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Get Real: no drug or vaccine will avoid a very big coronavirus epidemic

blogs.sciencemag.org

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Re: Get Real: no drug or vaccine will avoid a very big coronavirus epidemic

#151

Post by fspeech »

empath75 wrote: post #71
kiterunner2346 wrote: post #61

The key may not be a vaccine but simply staying alive. Covid-19 kills with a "cytokine storm": cytochine release syndrome(cytokine storm): https://en.wikipedia.org/wiki/Cytokine_release_syndrome Article discussing coronavirus et al and cytochine storm: "Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China" https://www.thelancet.com/journals/lancet/article/PIIS0140-6... From the article:…

I haven’t seen anyone say it kills with a cytokine storm — spanish flu did that.

Look up ARDS and cytokine storm. Cytokine storm is not specific to pathogen.

Re: Get Real: no drug or vaccine will avoid a very big coronavirus epidemic

#152

Post by bluGill »

mellavora wrote: post #149
HelloNurse wrote: post #60

Earlier quoted context omitted.

Production of pharmaceuticals (such as a vaccine, when it's ready) and medical equipment (such as ventilators) can be ramped up by commissioning and requisitioning an arbitrary number of factories, but developing a vaccine is inherently a sequence of trials that can only be "multithreaded" between relatively few research teams trying different approaches semi-independently.

Ummm, not quickly. Vaccine production requires very sterile facilities which take time to build. You do not want to be taking vaccines produced under non-sterile conditions. Also, are you assuming that supply chains are intact? How are you getting the raw and the finished materials to build the factories?

Raw materials are not my concern - the industries that supply them can get all the people they need from others. You might find yourself demoted from programmer to some third shift factory labor job, but with a few weeks training you can do it (with okay odds that you won't lose life/limb from missing some safety item)

Re: Get Real: no drug or vaccine will avoid a very big coronavirus epidemic

#153

Post by WaltPurvis »

edmundsauto wrote: post #105
capkutay wrote: post #94

Earlier quoted context omitted.

3.4% of reported cases have died. That doesn’t mean the actual IFR is 3.4%. Data modeling suggests it’s closer to 0.98%. It’s also important to note that age plays a significant factor. The IFR is about 0.2% for young healthy people, while it is quite dangerous for people over 60 with existing conditions. https://institutefordiseasemodeling.github.io/nCoV-public/an...

Just curious, what is the mortality rate of the regular flu for young healthy people?

For US adults ages 18-49, it varies (depending on the severity of flu strains) between .01% and .02%.

https://www.cdc.gov/flu/about/burden/2016-2017.html

Re: Get Real: no drug or vaccine will avoid a very big coronavirus epidemic

#154

Post by anu7df »

Yes. It is worse than a regular flu. But, if you look at statistics from S. Korea, the only country with a substantial infection and trust worthy numbers (as in they test heavily), the death rate is around 0.6% overall. So not the end of the world, but nothing to be complacent about either. If the White house will get out of the way and let the system work, we may still have time to mitigate the worst here in the USA. But of course, we don't even want to cancel SXSW. What more needs to be said?

Addition: No, I "trust" the reported numbers from Italy. I think they are missing a lot of mild cases that are not being reported or tested. When I checked a few days ago, it looked like of the tests that South Korea ran, only 5% or so were positive. So, their infected numbers are probably more accurate. The death rate may still be higher, because we don't know how many in the infected population as of today will recover. One could for example calculate the death rate as [Number_of_deaths.today]/[Number_infected.x_days_ago] I don't really know the "x" to use in this circumstance, but just using 7 days (since a lot of deaths occurred in 7-9 days from positive detection), the death rate may be about a factor of 2 higher. So about 1% overall. I have been looking at so many different sources in the last few days, I can't seem to find the sites where I got the numbers for the above calculations from. So I might be off by a bit.

Re: Get Real: no drug or vaccine will avoid a very big coronavirus epidemic

#155

Post by bluGill »

jefftk wrote: post #59
hannob wrote: post #51

Earlier quoted context omitted.

> Drug development has been very conservative especially in the US for the past several decades That is actually not what I hear from people who know this stuff. In fact many are very concerned that the FDA is far too quick with drug approval based on weak outcomes. (Big recommendation: Follow Vinay Prasad on twitter, he's spot on on these issues.) > During WWII design and production ramped up to an unprecedented deg…

> very concerned that the FDA is far too quick with drug approval based on weak outcomes The current FDA requires strong evidence of safety, over a long period. Prasad etc are arguing the FDA should be stricter on efficacy. In a pandemic, it makes sense to lower your standards for safety to get new treatments out sooner.

The FDA already allows lesser standards for efficacy for rare things. Which is why there are a lot of treatments for rare things - once you are on the market you can "wink wink" tell doctors about the more common thing you also work on.

Re: Get Real: no drug or vaccine will avoid a very big coronavirus epidemic

#156

Post by rjkennedy98 »

mhb wrote: post #93
blobbers wrote: post #47

Earlier quoted context omitted.

`...would rather lose a lot of good drugs than approve a bad drug.` Thanks for saying this, and rightfully so! Approving a bad drug in the world where distribution channels are very well set up could have disastrous effects. We can point to things like the opioid crisis in the USA right now - a drug that is so addictive it should have never been put into use the way it was.

I don't understand the "rightfully so!" There is a real cost to not approving good drugs in order to avoid approving bad ones.

> There is a real cost to not approving good drugs in order to avoid approving bad ones.

Do you have any evidence for this? Seems to me like a classic shibboleth of the pharma guild.

Re: Get Real: no drug or vaccine will avoid a very big coronavirus epidemic

#157

Post by carapace »

aazaa wrote: post #82

For those suggesting that a COVID-19 vaccine can somehow be fast tracked, consider what happens if something goes wrong during deployment to the population. The US has an active, very vocal anti-vax community. They've been growing and gaining ground for decades. The first sign of trouble of any kind with a new COVID-19 vaccine would result in a backlash of biblical proportions. It could be so strong as to derail any…

> first sign of trouble of any kind with a new COVID-19 vaccine

Like what?

Vaccines do not cause autism.

Re: Get Real: no drug or vaccine will avoid a very big coronavirus epidemic

#158

Post by bluGill »

jfk13 wrote: post #68
jefftk wrote: post #62

Earlier quoted context omitted.

You can speed up clinical trials by running larger ones at earlier stages. This risks more deaths from bad medicines, which may still be worth it in a pandemic.

Though the people dying (or losing their friends and families) from the bad medicines might not see it that way.

When people are dying in mass numbers from not being in the trail though...

Re: Get Real: no drug or vaccine will avoid a very big coronavirus epidemic

#159

Post by mellavora »

owlninja wrote: post #142
aazaa wrote: post #82

For those suggesting that a COVID-19 vaccine can somehow be fast tracked, consider what happens if something goes wrong during deployment to the population. The US has an active, very vocal anti-vax community. They've been growing and gaining ground for decades. The first sign of trouble of any kind with a new COVID-19 vaccine would result in a backlash of biblical proportions. It could be so strong as to derail any…

I hear more people talking about anti-vaxxers than I do from any actual anti-vaxxers. I don't think they are all that powerful.

Huh. Wonder where you heard this?

Perhaps you missed the recent American Academy of Family Physicians survey on the topic?

Here is the NBC recap: https://www.nbcnews.com/health/cold-and-flu/millennials-leas...

Re: Get Real: no drug or vaccine will avoid a very big coronavirus epidemic

#160

Post by xyzzyz »

hannob wrote: post #58
ericlewis wrote: post #54

Earlier quoted context omitted.

America did a lot of science to produce a nuclear weapon quite quickly once given the resources to do so.

It didn't involve clinical trials on humans. That's the one thing that takes time in medicine and can't be optimized away. You can't do medicine without clinical trials.

Human trials cannot be optimized away, but they sure can be optimized. For example, you can do away of IRB reviews, which require lots of effort on the side of researchers, take lots of time and heavily restrict what researchers can do, but which ultimately aren't necessary to run a human trials. Of course, IRB reviews have their purpose, and doing away with them altogether in normal times is most likely a non-starter, but in emergency pandemic time having drug earlier might justify lots of risk of harm to trial subjects.
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