://www.thehastingscenter.org/accepting-the-challenge-covid-vaccine-challenge-trials-can-be-ethically-justified/
    
Their conclusion states: "Altruism and a spirit of public service seem to animate challenge-study volunteers. Those who oppose SARS-CoV-2 challenge studies do not only miscalculate the risks; they also misjudge the value that drives participation."
    
-------------------------------------------------------------------------------    
    
How about a link to an actual peer-reviewed academic journal article instead of opinion pieces?
    https://science.sciencemag.org/content/368/6493/832
    
note: CHIs = controlled human infection studies (aka Challenge Trials)    
    
Conclusion: "Given the extraordinary nature of the pandemic, our framework and analysis support laying the groundwork for SARS-CoV-2 CHIs—for example, by developing a challenge strain, drafting consensus protocols that address ethical concerns, and engaging stakeholders to enhance their social value, minimize risks, and build public trust."

-------------------------------------------------

I've been accused multiple times in my life of being too rational.  Accusation accepted.

Zulu, this thread seems, to me, to have run its course.  Our minds appear to be wired differently.  And I find different perspectives very valuable.

Suggestion: Post any closing thoughts you have, and let's move on.

Edited July 15, 2020 by DanZemke