Cruising - Vaccine - Issue Older Persons Immune System

[Doubt It]

Georgia_Peaches, so glad to have you back, don't leave again.

[TeeRick]

15 hours ago, Georgia_Peaches said:

Sorry, I missed that post.  I "grounded" myself from CC for an entire week bc the hostility and negativity was messing with my head.  I do rather enjoy and appreciate your perspectives though 🙂.

Definitely understand why you would do this for mental health. 

[TeeRick]

16 hours ago, Jimbo59 said:

There may or may not be a Covid-19 vaccine. There is no vaccine for AIDS, even after 35 years. There are treatments for people with AIDS, but no vaccine to prevent it.

You are correct about AIDS vaccines, but HIV is a virus that destroys the very same immune system cells needed for a robust host immune response.  So kind of a special case on its own.  COVID-19 vaccine efforts might not be successful as you state for a number of reasons.  But in the absence of a vaccine, if we had very good drug therapies like the ones eventually developed for AIDS, then we would be in very good territory for resumption of normal activities.  We seem to focus here on vaccines but forget the potential breakthrough of a good anti-viral therapy as being just as important- perhaps even more important since everybody will not get vaccinated.

[Georgia_Peaches]

2 minutes ago, TeeRick said:

We seem to focus here on vaccines but forget the potential breakthrough of a good anti-viral therapy as being just as important- perhaps even more important since everybody will not get vaccinated.

Absolutely!  In my view, a good treatment is just as, perhaps even more important than a vaccine that may or may not work.  

[Fouremco]

I'm all in favour of developing an anti-viral therapy in parallel with developing a vaccine, but I think that the priority being placed on the vaccine is very much in keeping with the maxim that an ounce of prevention is worth a pound of cure.

[SHIP TRAVELER]

How I hate the word "Elderly" and all the baggage that goes with it.  I think you can guess why I hate the word.

[kearney]

I suspect a vaccine will be longer to develop than we would like and once one is approved it will likely not be as effective as we would like either. Flu vaccines for elderly were developed long after a basic flu vaccine was available. As I recall they use an additive which helps activate T-cells to aid the effectiveness of the vaccine. They may have to do something like this with a covid vaccine as well... but they likely won't play around with tweeking a vaccine until they have one that works. The next question is how well does it work and for how long... does the virus mutate requiring changes like the flu vaccine goes through each year. 

 

What I hope they get soon is a series of effective therapies... seems to me that is more likely to happen. We are starting to see treatments for the most severe... what we now need is a Tamiflu equivalent... something you can take at the first signs of illness. Seems to me if there is a basket of treatment options available... cruise ships could more easily sale....  until that happens... I am just not sure when ships can sail safely.  I for one am getting stir crazy. Thought about a car trip to Hilton Head... but then wondered if being stuck in a hotel or condo room for a few days would really feel like getting away...other than a view... why spend the money... and unlike a cruise...that new view does not change.. in the meantime I am taking my Vit C, zinc, and Vit D... and using my mask

[sippican]

On 6/27/2020 at 11:25 PM, dandee2 said:

Consider yourself lucky that the virus is different from the 1918 Influenza where most death occured for those under 30, or the Smallpox epidemic of 1884 where children died horrible death.

 

Can you clarify please?

IMHO, it's pretty unlucky to be a target group no matter your age. The senior population is no more expendable or less tragic. Of course, some may not see it that way.

[Georgia_Peaches]

46 minutes ago, kearney said:

I for one am getting stir crazy. Thought about a car trip to Hilton Head... but then wondered if being stuck in a hotel or condo room for a few days would really feel like getting away...other than a view... why spend the money... and unlike a cruise...that new view does not change

Stir crazy about sums it up for me as well.  We thought about a trip to Florida...but not doing that.  St. Simons?  Maybe.  It doesn't excite me though.  Then we considered an all inclusive resort like a Sandals.  But no casino...and I don't really want to fly. 

It's so hot today, a trip to the mountains might be nice.  We have finally settled on taking a few day trips here and there, just to get out.  Heading to North GA on Sunday for some wine tastings.

[Happy Cruiser 6143]

1 hour ago, kearney said:

I suspect a vaccine will be longer to develop than we would like and once one is approved it will likely not be as effective as we would like either. Flu vaccines for elderly were developed long after a basic flu vaccine was available. As I recall they use an additive which helps activate T-cells to aid the effectiveness of the vaccine. They may have to do something like this with a covid vaccine as well... but they likely won't play around with tweeking a vaccine until they have one that works. The next question is how well does it work and for how long... does the virus mutate requiring changes like the flu vaccine goes through each year. 

 

What I hope they get soon is a series of effective therapies... seems to me that is more likely to happen. We are starting to see treatments for the most severe... what we now need is a Tamiflu equivalent... something you can take at the first signs of illness. Seems to me if there is a basket of treatment options available... cruise ships could more easily sale....  until that happens... I am just not sure when ships can sail safely.  I for one am getting stir crazy. Thought about a car trip to Hilton Head... but then wondered if being stuck in a hotel or condo room for a few days would really feel like getting away...other than a view... why spend the money... and unlike a cruise...that new view does not change.. in the meantime I am taking my Vit C, zinc, and Vit D... and using my mask

 

Vitamins C and D and zinc are excellent for keeping your immune system ready to attack invaders.  Just don't forget to take vitamin K2 along with the D to direct the D to the appropriate places.

 

I'm joining you in being stir crazy!  Normally travel a lot.

[Fouremco]

53 minutes ago, sippican said:

The senior population is no more expendable or less tragic.

As a senior, I certainly don't consider myself expendable, but at this late stage in my life, I would view its loss far less tragic than that of my children or grandchildren. They still have a lifetime ahead of them to contribute to this world and, hopefully, to make it a better place.

[phoenix_dream]

On 6/28/2020 at 4:08 PM, Jimbo59 said:

There may or may not be a Covid-19 vaccine. There is no vaccine for AIDS, even after 35 years. There are treatments for people with AIDS, but no vaccine to prevent it.

I don't know why people keep bringing up AIDS.  Yes, there is no vaccine after so many years.  But expert scientists and immunologists have stated that they believe that a Covid-19 vaccine will be relatively easy to develop (as vaccines go).  Most predict within the next year if not sooner.  I choose to believe them as they know a heck of a lot more about it than I do.🙂

[phoenix_dream]

12 minutes ago, Fouremco said:

As a senior, I certainly don't consider myself expendable, but at this late stage in my life, I would view its loss far less tragic than that of my children or grandchildren. They still have a lifetime ahead of them to contribute to this world and, hopefully, to make it a better place.

I feel exactly the same way.  I want to live as much as the next person, but if you asked me who is more important to protect - me or my children or grandchildren - the answer is simple (and I mean all people of those ages - not just the ones I love).  That said, I have read that they realize seniors may not get as much immunity with the initial vaccines as younger people but they are working on ways to mitigate that.  Also, at this point I certainly would rather have a vaccine that offers me some protection rather than the zero I have now - perhaps I would still get sick, but if I did it would likely not be as serious had I not had any vaccine.  The initial shingles vaccine works like that - you may still get shingles, but if you do you will in all likelihood have a much lighter case.

Edited June 29, 2020 by phoenix_dream

[phoenix_dream]

50 minutes ago, Happy Cruiser 6143 said:

 

Vitamins C and D and zinc are excellent for keeping your immune system ready to attack invaders.  Just don't forget to take vitamin K2 along with the D to direct the D to the appropriate places.

 

I'm joining you in being stir crazy!  Normally travel a lot.

Unless you are on blood thinners, then you need to talk to your doc before taking any Vitamin K, even K2 (although they are less sure of the impact of that as opposed to K1).  You may know this already but wanted to put this note in for readers who may not.

[Fouremco]

2 minutes ago, phoenix_dream said:

Also, at this point I certainly would rather have a vaccine that offers me some protection rather than the zero I have now - perhaps I would still get sick, but if I did it would likely not be as serious had I not had any vaccine.

Absolutely! Many vaccines have never offered 100% protection, and we would be foolish to believe that one for COVID-19 will provide it. But I'll be very happy to have access to a vaccine that affords even a modest degree of protection.

[Threedrones]

My reaction to the article was “yawn”

[markeb]

28 minutes ago, Fouremco said:

Absolutely! Many vaccines have never offered 100% protection, and we would be foolish to believe that one for COVID-19 will provide it. But I'll be very happy to have access to a vaccine that affords even a modest degree of protection.

 

I think that's a very reasonable goal, but will probably be the hardest thing to demonstrate in clinical trials.

 

I haven't independently verified it, but there was information on  another thread (that seems to have gotten out of control and been deleted...) describing the Phase III clinical trial. If accurate, they're recruiting 30,000 people. 20,000 would get the vaccine and 10,000 a placebo (probably considered ethical as you're not asking either group to change behavior, and both would get treated). To demonstrate effectiveness in the vaccine group, you've got to have disease in the control group. Death is a fairly obvious, but likely uncommon endpoint, so decreased case fatality rate in the vaccinated group compared to the unvaccinated would be an indicator of effectiveness (both groups would get accepted standard of care if ill). Some measure of time sick, with the same caveats, and easiest to measure but almost certainly hardest to achieve would be to find a statistically significant difference in PCR positive swabs in both groups, which would probably require 30,000 swabs on some sort of realistic schedule over a period of possibly months, or until there was a statistical difference.

 

The hardest will almost certainly be demonstrating a difference in clinical severity, which is where you'd see that modest degree of protection.  And again, to actually demonstrate that effect, a "lot" (non-technical term as the statisticians will calculate how many they need for the study to have power) of people in the control group have to get sick. And if it does take months, and clinical practice evolves as fast as it has up until now, there will always be a question as to whether clinical improvement is from the vaccine or the changes in care.

 

It's possible they're going to do a smaller "wild" study and measure antibody levels, then do a larger study only measuring antibody levels (if they prove predictive), but that could take longer, and if subsets of population react differently due to age, blood type, or some other factors, could ultimately prove not terribly useful.

 

I think we'll get there, but lacking years of understanding the virus and the disease it causes (there are still associated syndromes being identified that may or may not be due to the virus), there's a much higher level of uncertainty than I think many (most?) people realize.

[UnorigionalName]

I like how everyone these days is now an expert in virology and immunology (as well as epidmiology and infectious disease).

 

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

[Georgia_Peaches]

13 minutes ago, UnorigionalName said:

I like how everyone these days is now an expert in virology and immunology (as well as epidmiology and infectious disease).

 

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

Well what else have we had to do over the last 12 weeks?!  I am also now an expert mixologist, hair stylist, and chef!  😉

[cangelmd]

53 minutes ago, markeb said:

 

I think that's a very reasonable goal, but will probably be the hardest thing to demonstrate in clinical trials.

 

I haven't independently verified it, but there was information on  another thread (that seems to have gotten out of control and been deleted...) describing the Phase III clinical trial. If accurate, they're recruiting 30,000 people. 20,000 would get the vaccine and 10,000 a placebo (probably considered ethical as you're not asking either group to change behavior, and both would get treated). To demonstrate effectiveness in the vaccine group, you've got to have disease in the control group. Death is a fairly obvious, but likely uncommon endpoint, so decreased case fatality rate in the vaccinated group compared to the unvaccinated would be an indicator of effectiveness (both groups would get accepted standard of care if ill). Some measure of time sick, with the same caveats, and easiest to measure but almost certainly hardest to achieve would be to find a statistically significant difference in PCR positive swabs in both groups, which would probably require 30,000 swabs on some sort of realistic schedule over a period of possibly months, or until there was a statistical difference.

 

The hardest will almost certainly be demonstrating a difference in clinical severity, which is where you'd see that modest degree of protection.  And again, to actually demonstrate that effect, a "lot" (non-technical term as the statisticians will calculate how many they need for the study to have power) of people in the control group have to get sick. And if it does take months, and clinical practice evolves as fast as it has up until now, there will always be a question as to whether clinical improvement is from the vaccine or the changes in care.

 

It's possible they're going to do a smaller "wild" study and measure antibody levels, then do a larger study only measuring antibody levels (if they prove predictive), but that could take longer, and if subsets of population react differently due to age, blood type, or some other factors, could ultimately prove not terribly useful.

 

I think we'll get there, but lacking years of understanding the virus and the disease it causes (there are still associated syndromes being identified that may or may not be due to the virus), there's a much higher level of uncertainty than I think many (most?) people realize.

You’re making an argument for a challenge trial 😉.

 I think that it is likely that they will be crunching the data as close to real time as they can, and as soon as the number of infected people reaches significance, hopefully it will, they will stop the control arm on ethical grounds. My concern is that they won’t pick the right place to test, because this thing seems very sensitive to any physical distancing intervention and many people catch and don’t know it. My other concern right now is that it will take 2 shots for everyone, not just older folks, but it is what it is - any safe vaccine is better than no vaccine

[markeb]

20 minutes ago, cangelmd said:

You’re making an argument for a challenge trial 😉.

 

That would be truly scary. And why you have ethicists and not just statisticians involved in study design! Depending on your specialty, you may or may not have ever read about Operation Whitecoat. Different times for sure, but also a lack of understanding of the potential pathology. Some things that appeared ethically treatable had long term health effects.

 

20 minutes ago, cangelmd said:

I think that it is likely that they will be crunching the data as close to real time as they can, and as soon as the number of infected people reaches significance, hopefully it will, they will stop the control arm on ethical grounds. My concern is that they won’t pick the right place to test, because this thing seems very sensitive to any physical distancing intervention and many people catch and don’t know it. My other concern right now is that it will take 2 shots for everyone, not just older folks, but it is what it is - any safe vaccine is better than no vaccine

 

I agree they're going to terminate the control arm as soon as statistically possible, but I suspect they'll have multiple endpoints, which will make it harder. Preventing infection prevents everything downrange, and since they're going after the SPIKE, might be possible, but they're going to have to measure disease burden somehow just in case. And since there's at least some evidence you can be PCR positive and "immune" (non-viable virus), swabbing for PCR without culture may be meaningless.

 

Concur completely on the rest of your post.

 

1 hour ago, UnorigionalName said:

I like how everyone these days is now an expert in virology and immunology (as well as epidmiology and infectious disease).

 

I won't claim to be an expert, but much of this is my trained area of expertise, although in the other hundreds of thousands of animal life forms not including humans. But I've been engaged in all of those areas involving everything but the diagnosis and treatment of disease in humans. Of course, for reasons of personal privacy, I'm not posting any of those credentials, and even if I did, they could easily not be mine. And I've actually put  down the mouse and keyboard a lot on these topics over the last months, as I suspect is true of cangelmd as well. 

[TeeRick]

23 hours ago, Fouremco said:

I'm all in favour of developing an anti-viral therapy in parallel with developing a vaccine, but I think that the priority being placed on the vaccine is very much in keeping with the maxim that an ounce of prevention is worth a pound of cure.

I think in the absence of a vaccine, an effective anti-viral drug broadly available would allow us to cruise and travel.  Ships could carry such a drug and administer as necessary.

[Happy Cruiser 6143]

16 hours ago, phoenix_dream said:

Unless you are on blood thinners, then you need to talk to your doc before taking any Vitamin K, even K2 (although they are less sure of the impact of that as opposed to K1).  You may know this already but wanted to put this note in for readers who may not.

 

I wasn't aware of this as I do not take any prescription medications.  Thanks for pointing it out.

[Fouremco]

12 minutes ago, TeeRick said:

I think in the absence of a vaccine, an effective anti-viral drug broadly available would allow us to cruise and travel.  Ships could carry such a drug and administer as necessary.

Even if they were to develop an effective anti-viral drug in advance of a vaccine, I wonder how many people would want to cruise. My goal is to not catch COVID-19, not to risk catching it and be cured.  

[mac_tlc]

On 6/28/2020 at 5:54 PM, Georgia_Peaches said:

Sorry, I missed that post.  I "grounded" myself from CC for an entire week bc the hostility and negativity was messing with my head.  I do rather enjoy and appreciate your perspectives though 🙂.

I think we all need a week off now and then. 
 

mac_tlc