Oxford University breakthrough on global COVID-19 vaccine • Hacker News Board

Re: Oxford University breakthrough on global COVID-19 vaccine

#481

Post by mssundaram » Mon, Nov 23, 2020, 6:00 PM UTC

tboyd47 wrote: post #373

orzig wrote: post #345

Earlier quoted context omitted.

This is asserting that the number of incorrectly positive results is equal to ALL truly negative test takers ( https://en.wikipedia.org/wiki/False_positive_rate ). >> Citation needed <<

Why bother giving citation if I am going to be downvoted anyway? But, here you go. https://www.wral.com/coronavirus/are-nc-s-coronavirus-case-n... https://www.portugalresident.com/judges-in-portugal-highligh... (NYT) https://www.nytimes.com/2020/08/29/health/coronavirus-testin... https://en.yna.co.kr/view/AEN20200429007051320

Thank you for sharing

Re: Oxford University breakthrough on global COVID-19 vaccine

#482

Post by haltingproblem » Mon, Nov 23, 2020, 6:03 PM UTC

codeulike wrote: post #241

summerlight wrote: post #131

It's interesting to layman's eyes that the dosing regime using 1.5 doses is more effective than the one using 2 doses as I would expect the inverse; are there any plausible explanations for this?

These stats are based on 130 people getting covid out of an experiment of 25,000 people. They dont give a breakdown of the stats (e.g. who was on placebo, who was on which dosing regimen ) but those are small nubmers. I think its possible that this is just noise. The difference between '60%' and '90%' might just be a handful of cases. They show that it works though, thats the main thing. edit: e.g. of those 130 cases…

+Gold for the numerical workout :)

Re: Oxford University breakthrough on global COVID-19 vaccine

#483

Post by mchusma » Mon, Nov 23, 2020, 6:08 PM UTC

nabla9 wrote: post #405

mchusma wrote: post #393

Earlier quoted context omitted.

I strongly disagree with this. I cannot think of a valid utilitarian argument allowing willing people from getting a vaccine. First, vaccines have an extremely high success rate, 33% of vaccines make it through all trials to approval. 50% after phase 1 is complete. The worst vaccine side effect ever is widely considered to be the swine flu vaccine from 60 years ago, where 1 in 100,000 got GBS (a bad disease). If we k…

>I cannot think of a valid utilitarian argument allowing willing people from getting a vaccine. I think you should check your math. Because covid-19 infection fatality rate is "relatively low", only 10 times seasonal influenza (3X for people in their 30's 15X for people in their 70s) the limit where utility turns negative is quite low. One purpose of approval is to move responsibility from drug companies to the gover…

Thanks for responding, I am genuinely curious if my math is wrong so appreciate the discussion.

First, regarding "worst case side effects", I am willing to accept your premise that elevated rates of narcolepsy was in the 2009 A(H1N1) vaccine was worse, and do some math based on that.

Looking solely at deaths (let alone potential long term health risks of contracting covid). The IFR for those over 75 is about 4.6% now https://www.medrxiv.org/content/10.1101/2020.07.23.20160895v....

If you assume that people had a 10% chance of contracting the disease, you can say that those over 75 would have approximately a 0.46% chance of dying (4.6 in 1,000 dead) if they don't get the vaccine.

If they do get a vaccine, that turns out to be as bad as Pandemrix (I believe your example of the worst case side effects), then you would expect 1 in 18400 to get narcolepsy. (source: https://en.wikipedia.org/wiki/Pandemrix).

So if you are a regulator looking at the elderly population, and you assume this is tied for Pandemrix, then for every 18,400 people you would assume 1 case of narcolepsy if you give the vaccine, and 84.64 dead. (85x by volume).

I don't know your opinion of "how much worse is death versus narcolepsy?". If you believe death is 10x worse than narcolepsy, then by severity and volume, taking a vaccine with the worst side effects ever would seem about 850x better than not taking it (in elderly populations). Earlier in the pandemic, when IFRs were over 2x as bad, this was well over 1,000x better.

If you are getting different math, please let me know, because even using Pendemrix, I cannot seem to justify banning vaccines on utilitarian grounds.

Now I do agree that moving responsibility from drug companies to the government is fine, but I think that can be addressed directly if that is a concern. If the argument is "without government assuming responsibility they would be too expensive", I don't think we have any proof of that, not enough for a ban.

Re: Oxford University breakthrough on global COVID-19 vaccine

#484

Post by guscost » Mon, Nov 23, 2020, 6:14 PM UTC

mantap wrote: post #390

moultano wrote: post #346

Earlier quoted context omitted.

Challenge trials. https://www.1daysooner.org/ If it were considered ethical to do them, we could have known in a few weeks. "Medical ethics" claims another million lives.

We've subsequently learned that even young healthy and initially asymptomatic people can become permanently ill from so called "long COVID". The ethicists were right to say no.

As a young and healthy challenge trial volunteer, who is now watching the panic metastasize into an existential threat to free civilization, no they were not. Blocking these trials is the worst miscarriage of ethics that I have ever seen.

Re: Oxford University breakthrough on global COVID-19 vaccine

#485

Post by coliveira » Mon, Nov 23, 2020, 6:21 PM UTC

bumby wrote: post #456

coliveira wrote: post #452

Earlier quoted context omitted.

You probably don't know how the US system works. The only access that is guaranteed by law is to emergency services. If you don't have a paid insurance (through your employer or yourself), then you cannot access preventive care or otherwise normal medical consultation. Millions of people in the US don't have access. For example, if someone needs to treat cancer, it doesn't make any good to go to an emergency unit: th…

> if someone needs to treat cancer, it doesn't make any good to go to an emergency unit That's because the ER is meant to stabilize a patient, not cure chronic disease. Which is to my point: people will forgo preventative medicine until their condition deteriorates and they need to be stabilized in an ER. People get their non-emergent conditions treated all the time in American emergency rooms. E.g., if I have diabet…

And how would anyone know if he has diabetes (for example) if the person doesn't have regular visits to medical facilities? In such a case they will go to emergency only when an emergency happens, probably when it is already too late. By saying that such a person has access to health care, you're just redefining health care to "emergency health care".

If this was not enough, hospitals are catching up to the "loopholes" in the law and abandoning poor neighborhoods, to make it even harder for people to use emergency rooms.

https://www.governing.com/news/headlines/health-care-facilit...

Re: Oxford University breakthrough on global COVID-19 vaccine

#486

Post by potamic » Mon, Nov 23, 2020, 6:23 PM UTC

sgt101 wrote: post #189

An important fact that I haven't seen mentioned in this thread is that 3m doses have been manufactured already and are available in the UK supply chain today. "All" that's required is the approval from the regulator - but I guess that is still a little way off. 3m would do a lot of good though - frontline staff, the most vulnerable, hotspots....

India has already made 40m and is ramping up to 100m

https://www.bloomberg.com/news/articles/2020-11-13/india-to-...

Re: Oxford University breakthrough on global COVID-19 vaccine

#487

Post by Exmoor » Mon, Nov 23, 2020, 6:25 PM UTC

beagle3 wrote: post #473

Exmoor wrote: post #461

Earlier quoted context omitted.

As far as I know, none of the COVID19 vaccines have been tested on children under 12 or are currently planned on being given to children. Additionally, it's not as if the average vaccine has a 0.005% chance of giving you narcolepsy. That figure was for the one vaccine in one country which appears to be the only example in most people's living memory of a vaccine possibly causing long-term side effects (it's not even…

I've also mentioned the cutter polio vaccine and the 1976 swine flu vaccine which seems to have caused an uptick of GBS. > There have been tens of billions of vaccines given during this time period and this is the only example where there may have been long term side effects. No, there are other examples, the other two I just mentioned are from memory, I suspect if I go research I will find more (I don't have the tim…

> I've also mentioned the cutter polio vaccine and the 1976 swine flu vaccine which seems to have caused an uptick of GBS.

That Polio vaccine wasn't a side effect of the vaccine though, it was an issue with people accidently getting injected with a live virus. Since no live virus is even remotely involved in any COVID19 vaccines it has zero relevance here. Even if they were, we have 60+ years of history with no similar incidents since then.

> I suspect if I go research I will find more

You really won't. I've been reading about this extensively during this period and those are the only examples where there may have been long term effects that anyone can point to.

I qualified my original comment with "in most people's living memory" and didn't include the '76 swine flu vaccine because, frankly, I don't think pointing to an issue that happened 44 years ago in a field that has seen pretty significant technological advancement in knowledge, methods, and manufacturing processes really makes sense.

> why it is hard to acknowledge and discuss the risk profile of vaccines

My issue is not that there's isn't some theoretical risk, it's that it just isn't put in context of how minute it is. In all likelihood your risk of facing long term effects from a car accident happening on your way to get vaccinated are higher than anything that could happen from the vaccine. And both those risks are, of course, many orders of magnitude less than your chance of suffering long-term effects from catching COVID19.

Re: Oxford University breakthrough on global COVID-19 vaccine

#488

Post by mchusma » Mon, Nov 23, 2020, 6:26 PM UTC

I'm reposting some of my thoughts below to try and genuinely see is someone has an answer to the question: From a utilitarian perspective, why weren't these all approved for the elderly in Q2 2020?

In other words, its May 2020 and you have the option to ban vaccines or allow vaccines for the elderly, what do you pick?

We know the following about vaccines generally: -Vaccines have an extremely high success rate, 33% of vaccines make it through all trials to approval. 50% after phase 1 is complete. -The worst vaccine side effect ever is widely considered to be the swine flu vaccine from 60 years ago, where 1 in 100,000 got GBS, or Pandemrix, where 1 in 18400 got narcolepsy. (1)(2) -Vaccine candidates have 85% chance of making it from phase III to approved (phase III is supposed to be the efficacy check), in other words we expect about a 15% chance that the vaccine is not effective, most of the tests are about safety.

We know the following about COVID: -Unknown long term side effects, reasonably likely to be worse than the worst vaccines ever, but unknown. -The IFR for those over 75 is about 4.6% now(1). Earlier in the pandemic it was about 11.6%(2). -If you assume that people have a 10% chance of contracting the disease, you can say that those over 75 would have approximately a 0.46% chance of dying (4.6 in 1,000 dead) if they don't get the vaccine. This seems to be a conservative estimate.

So if you have to decide whether to ban a vaccine or not in May 2020, and you assume with 100% confidence that this vaccine was tied for the "worst side effects ever", for example it turns out to be as bad as Pandemrix, then you would expect 1 in 18400 to get something like narcolepsy if you give them the vaccine.

Using the IFR and 10% number above, you assume that not giving the vaccine would leave 84.64 dead for the same population. (85x by volume).

I don't know your opinion of "how much worse is death versus narcolepsy?". If you believe death is 10x worse than narcolepsy, then by severity and volume, taking a vaccine with the worst side effects ever would seem about 850x better than not taking it (in elderly populations). Earlier in the pandemic, when IFRs were over 2x as bad, this was well over 1,000x better.

I mean, the numbers so dramatically favor vaccination that I don't get it at all. Why is this not approved already? Why does it take the FDA 3 weeks to even discuss the matter of approval when this made sense to approve in May? Why did all governments opt to ban the vaccines versus allow them?

Sources: (1) https://en.wikipedia.org/wiki/Pandemrix (2) https://www.cdc.gov/vaccinesafety/concerns/concerns-history.... (3) https://www.medrxiv.org/content/10.1101/2020.07.23.20160895v... (4) https://www.nature.com/articles/d41586-020-02483-2

Re: Oxford University breakthrough on global COVID-19 vaccine

#489

Post by tinus_hn » Mon, Nov 23, 2020, 6:29 PM UTC

mrtksn wrote: post #322

arichard123 wrote: post #315

Here [1] it says the vaccine was designed mostly over the weekend of 11th Jan 2020. Here we are 10 months later and we know it works. If our knowledge of vaccine design is so good experts can design a vaccine that works over a weekend, what new breakthroughs are required to reduce the time between then and now substantially? A lot of benefit could have been had if we'd been able to get along this path more quickly. […

Definitely. It’s a similar situation with the aviation too. Unfortunately, rules in fields like medicine and aviation are written with blood. Someone gets too greedy or too comfortable and you have large numbers of people death or incapacitated. We already have large numbers of charlatans preying on the hopes of desperate people, must be very careful not to lower the barrier too much or these might jump too. Even wor…

Yeah, too bad for these millions of people who died from the disease! At least we followed the procedure!

Re: Oxford University breakthrough on global COVID-19 vaccine

#490

Post by tinus_hn » Mon, Nov 23, 2020, 6:30 PM UTC

moultano wrote: post #346

arichard123 wrote: post #315

Here [1] it says the vaccine was designed mostly over the weekend of 11th Jan 2020. Here we are 10 months later and we know it works. If our knowledge of vaccine design is so good experts can design a vaccine that works over a weekend, what new breakthroughs are required to reduce the time between then and now substantially? A lot of benefit could have been had if we'd been able to get along this path more quickly. […

Challenge trials. https://www.1daysooner.org/ If it were considered ethical to do them, we could have known in a few weeks. "Medical ethics" claims another million lives.

Considering Russia and China started using their vaccines months ago we could have had the answer anyway. We just didn’t want to look.