Coronavirus Pandemic (COVID-19) (SARS-CoV-2) [2020]

Good point. And the majority of serious illnesses which spread readily are airborne (Covid, Flu, Measles, Colds, etc etc) so being able to elicit a strong mucosal response would be very helpful.
 
On that point of spreading, contagious diseases that aren't airborne are readily controlled such as through good hygiene which is why they aren't a problem - Cholera isn't an issue for societies with adequate infrastructure. The respiratory tract is our only major weakness so seems an obvious point to concentrate on to harmonise medicine with immunity.
 
In what appears to be more not good news covid has been detected in deer in California.

 
For over a year, researchers across the US (Stanford, Scripps Institute, FDA, UNC Chapel Hill and to hers) tracked antigen specific memory B cells or MBCs after vaccination of macaques.

They tracked the maturation of these MBCs and the antibodies they produced. In all they analyzed over 500 antibodies and identified the ones which were the most broadly neutralizing antibodies or bnAbs.

They also tested a number of adjuvants and found the combination of RBD and spike protein targets and adjuvants which had the most broad and durable protections vs. several coronaviruses. Not only most of the Omicron strains but also MERS and other zoonotic viruses which have the potential to jump to humans. So they tested bat viruses and pangolin viruses.

(Obviously these researchers are operating from the hypothesis that covid-19 was a zoonotic virus which jumped to humans, not some lab leak nonsense.)

They produced a vaccine based on these findings and tested in macaques which showed much more broad and durable protection than current covid vaccines.

MBCs mature over time after SARS-CoV-2 infection or mRNA vaccination (34–39). We recently showed that an AS03, a squalene oil-in-water emulsion adjuvant developed by GlaxoSmithKline, -adjuvanted nanoparticle vaccine conferred durable and heterotypic protection against Omicron challenge with 100% and about 65% protection at 6 weeks and 6 months after the booster, respectively (11). The rapid elicitation of bnAbs in serum after the booster suggested the evolution of a broad and potent antibody repertoire encoded in the MBC compartment. Consistent with this notion, we found in this study that SHMs and the potency and breadth of antibodies encoded by B cell receptors in MBCs evolved after the primary vaccination. Those matured MBCs with greater potency and breadth can rapidly differentiate into antibody-secreting cells in response to a booster immunization or infection. Although it is well known that adjuvants can modulate and enhance the magnitude, breadth, and durability of the vaccine-induced serum antibody response, few studies have investigated their effects on the monoclonal level (28, 40–46). In this study, we found that the primary vaccination of the AS03-adjuvanted nanoparticle–based subunit vaccine elicited a progressive antibody evolution toward greater potency and breadth over a period of 1 year, presumably driven by antigen-antibody complexes on follicular dendritic cells.


This research appears to have been funded by the Gates foundation, so perhaps no federal funding?

But people think the threat is over so why bother make more vaccines and treatments?
 
A little ad hoc analysis of UK patterns:

1683835189782.png

Data is covid positive hospital patients. The red line shows the ascending minimum which has changed trajectory for the first time in seven waves. The boxes* are the same size, the cadence of the first waves, where we can see future waves have been shorter. The last wave is very differently shaped, much broader.

Existing patterns would expect a new wave beginning in the next week or two.

* Apologies to the colour-blind.
 
Slate Money Podcast host and chief financial correspondent of Axios has written a book about the recovery of the economy after the pandemic.



So one of the first lessons he draws is that Steve Mnuchin helped save the economy. Salmon is no fan of Trump or the Republicans.

His contention is that the world barely recovered from 2008 Great Recession by the time covid hit. Despite all the complaints from Republicans, zero interest rates and QE by Bernanke didn't bring the economy back fully from 2008.

Monetary policy wasn't enough and what Obama and Democrats were able to pass as stimulus wasn't enough of a fiscal boost to complement the monetary policies.

So this was a conclusion that wasn't widely disseminated by many economists believed this and Mnuchin apparently believed it as well.

When covid hit, Mnuchin got Trump and the Republicans to pass the covid relief act, the first of which was $1 trillion. There was a lot of waste and fraud in disbursement but if they didn't pass it, we'd have been in a deeper hole.

Mnuchin had credibility with Trump because among other things, he was loyal. So when Charlottesville happened -- Jews will not replace us! -- Mnuchin, a Jew, backed Trump publicly unlike Gary Cohn, who resigned shortly after.

Also Trump wanted the economy to be as strong as possible in his re-election bid so he was inclined to do fiscal stimulus as Mnuchin advised.

Of course the money they put in the pockets of Americans, along with more money that Biden signed into law shortly after he was inaugurated, had all kinds of distorting effects on real estate and many other markets, which when combined with supply chain disruptions led to the highest inflation in 40 years.


Salmon cites some interesting facts and stats.

For instance, deaths of 18-25 year old males spiked during the pandemic, not because of covid but because of the side effects of covid. A lot of these deaths reflected people not caring or throwing caution to the wind so people auto accidents increased and people died from not wearing seat belts. Smoking and use of drugs also increased. The increase in smoking is unheard of because it's had a long history of declining for decades.

So it reflected a kind of YOLO mentality, which we've seen as lot of people stopped masking or avoiding crowded indoor places. Or they had to go to church choir and bars or concerts.


Another interesting data point, the prices of lobster rolls spiked. Why? Not because of labor costs. Salmon talked to an owner of a factory which made the lobster fillings which went into lobster rolls. His labor costs didn't increase at all but what he saw was spiking demand, so he was forced to raise prices so that his customers wouldn't sour on his inability to produce enough supply.

Again, reflects greater YOLO behavior.

But now, to combat high inflation, Fed is trying to slow down the economy and soft landing is far from guaranteed.
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Longer term, there will be continuing economic impact. I posted an article about how health care workers are among those hardest hit by Long Covid, unable to work. And we know a lot of nurses and even some doctors have left or plan to leave their profession from burnout, even if they didn't get sick themselves.

Health care was already a drag on the economy. Now costs are likely to continue a fast growth trajectory, since health care costs have been outpacing general inflation for decades.

Besides likely shortages of doctors and nurses, there will be more care and management required for greater incidence of chronic diseases -- diabetes, heart disease, strokes -- from patients even if they didn't become afflicted with long covid and had acute, debilitating symptoms.


Most of this is going to be invisible or not seen by most people, who've become inured to the high number of people lost the last 3 years and counting. Most were old people so they're not going to have direct impact on the economy, since they likely weren't working.

But even those who are still of working age and have escaped so far relatively unscathed are going to behave differently, impacting employers and those effects are going to reverberate throughout the economy.

Many white collar workers who've accumulated some wealth are now being selective in which jobs they choose to do, where they do it, under which terms. So a much greater number who will insist on WFH, not coming into the office -- maybe another form of YOLO.

This loss of workers coming into the offices regularly will have devastating economic impact on local economies, at least for the short term. Commercial real estate could be decimated, not to mention all the businesses which have developed around serving these workers daily -- restaurants which specialized on serving breakfast and lunch to these workers, stores, etc.

Several major cities will face budgetary collapses, leading to thousands of workers being dislocated. Level of basic services like police and firefighting, as well as public housing and social services could be cut back drastically.
 
For the people who haven't fallen for the lab leak theory BS, here's some reporting about increasing likelihood of future pandemics from zoonotic viruses.


First of all, there doesn't have to be some intermediary host to infect humans, as was posited about Covid.

Bats have been known to trigger Ebola outbreaks and in this case, rapid deaths from the Nepa virus, such as happened recently to a young Indian male, who got infected from consuming fruit which had been partially eaten by bats, leaving bite marks on the fruit.

The patient died in two days, in a part of India where Nepa virus infections were until that point unknown.

The cause is the expansion of "jump zone" or regions where humans encroach into habitats of these zoonotic hosts.

For instance, in Laos, there are now high-speed rail lines into places which were predominantly inhabited by bats. These were built by the Chinese to move people and material back to China. However, this modern transport is also being used to expand tourism into these areas, including tours into bat caves.

Wouldn't be the first thing I'd be looking to do as a tourist in SE Asia. Maybe the only things worse would be frequenting wet markets or going for some submersion "therapy" in bat guano.

But the point is, humans are expanding into places which are full of species, particularly bats, which could infect them with zoonotic pathogens.
 
The RECOVER initiative is a NIH-funded program to study Long Covid.

Based on a study of almost 10,000 participants, RECOVER has started to define as well as quantify the problem of LC.

They start by defining 12 symptoms and scoring each to meet a threshold of 12 points for a LC diagnosis.

To meet the study’s definition of long covid, a participant needed to score a total of 12 points once all their symptoms were added up. The 12 key symptoms and their corresponding scores are:

- Loss of smell or taste: 8 points.
- Post-exertional malaise: 7 points.
- Chronic cough: 4 points.
- Brain fog: 3 points.
- Thirst: 3 points.
- Heart palpitations: 2 points.
- Chest pain: 2 points.
- Fatigue: 1 point.
- Dizziness: 1 point.
- Gastrointestinal symptoms: 1 point.
- Issues with sexual desire or capacity: 1 point.
- Abnormal movements (including tremors, slowed movements, rigidity, or sudden, unintended and uncontrollable jerky movements): 1 point.

In general, the higher someone’s score was, the worse their ability to carry out every day activities, said Tanayott Thaweethai, study lead author and researcher at Massachusetts General Hospital and Harvard Medical School. Higher symptom scores also correlated with a lower quality of life, he said.


These defining symptoms are affected 10-23 % of the sample of people studied by this program but they suspect overall incidence of LC is about 10% of infections.

Incidence of LC was higher in the unvaccinated and those who had multiple infections.

Some LC patients have had all these and other symptoms. They think the symptom list is too small.

Researchers found that patients tended to have multiple symptoms, across different parts of the disease, making LC a "total body disease."
 
Really interesting preprint here, summarised in the following twitter thread:


Immunocompromised folk aside, it seems that 60% of 'normal' people mount a broad response to Covid vaccination/infection with specific B and T cells becoming greatly enriched but the other 40% mount a more narrow response with fewer of these B and T cells produced. Unsurprisingly, those with a 'broad' response appeared to have better protection against Omicron BA.2 than the 'narrow' responders.

It strikes me that it is mostly likely to be genetic differences which decide whether you are a broad or narrow responder to vaccination/prior infection. It might ultimately be possible to develop a test so you had an idea whether you were 'broad' or 'narrow' and, therefore, perhaps the likelihood of being at greater risk. This could be helpful to know as regards organisation of vaccination programmes.

What also struck me is that this could end up being natural selection at work. The claim that pathogens mutate to become less severe doesn't make much sense in regards to a disease such as Covid, but if there's a chance that 40% of the population are more at risk of severe illness (and possibly Long Covid?), then it could certainly have a longer-term effect on the population. This, of course, assumes that the 'narrow' responders are more likely to suffer from severe illness/Long Covid. It almost certainly won't be as clearcut as this.
 
I think there's a strong chance of developing better vaccines.

For instance, the new Shingrix vaccine is way more effective than the previous one.

But they're learning more and more about the virus and the immune response. I linked a paper above about them identifying the most effective Memory B Cells and antibodies so vaccines designed with that data may hold some promise.

That is if there's any interest in developing, testing and manufacturing newer generations of vaccines.

People have kind of said they're done with the pandemic -- trying to avoid infections, getting boosters, avoiding risky venues, etc.

So there may not be enough interest or market demand for better vaccines, even though the virus will still infect and re-infect millions of people each day.
 
Until more is known about Long Covid and some potential treatments are developed, the pandemic is far from over.

The data indicates that you're at as much risk of developing it after subsequent infections as your first hit of the virus and vaccination doesn't remove all risk. With multiple waves of infection every year, it's going to remain a risk, though perhaps more so for some people.

Healthcare spending certainly doesn't seem to have ramped up to help cope with this and, with more infections, it's probable that medical staff are more likely to be affected with longer term issues.

Better vaccines would certainly be the easiest way of dealing with the risk, but there need to be other mitigations in place as well. Ventilation, air cleaning etc. It simply makes sense in hospitals, surgeries etc.
 
Remember how conservatives used to tout the Swedish model, how the faster herd immunity was achieved, the quicker they'd recover from the pandemic?

Of course we found out there were reinfections and reinfections led to greater likelihood of covid.

Now researchers, including those fro Sweden, looks at the whole of the Swedish response.

Among the highest death rates in the industrialized world of course and really callous policies:

First they quickly wrote off seniors:
The country’s treatment of the elderly and patients with comorbidities such as obesity was especially appalling.

“Many elderly people were administered morphine instead of oxygen despite available supplies, effectively ending their lives,” the researchers wrote. “Potentially life-saving treatment was withheld without medical examination, and without informing the patient or his/her family or asking permission.”

In densely populated Stockholm, triage rules stated that patients with comorbidities were not to be admitted to intensive care units, on grounds that they were “unlikely to recover,” the researchers wrote, citing Swedish health strategy documents and statistics from research studies indicating that ICU admissions were biased against older patients.

Then they used children to more quickly spread covid, while ignoring or denying that they could be vulnerable to covid.

The Nature authors show that Swedish government authorities denied or downplayed scientific findings about COVID that should have guided them to more reasoned and appropriate policies.

These included scientific findings that infected but asymptomatic or pre-symptomatic people could spread the virus, that it was airborne, that the virus was a greater health threat than the flu and that children were not immune.

The Swedish policymakers “denied or downgraded the fact that children could be infectious, develop severe disease, or drive the spread of the infection in the population,” the Nature authors observe. At the same time, they found, the authorities’ “internal emails indicate their aim to use children to spread the infection in society.”

Amazingly, nobody has been prosecuted. Not sure if anyone's been fired from these govt. jobs.
 
Op Ed by researchers advocating for govt. funding of a universal vaccine.

Their study claims that the cost of pandemics will be $700 billion a year or trillions in consecutive years of pandemic like the one we've been through in deaths and lost productivity.

While a universal coronavirus vaccine is a harder problem to solve than developing a vaccine for one specific variant, the benefits would also be large. If people were already vaccinated with a universal vaccine, we could limit the damage of a new variant even before it took off. Not everyone would be willing to take the universal coronavirus vaccines, but many would; roughly half of the American population took the first Covid-19 booster. What’s more, a universal vaccine could be stockpiled for those who are only likely to want it when a variant emerges, dramatically speeding up the response compared to starting the process of development when a new variant hits.

How much would it cost? We estimate that if the federal government made an advanced market commitment — a legally binding commitment to buy something if it is invented — to purchase enough universal coronavirus vaccine to vaccinate 33% of the American population, it would cost on the order of $5 billion and save the U.S. approximately $700 billion to $1 trillion.

The investment risks are relatively low. If a vaccine does not meet the target product profile for a universal coronavirus vaccine set out by the government, the government wastes no money. If it is met, we protect ourselves in advance against a very real public health threat.

Read in The Hill: https://apple.news/A-Rr9o_QYTEq5Isp82WKgUw

So it's kind of a penny wise, pound foolish argument.


They argue that it's the govt. which must do it because private companies won't invest to develop new vaccines for future outbreaks.

So, what can we do to protect ourselves? Unfortunately, we can’t leave it to private companies to make the investments we need. The economic, health, and education benefits to society from an innovative vaccine are hundreds or even thousands of times more than the revenue to a company from the vaccine. This leads to market failures and, as a result, inadequate innovation.

They also predict a variant as damaging as the delta wave to emerge within the next 7 years, based on current rates of mutations.
 
UK dashboard finally updated.

1687545091778.png

We're well past the point of another wave keeping the 3-month cadence with the past 6 waves - we should be in the middle of another spike if things were the same still but we're still trending downwards.

One theory I guess is that this is common for novel viruses - multiple waves of rapid, unrestricted evolution until biological equilibrium is reached. The future would then be slower evolution and the periodic break out of a new variant that bypasses the bulk of innate defences and creates a new wave of infections.
 
The NHS booster programme is still in place, but seems to be quite targeted. I was offered one as I'm immunosuppressed following chemotherapy earlier in the year. Judging by the letter I received It's that cohort and the over 75s that they are prioritising.

Visiting hospital recently I noticed that the perspex screens around reception desks, etc. have been removed in the past month or so, mask wearing is no longer compulsory and many of the staff aren't wearing one either.
 
The perspex screens are a foolish idea in any case. It's an airborne virus and screens only reduce airflow, making it more likely to linger in the air. What we need is ventilation and air filtration as that would have more of an impact on reducing infections of both Covid and other airborne pathogens, of which there are many.

The immunosuppressed have be sacrificed at the altar of normality and there will continue to be a significant number of deaths and Long Covid cases in the highest at risk groups. Places such as cancer clinics should really be doubling down on the filtration, ventilation and masking but they aren't and this will cause significant morbidity.

It will be interesting to see if we get any variants emerging which can (almost) completely evade prior immunity whether from infection, vaccination or 'hybrid'. It looks as though the next round of boosters will be monovalent, probably based on XBB.1.5, and this will hopefully prove quite effective at protection of those most at risk. Unfortunately, those who are unable to mount much of an immune response to the vaccines are shit out of luck, because that's the only concession governments are willing to make to them.
 
The perspex screens are a foolish idea in any case. It's an airborne virus and screens only reduce airflow, making it more likely to linger in the air. What we need is ventilation and air filtration as that would have more of an impact on reducing infections of both Covid and other airborne pathogens, of which there are many.

The immunosuppressed have be sacrificed at the altar of normality and there will continue to be a significant number of deaths and Long Covid cases in the highest at risk groups. Places such as cancer clinics should really be doubling down on the filtration, ventilation and masking but they aren't and this will cause significant morbidity.

It will be interesting to see if we get any variants emerging which can (almost) completely evade prior immunity whether from infection, vaccination or 'hybrid'. It looks as though the next round of boosters will be monovalent, probably based on XBB.1.5, and this will hopefully prove quite effective at protection of those most at risk. Unfortunately, those who are unable to mount much of an immune response to the vaccines are shit out of luck, because that's the only concession governments are willing to make to them.
Although I remember a study showing that people who wore glasses tended to have lower rates of infection in the Wuhan outbreak.
 
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