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A Third Solution

paulbuchheit.blogspot.com

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Re: A Third Solution

#341

Post by cryptonector »

> It is my belief that the best cure for any disease is to avoid the disease.

> Again, the best cure for any disease is to avoid the disease.

Sure, if we're talking about HIV or HSV (any variant), then yes, the best cure is to avoid getting it in the first place.

Some diseases you don't really get a choice. When 21% of NYC has had a disease that has been spreading for only a few weeks in spite of extreme public safety measures (social distancing, shutdowns), you have to wonder if you can avoid getting it, for how long, and at what cost. If you don't get it now, how do you keep from getting it later? Eradication is typically a decades-long project. Vaccination is anywhere from a months-long project if you don't care about establishing vaccine safety to a multi-year effort -- enough to eradicate if you're serious about it and have a vaccine that can cope with mutation rate (probably not).

> Catching this virus is a bit like playing a round of Russian roulette. You’ll probably be fine, but you could end up dead.

But that's not really the case. Risk factors for covid-19 are fairly well understood at this point: old age, past history of pneumonia, obesity, and diabetes. That's not not-a-big-deal, but it's in the realm of the manageable: isolate those at risk. But stopping the progression of this virus through the population is clearly not an option at this point -- we long ago passed the point where that was feasible. We can only slow down the progression, and definitely not long enough to obtain a tested vaccine because that's well over a year away and might be closer to two years if anything goes wrong with the current candidates. In terms of morbidity rates, this thing is not that bad as it has not overwhelmed the U.S. healthcare system (a few hospitals, yes, but the vast majority are far from capacity), and some treatments are available.

So it's not clear that we need to slow covid-19's progression further, or that we could if we really wanted to. Transmission rates are just extremely high.

> With this test, we can screen for the virus at the entrances to buildings and other areas, much like we currently use metal detectors to screen for weapons. [...] Longer term, it can be used to safely reopen more crowded areas such as festivals, sporting events, and even Disneyland.

With... a test that... takes 10 minutes to run? Color me skeptical. By the time amusement parks get the go-ahead to reopen, covid-19 will have worked its way through well over 50% of the population. The way things are going, that's not too long from now, maybe two more months and NYC will be at 50% -- by the end of the year maybe most of the U.S. will be past 50%.

Covid-19 is just too infectious. We can't stop it.

Re: A Third Solution

#342

Post by stonogo »

maxerickson wrote: post #165
stonogo wrote: post #88

Not only is it completely unrealistic at scale, the specific approach in the blog post is wildly impossible at all. It requires screeners to directly manipulate saliva samples; this is dangerous in a pandemic. The assays referred to (lazily) in a Google Scholar search are almost overwhelmingly antibody assays; this does not allow the screener to differentiate between "has COVID-19" and "had COVID-19". Also, there is…

I mean, my reaction is certainly on the "let us know when you start scaling out a quite accurate test" side of things, but I don't understand the point of declaring that it can't work. Especially based on assumptions. The petty whinging in your third paragraph is basically ridiculous. Imagine, waiting 10 or 20 minutes a day for a few months to help save millions of life- years .

People don't even observe yield signs reliably. You think everyone on earth is going to suddenly obey testing requirements?

Re: A Third Solution

#343

Post by joe_the_user »

mikepurvis wrote: post #290
TenJack wrote: post #286

Earlier quoted context omitted.

I gathered the same thing. Basically the gist is, if we can develop a cheap, fast, and effective test for COVID-19 then we can test everywhere and re-open everything.

Hasn't that always been everyone's argument? That's the crux of Pueyo's "dance" [1], that as long as you've contained the initial outbreak, you can pretty much go back to normal if you track movement and have the capacity to test everyone who comes in contact with an infected person. [1]: https://medium.com/@tomaspueyo/coronavirus-learning-how-to-d...

This has been one major argument. The others have been: "flatten the curve - just extend the time until everyone gets it" (obvious problem, exponential growth can't work that way), "shelter in place 'till a vaccine appears" (not very practical) and "it's really not that bad, there are so many asymptomatic carriers that in the end it's not actually worse than the flu after all or at least there's nothing we can do." (not that plausible, not appealing, non-fatal cases still much worse than the flu).

I think this is the best position, however but it still needs to be argued for since it's not the only position.

Edit: Also, it looks like the US has plateaued at this point but in a situation with a fairly dysfunctional testing arrangement. It is going to be hard to argue for people to sit tight until tests are in place so I'm not terribly optimistic.

Re: A Third Solution

#344

Post by predxionbio »

klipt wrote: post #333
predxionbio wrote: post #278

Earlier quoted context omitted.

Hi, Walker here, one of the PreDxion Bio co-founders. Heres a some more information on the technology underlying the test we are developing: https://pubmed.ncbi.nlm.nih.gov/25790830/ . Unfortunately, up until about a month ago us like many folks, were blissfully minding our business developing a rapid point of care cytokine detection platform for use in monitoring patients experiencing certain immune responses follow…

What do you think of the article's claim that eliminating the cold virus would be a good thing? I think I read somewhere that early exposure to cold viruses reduces the chance of acute lymphoblastic leukemia, which makes me wary of trying to eliminate them completely...

There’s a lot of really interesting work left to be done in this area. In our company’s other life we’re involved in CAR-T research, which involves exploiting natural pathways in our immune systems to target them at cancer cells. It’s a super exciting area of research and is bleeding edge in terms of breakthrough therapies coming into the clinic. These therapies[0][1] cure upwards of 90% of what would otherwise be incurable cancers, but they also induce severe inflammatory responses (cytokine storm) which results in respiratory failure and neurological adverse events (that’s a nice clean clinical way of saying putting them in a coma).

The holy grail would be real-time targeted therapeutics to modulate our immune systems up and down in response to various cues. We’re a long way off from that but it’s an idea that’s beginning to get wider acceptance in the medical community. [0] - https://www.novartis.us/sites/www.novartis.us/files/kymriah.... [1] - https://www.gilead.com/-/media/files/pdfs/medicines/oncology...

Re: A Third Solution

#345

Post by taneq »

behnamoh wrote: post #340
taneq wrote: post #336

Earlier quoted context omitted.

Yeah but maybe we shouldn't. We have the technology to compartmentalise our society WAY more than it currently is, at relatively little cost. COVID-19 is a fantastic dress rehearsal for the next disease, which will be far scarier and will come relatively soon. Humanity is a monoculture and like all such, is very vulnerable to pathogens. We need to start building social distancing into our culture the same way we buil…

Ever since 2000, we've have a pandemic once every decade. The next one will occur soon, but it's not certain whether it'll be as scary as COVID-19. > We need to start building social distancing into our culture the same way we built protection for sex into our culture. While I agree with the general gist of your comment, I should emphasize that what we need is physical -distancing, not social . Humans are social bein…

> I should emphasize that what we need is physical-distancing, not social.

Good distinction. We should be focusing more on hygiene while finding ways to connect remotely with the people who are important to us.

Re: A Third Solution

#346

Post by renewiltord »

clairity wrote: post #339
renewiltord wrote: post #332

Earlier quoted context omitted.

Allow me to ensure I understand your position. Overall, you believe that lower speed limits will result in more accidents? I am certainly on the side of raising speed limits to 100 mph where possible. Or providing turbo lanes for "Class C+" drivers or something. But that's because I think I'm willing to make the trade-off in lives. Your opinion is more that we're making not a trade-off but costing ourselves both live…

no, i’m saying speed is largely beside the point when discussing saving lives in auto accidents. the critical behavior change we need is constant active driving, which is hard, but that’s what would make a meaningful difference, not lowering speed limits. people tend to drive as fast as conditions allow anyway.

Sure, but you work within the constraints you have. What we really need is a cure for all cancers but that doesn't exist just like no universal method for constant active driving exists. Given that, it's a pointless thing to bring up.

"Just have everyone be better at things" isn't a helpful alternative.

Re: A Third Solution

#347

Post by renewiltord »

Mikeb85 wrote: post #285
renewiltord wrote: post #188

Earlier quoted context omitted.

Test positive. Wait 14 days. Now you're positive clean.

And is someone going to verify I waited 14 days? Also, why should I have to if I already am clean?

> And is someone going to verify I waited 14 days?

Sure, good idea.

> Also, why should I have to if I already am clean?

Oh, you don't have to. You can just stay at home like now.

Re: A Third Solution

#348

Post by timr »

selimthegrim wrote: post #320
not_a_moth wrote: post #190

Earlier quoted context omitted.

> The arithmetic on that is ~1 million early deaths in the US. Sorry that's baseless histeria. We can easily think through how healthy people go back to normal (exponentially lower fatality rate than elderly/sick), while vulnerable take more precaution, how then getting to 60% of population gives us herd immunity which grinds R0 to a halt. Then a vaccine arrives in 18 months. Not to mention heat/humidity/summer is be…

I like how you're ignoring the organ damage in even younger survivors like it's rosacea or something.

Cite something -- anything -- legitimate that points long-term organ damage in young, otherwise healthy people. Newspaper anecdotes don't count.

All evidence so far is that a small fraction of people sick enough to be in the ICU end up with some sort of non-lung organ involvement. The vast majority (>99.98%) of young (https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidvi...

Re: A Third Solution

#349

Post by kordlessagain »

dekhn wrote: post #220
zmmmmm wrote: post #212

The post refers to an alternative method of testing for COVID-19 based on surface plasmon resonance that would have significant advantages, but unfortunately it provides absolutely no real substantiation that the test exists or works. The link about surface plasmon resonance goes to a generic Wikipedia page, the link about saliva is a small scale study that was conducted on RT-PCR not surface plasmon resonance, and t…

He should also disclose any personal interest in it more clearly at the top of the article.

At this point all our personal interests are to stay virus free as long as possible, given what we don't know might kill us. I really don't care why he's speculating about the things he is. Many of the things we postulate may be proven wrong simply by waiting long enough to get more data - i.e. it's not always necessary to formulate a test for disproving an idea, sometimes they evaporate on their own. (Software features for example frequently meet their ends this way).

I just found out about Covid Toes. What will come tomorrow?

And now, a shameless plug for a next-day delivered PPE from Amazon built from a full faced snorkel, a vacuum filter and a 3D printed adapter I designed: https://3dprint.nih.gov/discover/3dpx-013899. There's a video too, which shows a bit cheaper version's assembly: https://www.youtube.com/watch?v=wydRpFpQD4I

I haven't been into an indoor shared space without it on for almost 3 weeks. You probably shouldn't use Gorilla Tape on it, because it might off gas something. Try surgical tape.

Re: A Third Solution

#350

Post by clairity »

renewiltord wrote: post #346
clairity wrote: post #339

Earlier quoted context omitted.

no, i’m saying speed is largely beside the point when discussing saving lives in auto accidents. the critical behavior change we need is constant active driving, which is hard, but that’s what would make a meaningful difference, not lowering speed limits. people tend to drive as fast as conditions allow anyway.

Sure, but you work within the constraints you have. What we really need is a cure for all cancers but that doesn't exist just like no universal method for constant active driving exists. Given that, it's a pointless thing to bring up. "Just have everyone be better at things" isn't a helpful alternative.

that’s a false equivalence. every driver has the ability to refrain from texting, talking on the phone, eating their breakfast, doing their makeup, reading the paper (yes, i’ve seen this), etc. and instead focus on scanning the road and their mirrors while actively controlling their car.
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