Are vaccines the light at the end of the tunnel?

[TeeRick]

23 minutes ago, markeb said:

 

Epidemiologically, a disease is endemic when it's occurring at a more or less expected prevalence in a population. We probably don't know what that is for SARS-CoV-2, but as the population (local and global) develops immunity, it's going to settle down, hopefully to the occasional case and rare localized outbreak. And that will become the baseline. And if transmission continues more than sporadically at that baseline, most people would consider it endemic.

 

The CDC has a pretty good principles of epidemiology course online. Their definition is:

 

Endemic refers to the constant presence and/or usual prevalence of a disease or infectious agent in a population within a geographic area.

 

Haven't seen the 1-year concept mentioned by UnoriginalName, but that makes sense in the context of a specific disease. 

Yes Mark thank you.  I have seen definitions but I admit to not being an epidemiologist by any stretch.  But I think we are asking something beyond definitions.  When a Pandemic is receding who declares it over?  Or WHO declares it over ?  and when?  Who's On First. Or is it WHO is on First?😄

WHAT is on Second.  I DON'T KNOW on Third.  Sounds like Abbott and Costello had a routine for the pandemic.

https://www.baseball-almanac.com/humor4.shtml

 

[Ken the cruiser]

Just as I side note, us folks over 65 in Alabama will be able to start getting our vaccines Feb 8th. Yay!! It will be interesting to see which vaccine shows up at a health department (or maybe even a pharmacy) near where we live.

[LGW59]

1 minute ago, Ken the cruiser said:

Just as I side note, us folks over 65 in Alabama will be able to start getting our vaccines Feb 8th. Yay!! It will be interesting to see which vaccine shows up at a health department (or maybe even a pharmacy) near where we live.

I have a friend in Orange Beach, he is 57 and can get his shot this weekend

[Ken the cruiser]

4 minutes ago, LGW59 said:

I have a friend in Orange Beach, he is 57 and can get his shot this weekend

I take it he's a first responder or someone in one of the first categories rather than some normal retired person with no extenuating circumstances like we are.

Edited January 29, 2021 by Ken the cruiser

[markeb]

1 hour ago, TeeRick said:

Yes Mark thank you.  I have seen definitions but I admit to not being an epidemiologist by any stretch.  But I think we are asking something beyond definitions.  When a Pandemic is receding who declares it over?  Or WHO declares it over ?  and when?  Who's On First. Or is it WHO is on First?😄

WHAT is on Second.  I DON'T KNOW on Third.  Sounds like Abbott and Costello had a routine for the pandemic.

https://www.baseball-almanac.com/humor4.shtml

 

 

I'm going to assume, dangerously, that since the WHO declared the pandemic, they'd declare it over. I'm not seeing anything on WHO's web page yet on proposed criteria for declaring an end. There's an interesting paper on the process to declare the last Ebola outbreak over. And some articles on H1N1 that might provide some ideas.

 

This may prove much more like measles than those examples, though. H1N1 was global but kind of went away. Ebola has always been at least somewhat localized, so those have pretty much been classed as outbreaks. With Ebola, the criteria was pretty much an end of transmission, and I'm not sure that's going to be a realistic expectation here. SARS-CoV-2 is somewhat likely to become endemic and be with us for a long time at a much lower prevalence.

 

What I would sort of expect to see is as countries and regions move to a baseline prevalence, you'll go from it's epidemic everywhere to it's epidemic regionally to the prevalence is down regionally. In theory, once you're dealing with regional outbreaks/epidemics, you no longer have a pandemic. And at that time, the WHO would declare the pandemic over, but there could still be epidemic transmission on a local/regional level.

 

Of course, we've not really done this in the modern era. Certainly we've had emerging infectious diseases, but not with the type of global spread we've seen in the last 12 months or so. (Well, HIV, obviously, but there's a lot of politics on the use of the term pandemic for HIV...)

[downsmead]

21 hours ago, nocl said:

Germany's vaccine commission says that AstraZeneca's vaccine should not be given to anyone over 65 due to lack of data on that age group.  This is due to the small number of trial participants in that age group.  They (STIKO) is recommending it only for those in the 18-65 age group.

And yet Germany have approved the vaccine for all age groups 🤷‍♀️

[Ken the cruiser]

Here's an interesting development between the DOD and FEMA.

 

The Pentagon and the Federal Emergency Management Agency are negotiating the final terms of an agreement that could see the military provide around 450,000 Covid-19 vaccinations a day.

 

I heard about the possibility of this a few days ago, but didn't imagine they would be moving so quickly on this. Cool!!!

 

Pentagon close to reaching agreement to provide around 450,000 Covid-19 vaccinations a day - CNNPolitics

[Charles4515]

21 minutes ago, Ken the cruiser said:

Here's an interesting development between the DOD and FEMA.

 

The Pentagon and the Federal Emergency Management Agency are negotiating the final terms of an agreement that could see the military provide around 450,000 Covid-19 vaccinations a day.

 

I heard about the possibility of this a few days ago, but didn't imagine they would be moving so quickly on this. Cool!!!

 

Pentagon close to reaching agreement to provide around 450,000 Covid-19 vaccinations a day - CNNPolitics

 

Given the bureacratic micro managing way they are giving out the vaccine here, to be equitable, it is by zip code in addition to all the other formulas, those military sites might be my best shot at getting vaccinated. I have friends in my grouping who have been vaccinated in California and I have had no luck.

[markeb]

29 minutes ago, Ken the cruiser said:

Here's an interesting development between the DOD and FEMA.

 

The Pentagon and the Federal Emergency Management Agency are negotiating the final terms of an agreement that could see the military provide around 450,000 Covid-19 vaccinations a day.

 

I heard about the possibility of this a few days ago, but didn't imagine they would be moving so quickly on this. Cool!!!

 

Pentagon close to reaching agreement to provide around 450,000 Covid-19 vaccinations a day - CNNPolitics

Really happy I’m not in the Building anymore...

[deadzone1003]

Apparently, J&J had 3 clinical trials.  US had 72% efficacy rate.  South Africa had 57% efficacy rate.  I believe Brazil had a 67% efficacy rate.  In total, it ended up at a 66% efficacy rate.  For contrast, Novamax had an 89.4 efficacy rate, but they apparently did a small trial in South Africa to get an idea how it will do against that variant and it was reported they got a 49.4% efficacy rate.  Novamax is a UK company and they are contracted to supply 100,000,000 doses (I'm assuming within 3 months of approval or EUA as it seems to be the standard Operation Warp Speed requirement).  Maybe, by May or June the USA could be drowning in vaccines.  

[nocl]

1 hour ago, downsmead said:

And yet Germany have approved the vaccine for all age groups 🤷‍♀️

The EU authorized it for all over 18.  Even though Germany's vaccine committee recommended against is use in those over 65 due to lack of data, the German regulatory authority did agree to follow the EU's approval.

[downsmead]

30 minutes ago, nocl said:

The EU authorized it for all over 18.  Even though Germany's vaccine committee recommended against is use in those over 65 due to lack of data, the German regulatory authority did agree to follow the EU's approval.

Sitting here in the U.K., we are following with interest the situation between the EU and U.K. with regards to the various COVID vaccines. President Macron of France has claimed the AstraZeneca vaccine is 'almost ineffective' on people who are over 65 years of age, this was prior to the EU approval. It will be interesting to see if France and Germany will then only use the Pfizer vaccine for their over 65’s. 
On the plus side it looks as though there are two more vaccines with promising results on the horizon to add to our arsenal.

[Porky55]

10 hours ago, cangelmd said:

can/will we as a society accept that and return to normal? Will masking and more importantly social distancing be required if Covid settles into a death/hospitalization rate comparable to flu? Can we tolerate that to have a normal life? Remember that you could see headlines “Death rate from infectious disease twice the rate in 2010”. - well of course, Covid didn’t exist then.

I think we will because we have managed to do this for the flu - from the 1918 Spanish flu thru (at lest) to the now vaccinated modern day flus. We adapt to changes - as that’s what humans do - adapt 🤔

[HeddaGarbled]

There’s some major political stuff kicking off in the EU re vaccine supply, so we need to be a bit sceptical about the motivation behind some of the statements. 

[deadzone1003]

2 hours ago, downsmead said:

Sitting here in the U.K., we are following with interest the situation between the EU and U.K. with regards to the various COVID vaccines. President Macron of France has claimed the AstraZeneca vaccine is 'almost ineffective' on people who are over 65 years of age, this was prior to the EU approval. It will be interesting to see if France and Germany will then only use the Pfizer vaccine for their over 65’s. 
On the plus side it looks as though there are two more vaccines with promising results on the horizon to add to our arsenal.

Problem is how much of that assessment is politics?  The EU was what you might term late to the party.  Their order was 3 months after UK's order of AZ.  The USA is ahead of the EU in getting the AZ vaccine.  The bureaucrats in the EU who have a propensity to not take risk sat on their behinds.  Now, they want to cut in line because their citizens are at the gate like barbarians ready to cut off their heads (as if the world is going to miss them).  

[nocl]

3 hours ago, downsmead said:

Sitting here in the U.K., we are following with interest the situation between the EU and U.K. with regards to the various COVID vaccines. President Macron of France has claimed the AstraZeneca vaccine is 'almost ineffective' on people who are over 65 years of age, this was prior to the EU approval. It will be interesting to see if France and Germany will then only use the Pfizer vaccine for their over 65’s. 
On the plus side it looks as though there are two more vaccines with promising results on the horizon to add to our arsenal.

The primary issue is that AZ made a mess of their clinical trials and combined a number of trials with different protocols with a meta analysis.  They did not have a good mix of demographics across all of their trials.  For example the half dose data that indicated very high efficacy was in a small group in Brazil and included no one over 55.

 

If the trials had been designed and executed well they would not be having these issues. It may work just fine in the different groups, unfortunately the trial is lacking in some details.

Edited January 30, 2021 by nocl

[nocl]

10 minutes ago, deadzone1003 said:

Problem is how much of that assessment is politics?  The EU was what you might term late to the party.  Their order was 3 months after UK's order of AZ.  The USA is ahead of the EU in getting the AZ vaccine.  The bureaucrats in the EU who have a propensity to not take risk sat on their behinds.  Now, they want to cut in line because their citizens are at the gate like barbarians ready to cut off their heads (as if the world is going to miss them).  

The EMEA (European Medicines Evaluation Agency) is a quality organization. They are headquartered in Amsterdam.  They used to be located in London prior to brexit. Do not know if the move impacted the organization much.

 

Part of the issue with the EU is the failure of some of the vaccine candidates  from EU based pharmaceutical companies.

Edited January 30, 2021 by nocl

[hcat]

Not a Scientist,  but I doubt there will be a Covid free future..for many yrs. Esp if it behaves like regular seasonal flu.

 

Even with  targeted flu vaccines every yr...many  people get the flu and some die.  Still a serious challenge.   Same will .probably apply to Covid.

[nomad098]

9 hours ago, nocl said:

The primary issue is that AZ made a mess of their clinical trials and combined a number of trials with different protocols with a meta analysis.  They did not have a good mix of demographics across all of their trials.  For example the half dose data that indicated very high efficacy was in a small group in Brazil and included no one over 55.

 

If the trials had been designed and executed well they would not be having these issues. It may work just fine in the different groups, unfortunately the trial is lacking in some details.

 

You have quite obviously been reading internet conspiracy theories and poor research.

 

Try something a little more authoritative.

 

https://www.bmj.com/content/372/bmj.n86

 

 

A little insight into how and why decisions were made with the full knowledge and consent of the MHRA.

 

 

 

 

[TeeRick]

16 hours ago, markeb said:

 

I'm going to assume, dangerously, that since the WHO declared the pandemic, they'd declare it over. I'm not seeing anything on WHO's web page yet on proposed criteria for declaring an end. There's an interesting paper on the process to declare the last Ebola outbreak over. And some articles on H1N1 that might provide some ideas.

 

This may prove much more like measles than those examples, though. H1N1 was global but kind of went away. Ebola has always been at least somewhat localized, so those have pretty much been classed as outbreaks. With Ebola, the criteria was pretty much an end of transmission, and I'm not sure that's going to be a realistic expectation here. SARS-CoV-2 is somewhat likely to become endemic and be with us for a long time at a much lower prevalence.

 

What I would sort of expect to see is as countries and regions move to a baseline prevalence, you'll go from it's epidemic everywhere to it's epidemic regionally to the prevalence is down regionally. In theory, once you're dealing with regional outbreaks/epidemics, you no longer have a pandemic. And at that time, the WHO would declare the pandemic over, but there could still be epidemic transmission on a local/regional level.

 

Of course, we've not really done this in the modern era. Certainly we've had emerging infectious diseases, but not with the type of global spread we've seen in the last 12 months or so. (Well, HIV, obviously, but there's a lot of politics on the use of the term pandemic for HIV...)

I think there are some consequences to when the pandemic is declared over maybe in the US at least.  Private health insurance for example.  Will they start charging individuals for COVID testing?  Will the US government end free vaccine programs?  Will Health insurance then charge for the vaccines and the administration of vaccines?  Future booster shots? I think I have read that a lot of this depends on whether we are still considered officially in a pandemic.  Also private travel insurance companies have linked some of their coverage to pandemics.

[mayleeman]

I wonder how much of the lower amount of flu death/hospitalization this year is due to the high mortality rate of Covid in nursing homes and other highly vulnerable senior populations. Those are the groups that disproportionately suffer most from the flu.

 

Incidentally, early on there were some reports of higher resistance to Covid among people who had a combo of certain other vaccinations. Has anything more been reported on this? And are there any indications of any Covid vaccines varying in effectiveness in people who did or did not get flu vaccinations?  Or possibly having reduced flu symptoms than normal even if not getting the flu vaccine?

Edited January 30, 2021 by mayleeman

[nocl]

3 hours ago, nomad098 said:

 

You have quite obviously been reading internet conspiracy theories and poor research.

 

Try something a little more authoritative.

 

https://www.bmj.com/content/372/bmj.n86

 

 

A little insight into how and why decisions were made with the full knowledge and consent of the MHRA.

 

 

 

 

The article you linked to does not talk about the execution of the clinical trials.

 

no conspirency theories.

 

Just read the published data on the trials as well as the public information from the various vaccine committees.

 

The AZ trials were a hodgepodge of a numbers of trials, that were combined doing a meta analysis. This was also noted by a number of papers when their results were first released.

 

For anyone that has done clinical trials, combining data from a number of trials with different protocols results in a much less rigorous result. Again this was identified at pointed out when the results were released.

 

It is also well documented about the half dose, mistake, in the Brazilian trial. That yielded 90% efficacy, but did not include any patients over 55.

 

Several review groups have also documented e demographics and the lack of data in the over 65 group. Even the EU who just approved it commented on the lack of proof that it is effective in over 65, but stated while evidence is lacking that are approving it in that age group on the expectation that it will work.

 

Lots of documentation out there that the AZ trials were not well executed.

 

 

Edited January 30, 2021 by nocl

[Arizona Wildcat]

1 hour ago, mayleeman said:

I wonder how much of the lower amount of flu death/hospitalization this year is due to the high mortality rate of Covid in nursing homes and other highly vulnerable senior populations. Those are the groups that disproportionately suffer most from the flu.

 

Incidentally, early on there were some reports of higher resistance to Covid among people who had a combo of certain other vaccinations. Has anything more been reported on this? And are there any indications of any Covid vaccines varying in effectiveness in people who did or did not get flu vaccinations?  Or possibly having reduced flu symptoms than normal even if not getting the flu vaccine?

Flu is almost non existent this year according to Arizona Department of Health because vaccination percentage slightly higher than average, people staying home and bubbling and most important social distancing and masking.  The same protocols are effective against both flu and Covid.

Influenza requires a lab test.  Today few to no influenza tests are being requested.  Only COVID.  Get pneumonia and repeated COVID testing.  COVID is assumed if you are ill with any respiratory illness.

[TeeRick]

1 hour ago, mayleeman said:

I wonder how much of the lower amount of flu death/hospitalization this year is due to the high mortality rate of Covid in nursing homes and other highly vulnerable senior populations. Those are the groups that disproportionately suffer most from the flu.

 

Incidentally, early on there were some reports of higher resistance to Covid among people who had a combo of certain other vaccinations. Has anything more been reported on this? And are there any indications of any Covid vaccines varying in effectiveness in people who did or did not get flu vaccinations?  Or possibly having reduced flu symptoms than normal even if not getting the flu vaccine?

I think you are referring to MMR vaccine and BCG vaccine.  Large studies are ongoing. Here is a link to a tracker.  I have been waiting to see some updates or results announced.  Then I might consider an MMR booster if I cannot get a COVID vaccine for months to come.

https://biorender.com/covid-vaccine-tracker

Edited January 30, 2021 by TeeRick

[deadzone1003]

14 hours ago, nocl said:

The EMEA (European Medicines Evaluation Agency) is a quality organization. They are headquartered in Amsterdam.  They used to be located in London prior to brexit. Do not know if the move impacted the organization much.

 

Part of the issue with the EU is the failure of some of the vaccine candidates  from EU based pharmaceutical companies.

Under Operation Warp Speed, I believe the USA bet on 7 companies coming up with a vaccine.  So far, only 1 gave up (Merck) and 1 is expected later in the year (GlaxoSmith).  I guess they expected a higher failure rate.  There is a shortage now because only 2 companies have an EUA and the demand is great.  If approval, actually an EUA, comes as expected for 3 other companies, AZ, J&J and Novavax, the USA should have an excess of vaccines by end of Spring or beginning of Summer.  Companies can't start making the vaccines until they are sure they have a viable product.  This was all planned back in Spring 2020.  This appears to be more successful than expected despite what people think of their immediate situation.  Now, as paying passengers, we all could be vaccinated by beginning of summer.  The question, can we get the crew to be vaccinated?  Can we get the CDC to open up cruising?  This is just my opinion based on contractual obligations, past EUA approval method applied to current candidates, and simple math.