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BBC: China pneumonia outbreak: COVID-19 Global Pandemic


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Listening to Andy Slavitt's podcast (Health expert under Obama) and he had a couple of experts on regarding vaccines. Oxford vaccine trials are doing well. Been giving to 11,000 individuals with ZERO adverse effects yet. They are expecting this to still be available in the fall/late 2020. Rollout will be a ? maybe throughout 2021 and 2022. Maybe front line workers (and pro athletes, as things are going).

 

I've heard it before, and the first vaccines are only expected to be 50% effective and/or only "down modulating" the impact of the illness on the individual.

 

 

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My patient caught Covid-19 twice. So long to herd immunity hopes.

 

Emerging cases of Covid-19 reinfection suggest herd immunity is wishful thinking.

 

“Wait. I can catch Covid twice?” my 50-year-old patient asked in disbelief. It was the beginning of July, and he had just tested positive for SARS-CoV-2, the virus that causes Covid-19, for a second time — three months after a previous infection.


While there’s still much we don’t understand about immunity to this new illness, a small but growing number of cases like his suggest the answer is yes.

 

Covid-19 may also be much worse the second time around. During his first infection, my patient experienced a mild cough and sore throat. His second infection, in contrast, was marked by a high fever, shortness of breath, and hypoxia, resulting in multiple trips to the hospital.

 

Recent reports and conversations with physician colleagues suggest my patient is not alone. Two patients in New Jersey, for instance, appear to have contracted Covid-19 a second time almost two months after fully recovering from their first infection. Daniel Griffin, a physician and researcher at Columbia University in New York, recently described a case of presumed reinfection on the This Week in Virology podcast.

 

It is possible, but unlikely, that my patient had a single infection that lasted three months. Some Covid-19 patients (now dubbed “long haulers”) do appear to suffer persistent infections and symptoms.

 

My patient, however, cleared his infection — he had two negative PCR tests after his first infection — and felt healthy for nearly six weeks.

 

I believe it is far more likely that my patient fully recovered from his first infection, then caught Covid-19 a second time after being exposed to a young adult family member with the virus. He was unable to get an antibody test after his first infection, so we do not know whether his immune system mounted an effective antibody response or not.

 

Regardless, the limited research so far on recovered Covid-19 patients shows that not all patients develop antibodies after infection. Some patients, and particularly those who never develop symptoms, mount an antibody response immediately after infection only to have it wane quickly afterward — an issue of increasing scientific concern.

 

What’s more, repeat infections in a short period are a feature of many viruses, including other coronaviruses. So if some Covid-19 patients are getting reinfected after a second exposure, it would not be particularly unusual.

 

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Good luck with that...

 

Coronavirus: Some air conditioning units risk spreading Covid-19 and should be turned off, advise experts

 

Air conditioning units that recirculate air in rooms and offices should be turned off or used only with open windows because of the risk of spreading coronavirus, experts advise.

 

They fear that any Covid-19 droplets in the air could be transmitted more easily to people in the room, even those who are socially distanced.

 

And they are advising office bosses to ventilate rooms with fresh air whenever possible.

 

The World Health Organisation (WHO) said this week that coronavirus can spread through tiny droplets floating in the air in enclosed spaces, after scientists highlighted the risk.

 

The UK Health and Safety Executive says the risk of air conditioning spreading coronavirus in the workplace is extremely low “as long as there is an adequate supply of fresh air and ventilation” but adds: “if you use a centralised ventilation system that removes and circulates air to different rooms, it is recommended that you turn off recirculation and use a fresh air supply”.

 

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Japan is 'shocked' and furious at the US after a major coronavirus outbreak at 2 Marine bases in Okinawa — and says the US is not taking the virus seriously

 

Japanese authorities are demanding answers from the US after a large scale coronavirus outbreak among Marines stationed in the country's southern prefecture of Okinawa.

 

61 Marines have been infected with the virus in recent days, according to the Guardian newspaper, spread across two bases in the archipelago — which has long been a US military stronghold in the eastern Pacific.

 

38 of the reported cases are at the Futenma Marine air station. Another 23 occurred at Camp Hansen, a base that is home to around 6,000 US Marines.

 

"It is extremely regrettable that the infections are rapidly spreading among US personnel when we Okinawans are doing our utmost to contain the infections," Okinawa's governor, Denny Tamaki, said at a press conference, according to the Guardian.

 

"Okinawans are shocked by what we were told," he added. "We now have strong doubts that the US military has taken adequate disease prevention measures."

 

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Coronavirus immunity can start to fade away within weeks, according to a new study which puts a 'nail in the coffin' in the idea of herd immunity

 

Immunity to the coronavirus may disappear within months for many patients, according to a major new UK study which found that antibodies peaked three weeks after symptoms appeared, before gradually fading away.

 

For some patients, no antibodies were detected after just a few months, throwing doubt on hopes for a long-lasting vaccine.

 

The study, which was carried out by scientists at King's College London and first reported by The Guardian, "puts another nail in the coffin of the dangerous concept of herd immunity," one of its authors said.

 

The study was based on the antibody responses of 90 patients and health workers at Guy's and St. Thomas' NHS Foundation Trust. It showed that 60% of those tested had "potent" antibodies while battling COVID-19, but just 17% had the same level of potency three months later.

 

The potency of the antibodies fell by as much as 23 times over the three months, the study found, and in some cases were undetectable at the end of that period of time.

 

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On 7/12/2020 at 1:01 PM, Califan007 said:

 

I didn't see anything wrong with the article. It balanced the knowns, unknowns, and speculations and labeled each as such. It mentions a lot of qualifiers and even says re-infections are not unusual.

 

 


The article takes a sample size of mostly one patient and one doctor and attempts to portray a phenomena that is simply not being observed almost anywhere in the world right now. You can’t question the concept of herd immunity or the biological immune response to the virus because one person may have been reinfected (it’s not even confirmed). 
 

The virus is so widespread around the world that if reinfection was a serious phenomena, we would see clear data on it. There were some early reports out of South Korea about this which turned out to be just prolonged illnesses. And there is a good amount of data out there that the immune system does launch a robust response against the novel coronavirus with signatures of potential long-term immunity. I saw this absent in the article.

 

And even if the article is going to mention “well some viral illnesses are prone to reinfection in short periods of time”, it’s probably good to also mention that the closest analog to the current virus, the 2002 SARS coronavirus produced immunity that lasted years in most patients. 


Getting the right information to the public on immunity matters because as soon as a vaccine is released, you don’t want people thinking “well I read articles that said herd immunity isn’t possible and the immune response is weak”. It’s not a balanced article, it’s pure and simple fear mongering disguised as journalism.

 

 

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5 minutes ago, Springfield said:

So if immunity starts to fade within weeks then whats the point of a vaccine?

 

You can generate a stronger immune response from vaccines than you normally might through infection with a live virus. 
 

I remain skeptical of studies that suggest immunity may be gone in a few weeks by just looking at antibody levels. The body will generate multiple antibodies against the virus, some that will decrease over time faster than others. It’s entirely unclear if the antibodies that produce the strongest  response against the virus are actually decreasing in significant enough numbers within a few weeks of time. 
 

And most studies also don’t account for the role of T cells, which we know also mount a long term immune response to the virus. The immune system has an array of tools it uses to fight it.
 

Ultimately, the strongest data we need to see on immunity will come from within communities where the virus continues to circulate. We are yet to see a strong signature of reinfection anywhere in the world. 

On 7/13/2020 at 10:04 AM, The Evil Genius said:

US stats still show covid19 mortality rate at 4%. Not sure why anyone would think its 1%.

 

137k deaths out of 3.37 mil cases. 

 

That's 40x the mortality rate of the normal flu btw.


It is based on serological surveys. For instance, spread in NYC itself possibly infected 20% of its population. We know quite well that cases are likely undercounted by about 4x.

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1 hour ago, No Excuses said:


The article takes a sample size of mostly one patient and one doctor and attempts to portray a phenomena that is simply not being observed almost anywhere in the world right now. You can’t question the concept of herd immunity or the biological immune response to the virus because one person may have been reinfected (it’s not even confirmed).

 

 

Only thing is, the article does not do this.

 

"While there’s still much we don’t understand about immunity to this new illness, a small but growing number of cases like his suggest the answer is yes."

 

"It is possible, but unlikely, that my patient had a single infection that lasted three months. Some Covid-19 patients (now dubbed “long haulers”) do appear to suffer persistent infections and symptoms. My patient, however, cleared his infection — he had two negative PCR tests after his first infection — and felt healthy for nearly six weeks."

 

"Recent reports and conversations with physician colleagues suggest my patient is not alone. Two patients in New Jersey, for instance, appear to have contracted Covid-19 a second time almost two months after fully recovering from their first infection. Daniel Griffin, a physician and researcher at Columbia University in New York, recently described a case of presumed reinfection on the This Week in Virology podcast. "

 

(sidenote - the article explicitly let's it be known that the author's concern is not simply because "one person may have been reinfected")

 

"...the limited research so far on recovered Covid-19 patients shows that not all patients develop antibodies after infection. Some patients, and particularly those who never develop symptoms, mount an antibody response immediately after infection only to have it wane quickly afterward — an issue of increasing scientific concern."

 

(sidenote - an article posted above by China points to the very same question of the concept of herd immunity, that even the article you're criticizing alludes to when it says "an issue of increasing scientific concern"...and it's from far more than "one person maybe having been reinfected".)

 

"...repeat infections in a short period are a feature of many viruses, including other coronaviruses. So if some Covid-19 patients are getting reinfected after a second exposure, it would not be particularly unusual. "

 

(sidenote - the article acknowledges that what its author is concerned about may not be all that unusual an occurrence. Hardly alarmist.)

 

 

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36 minutes ago, Califan007 said:

(sidenote - the article acknowledges that what its author is concerned about may not be all that unusual an occurrence. Hardly alarmist.)

 

Here's the article's headline: "My patient caught Covid-19 twice. So long to herd immunity hopes?"

 

No, is it not "so long to herd immunity" because one patient was reinfected.

 

Here's the most egregious overstatement in the whole piece:

 

Quote

Second, despite scientific hopes for either antibody-mediated or cellular immunity, the severity of my patient’s second bout with Covid-19 suggests that such responses may not be as robust as we hope.

 

It's complete nonsense and not backed by any robust data. The severity of one patients condition does not indicate that when you don't even have evidence that it is in fact reinfection.

 

Here's another completely factless statement.

 

Quote

With no certainty of personal immunity

 

There is absolutely certainty of some personal immunity. How long that immunity lasts is a valid question, but with millions of cases around the world there has been no significant observation of reinfection anywhere.

 

We've already had reports of "reinfection" from South Korea that later turned out to be prolonged infections, with the exact signature of the one patient outlined in this article. Recovery and then a second bout of illness.

 

Amongst millions of people, you might end up in a situation where some don't even mount a short term immune response. Is it responsible to publish op-eds about these people, calling into question the broader idea of herd immunity or even personal immunity? Absolutely not.

 

The entire article is a masterclass on terrible scientific journalism. You take an almost irrelevant sample size, develop a narrative and push it under the cover of "broader scientific concern". Yes there is concern on the length of immunity, and it will inform how vaccination is considered. No, there is really not much concern in the scientific community that people will not develop immunity to the virus. We already know they do, it's the in global data where reinfection is not observed. When that starts to change, we'll see it in epidemiological data, not in a handful of cases that are extreme outliers.

Edited by No Excuses
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How much longer until countries start asking our military to leave because they are causing clusters overseas?

 

Japan may be first. South Korea and Europe may have a different line, Japan has been very vocal about wanting us to go before we even got here.

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28 minutes ago, No Excuses said:

No, there is really not much concern in the scientific community that people will not develop immunity to the virus. We already know they do, it's the in global data where reinfection is not observed. When that starts to change, we'll see it in epidemiological data, not in a handful of cases that are extreme outliers.

 

Every month new data on COVID patients paints a more accurate and fuller understanding of how the virus works and how our bodies respond to it. Nobody talked about blood clots in March or April, COVID was seen as a respiratory virus. Now it's seen as much, much, much more.

 

Not to mention, the article does not, in any way, reach any conclusions other than pointing out signs are there that herd immunity may not be the slam-dunk people are assuming it will be. He's most definitely NOT alone in the scientific community in that belief, and it's nowhere near accurate for you to clam "ther is really not much concern" in the medical community that people will not develop immunity. I won't quote from these articles but you can read them yourself to see that this concern is not limited to this one guy and his one patient...he's just synthesizing the known coronavirus studies, medical reports, and interaction with colleagues into something more personal and relatable, both to him and the readers.

 

We're wasting time talking about herd immunity

https://www.cnn.com/2020/07/13/opinions/herd-immunity-covid-19-uncomfortable-reality-haseltine/index.html

 

Spanish Covid-19 antibody study suggests herd immunity infeasible

https://medcitynews.com/2020/07/spanish-study-suggests-herd-immunity-against-covid-19-may-not-be-possible/

 

Risk for COVID-19 Reinfection Remains Unknown

https://www.physiciansweekly.com/risk-for-covid-19-reinfection-remains-unknown/

 

Antibodies and COVID-19 Reinfection: Some Context for Fielding Patient Questions

https://consultqd.clevelandclinic.org/antibodies-and-covid-19-reinfection-some-context-for-fielding-patient-questions/

 

 

One thing you'll notice in the above articles: none of the experts say that since mass reinfections have not taken place all over the world, they're not worried.

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Just another data point in our drive to understand this virus. I'd advise against applying it to any larger context.

 

https://directorsblog.nih.gov/2020/07/14/study-in-primates-finds-acquired-immunity-prevents-covid-19-reinfections/

 

NIH: Study in Primates Finds Acquired Immunity Prevents COVID-19 Reinfections

 

A recent study of rhesus macaques, which are among our close primate relatives, offers relevant insights into the first question. In a paper published in the journal Science, researchers found that after macaques recover from mild SARS-CoV-2 infection, they are protected from reinfection—at least for a while.

 

In work conducted in the lab of Chuan Qin, Peking Union Medical College, Beijing, China, six macaques were exposed to SARS-CoV-2. Following infection, the animals developed mild-to-moderate illness, including pneumonia and evidence of active infection in their respiratory and gastrointestinal tracts. Twenty-eight days later, when the macaques had cleared the infection and started recovering, four animals were re-exposed to the same strain of SARS-CoV-2. The other two served as controls, with researchers monitoring their continued recovery.

Qin’s team noted that after the second SARS-CoV-2 exposure, the four macaques developed a transient fever that had not been seen after their first infection. No other signs of reinfection were observed or detected in chest X-rays, and the animals tested negative for active virus over a two-week period.

 

While more study is needed to understand details of the immune responses, researchers did detect a reassuring appearance of antibodies specific to the SARS-CoV-2 spike protein in the macaques over the course of the first infection. The spike protein is what the virus uses to attach to macaque and human cells before infecting them.

 

Of interest, levels of those neutralizing antibodies were even higher two weeks after the second viral challenge than they were two weeks after the initial exposure. However, researchers note that it remains unclear which factors specifically were responsible for the observed protection against reinfection, and apparently the first exposure was sufficient.

 

 

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51 minutes ago, Califan007 said:

Every month new data on COVID patients paints a more accurate and fuller understanding of how the virus works and how our bodies respond to it. Nobody talked about blood clots in March or April, COVID was seen as a respiratory virus. Now it's seen as much, much, much more.

 

Not to mention, the article does not, in any way, reach any conclusions other than pointing out signs are there that herd immunity may not be the slam-dunk people are assuming it will be. He's most definitely NOT alone in the scientific community in that belief, and it's nowhere near accurate for you to clam "ther is really not much concern" in the medical community that people will not develop immunity. I won't quote from these articles but you can read them yourself to see that this concern is not limited to this one guy and his one patient...he's just synthesizing the known coronavirus studies, medical reports, and interaction with colleagues into something more personal and relatable, both to him and the readers.

 

The article doesn't have to "reach any conclusions" for it to be bad journalism. It creates a narrative that is not supported by data. In the middle of a pandemic, that serves no purpose other than scaring people. He's also not synthesizing known coronavirus studies, because there is a good amount of data on people actually generating immunity to the virus, from animal models to actual humans who have been infected.

 

Telling people right now that "herd immunity is not possible" is god awful messaging. Herd immunity through community transmission is not feasible. Herd immunity through mass vaccinations is possible. Achieving herd immunity through vaccination programs is our only way out of this.

 

If a bunch of bozos decide to write articles right now, like some of the ones you quoted, you can reasonably expect that some segments of the public will not heed advice when medical professionals start campaigning for mass vaccination programs to achieve herd immunity.

 

And the question at heart, "can people be reinfected" does have uncertainty. But the uncertainty isn't whether people are getting reinfected right now. Except possibly some outliers (and there's extreme skepticism warranted even for this batch), people are not being reinfected at the moment. Based on our understanding of coronaviruses, natural immunity will go away at some point and reinfection will be possible. We don't know what the point of diminished immunity is for this virus. But it hasn't arrived yet and there is zero reason for any outlet to be pushing questionable narratives, based on little evidence but personal hunches, to a public that is already scared.

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I don’t think full immunity is clear scientifically in anyway in regards to this virus. The whole thing is TBD. Maybe I’ve missed the news but I thought the whole thing is still up in the air. To argue That there is a clear answer yet for this virus is not supported by the data. If it has been reported I’d appreciate seeing it, because I’ve missed it. My understanding of what is out there is that we don’t know yet.

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3 hours ago, No Excuses said:

It is based on serological surveys. For instance, spread in NYC itself possibly infected 20% of its population. We know quite well that cases are likely undercounted by about 4x.

 

We also know that Covid deaths are under-counted.  Although not necessarily by 4x.  

 

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28 minutes ago, Larry said:

 

We also know that Covid deaths are under-counted.  Although not necessarily by 4x.  

 


From what I understand, the 1% mortality rate accounts for both under reporting of deaths by looking at excess mortality and by accounting for serosurvey estimates. 

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