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  HHS Clinical Trial page
Posted by: M_T - 01-31-2021, 06:36 AM - Forum: Treatments & ongoing Clinical Trials - No Replies

The US Health & Human Services has a page to connect people with clinical trials.
This is for people who never had COVID,  who have it now, and who have recovered from it.

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  How to get a genome sequencing done?
Posted by: M_T - 01-31-2021, 06:27 AM - Forum: COVID-19 - Replies (1)

A recent article indicated that the US has only sequenced 0.3% of the infections.

As I know someone currently with COVID, I was wonder how one could get their virus sequenced.  I looked around and couldn't find anything.  There is one site in the UK that may offer the service.

My thought is that knowing the genome might be useful for the future if other variants can reinfect (or not) those with prior variants.

Anyone know how to get this done, outside of finding some research program?  Or perhaps you know a research program that would be quick to get into for this purpose?

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Music Pfizer and Anti-Vaxxers
Posted by: Snorlax94 - 01-30-2021, 10:58 PM - Forum: Humor - Replies (3)

https://i.pinimg.com/236x/55/28/56/55285...96dca1.jpg

[Image: 552856077ff32352957958aa7296dca1.jpg]

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Wink The Worldwide Consequences of Incompetent and Immoral Leadership
Posted by: Snorlax94 - 01-30-2021, 08:50 PM - Forum: COVID-19 - Replies (9)

On the Cardboard, we discussed the great disparities in countries' responses to Covid. Some, like New Zealand and Taiwan were able to almost completely contain Covid with a combination of their governments' competence and responsible citizens. Almost all other countries in the world were more successful than the United States -- most European countries, most Asian countries -- had much fewer cases and fatalities as a percentage of their population.

A few countries stood out as being the most miserable failures, and having some of the worst case rates -- the United States, Brazil, and the UK. And, not surprisingly, all their leaders had similar responses to Covid, claiming it was "just a flu", undermining health initiatives, providing false health information (I think all three claimed hydroxychloroquine as "miracle cures”), demanding regional governors "liberate" their societies instead of using government action to contain Covid. Both Trump and Bolsonaro attacked the press whenever they presented facts contrary to their fictions, and claimed newspapers were full of "fake news." And not surprisingly, all three of those leaders -- Trump, Bolsonaro, and Johnson -- contracted Covid themselves, despite the fact that the United States and the UK are two of the wealthiest, most technologically advanced nations in the world. Trump and Johnson, two of the most powerful men in the world, both were hospitalized!

I and others on the Cardboard warned of these leaders' incompetence and failures -- that ignoring the science, behaving greedily and shortsightedly, by falsely calling their actions "liberating" societies and foolishly shooting for "herd immunity" through rampant infection would give the virus more chances to mutate and make it more difficult to contain.

And now look at the consequences of the "herd immunity" approach. The virus has mutated to the point where the vaccines we have created are far less effective.

Additionally, the US withdrew from the WHO and took an "America First" approach to international cooperation. I warned on the Cardboard how foolish and harmful this approach was. The US should never have withdrawn from the WHO (it has rejoined since Jan 20), it should never have disbanded its pandemic team on the National Security Council (it re-added it since Jan 20), it should have been part of the Covax initiative to help poorer countries (it joined since Jan 20). Why? Not only is it the morally right thing to be an ethical leader of the world, it was always in our best interest. I warned on the Cardboard that we cannot follow so selfish, so isolationist, so nationalist, and so short-sighted an "America First" policy because the virus could mutate in the developing world and make our vaccines less effective. I think I even specifically mentioned Africa as the kind of place it could mutate.

And look what has happened. 

Where are these mutations? The UK mutation. The Brazilian mutation. The Los Angeles (LA) mutation. What are those countries? The UK, Brazil and the US. Who were their leaders? Johnson, Bolsonaro and Trump. The three world leaders of the irresponsible “herd immunity” rampant infections went 3 for 3 getting sickened by Covid themselves and went 3 for 3 being the source of new mutations (the LA, UK and Brazilian strains). And then there is the South African mutation, in a developing country left alone to fend for itself by an "America First" world lacking in global leadership.

We are still learning what the consequences of these mutations will be. So far, our existing vaccines seem to be effective against the UK mutation, but most are already doing much worse against the S African mutation. We do not know yet how they will do against the Brazilian mutation.

You might think we will be fine, because there is still partial effectiveness by these vaccines, and mRNA vaccines can be tweaked rapidly to be re-formulated for new mutations, like an annual flu shot.

But consider these problems:
1) What happens when the S African strain mutates further and looks even less like the original strain? There is no help coming to S Africa. Covid will continue to rage there, and as Covid rages in Africa, so too will it continue to mutate even further. The S African strain will mutate more and more, and become even less similar to the original strain, and to our vaccines.

2) The world does not have enough vaccine for itself. Even if the US and Europe achieve herd immunity by the end of 2021, they will have achieved herd immunity to the original strain. Current estimates are that it could take the developing world until 2023 or 2024 to achieve herd immunity, if ever. What does that mean? The virus mutated enough to become a problem in less than a year. Without help, the virus will mutate all over the developing world in 2021, 2022, 2023 and beyond. One plane trip could bring a new mutation -- unlike any we've seen so far -- from anywhere in the world to the US.

3) Doctors say we can just have annual boosters, like we do for the flu. But does that mean no one gets the flu? No, there are good years and bad years. If we play that game of annual boosters, some years we will manufacture the right strains and contain it, other years we will guess wrong, just as we do for the flu, and we will have bad years for Covid. Some years a new strain will only be discovered after we've designed the booster. A bad year could mean a year where the elderly have to isolate themselves all winter long.

These are the consequences for all of humankind based on the decisions made by Trump, Bolsonaro and Johnson in 2020. These are the consequences of blind nationalism ("America first"), deception ("it's just a flu/hydroxychloroquine is a miracle cure"), greed ("liberate the economy"), and incompetence (the numbers of people dead, the unknown millions who will have long-term damage).

As Fauci said, the decreased efficacy of the vaccines against the mutations is a wake up call. All of humankind needs to take Covid more seriously. We need to stop politicizing masks.We need to stop politicizing "re-opening"/"liberating" and recognize when leaders restrict activities, it's not because they are "dictators" -- and certainly those who disagree should not plan kidnappings or attempt coups. We need to stop lies (that masks make things worse or that there is a miracle cure or that it's just a flu). We need to work together with other countries in the world, and we need to help the developing world. The US needs to lead a world-wide mobilization to make sure every country in the world has PPE and masks. Our society needs to set an example for all nations in terms of how a peaceful democratic society can positively work with social distancing and, when needed, government restrictions, and wear masks,and vaccinate with integrity and without lies or cronyism. The US needs to lead a world-wide mobilization to get every person in every country in the world -- rich or poor -- vaccinated. And the US needs to lead the world in many other ways -- in technologies, global cooperation, in truthful information sharing. 

If we do not change our course even more decisively, there is a "bad case" scenario that will last many years. I think there will be better testing, therapeutics, and hygienics, so I don't expect the US will have direct casualties like the past year again, but I could see a future where in "bad years" with a novel mutation (like years where there is a mismatch in the flu vaccines), it'll mean many more elderly die, and a changed way of life, especially for the most vulnerable. Until Covid is defeated globally, a novel mutation in a non-"America First" country would be just one plane trip away from another winter of increased deaths for the elderly, losses for the travel industry, and precautious across society until another booster is distributed.
 
Although this is a "bad case" scenario, if 2020 taught us anything, it is that we cannot just hope this doesn't happen. We need to lead and stop it from happening.

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  Johnson & Johnson single-shot Janssen vaccine
Posted by: M_T - 01-30-2021, 04:38 AM - Forum: Vaccine - Replies (5)

J&J's press release says

Quote: Wrote:Vaccine Candidate 72% Effective in the US and 66% Effective Overall at Preventing Moderate to Severe COVID-19, 28 Days after Vaccination

85% Effective Overall in Preventing Severe Disease and Demonstrated Complete Protection Against COVID-19 related Hospitalization and Death as of Day 28

The topline safety and efficacy data are based on 43,783 participants accruing 468 symptomatic cases of COVID-19.
The level of protection against moderate to severe COVID-19 infection was 72% in the United States, 66% in Latin America and 57% in South Africa, 28 days post-vaccination.

There was a clear effect of the vaccine on COVID-19 cases requiring medical intervention (hospitalization, ICU admission, mechanical ventilation, extracorporeal membrane oxygenation (ECMO), with no reported cases among participants who had received the Janssen COVID-19 vaccine, 28 days post-vaccination.

Efficacy against severe disease increased over time with no cases in vaccinated participants reported after day 49.

The B.1.351 lineage also known as 501Y.V2 variant and 20H/501Y.V2 (formerly 20C/501Y.V2) is a variant of SARS-CoV-2,

Study: NCT04505722.  18+ yo., not pregnant.   It began Sep. 7.  I don't see a date when they took a snapshot of the results that they announced.  Perhaps it was about 10 days ago, January 19, so I'll use that for a date.

Original primary outcome was number with COVID 14 days after vaccination.  During the study another primary outcome was added for the number with COVID 28 days after vaccination.

It appears the study accepted subjects from about Sep. 7, ending before Jan 25.


The good news and the bad news is that it has been tested against the South African variant. 

On the face of it, it appears that this vaccine is 7x (38% vs 5%) less effective than the Pfizer & Moderna for the disease spreading in the US.  It will be less effective at reducing the spread of the disease per vaccine given.   (If you gave 100K doses of Moderna or Pfizer in a general population where 10% were getting COVID, only 500 of the 100K would get COVID.  With this vaccine, 3800 would get COVID.  Without the vaccine, 100K would get sick. ***)

However, it is the long term damage or death that is the big concern for COVID.  Thus their claim that no one past 49 days has had a severe disease is  worth looking at closely.  A subject who was given the vaccine on the first day of the study (Sep. 7) would reach 28 days on Oct 5 and the 49th day at Oct. 26.  They indicate he would not have had a severe disease after 49 days.  Subjects vaccinated after about December 1 would not have reached 49 days when they took this snapshot of results.

*** I don't like this linear efficacy measure of the vaccine.  To my way of thinking, I'd like to see the effect of the vaccine on R.




The South African variant S.501Y.V2  was first detected in samples from October 5, where it quickly dominated all the other variants.  In 7 weeks, it was responsible for 90% of the cases.
[Image: South-African-Genomes.png]

It is difficult to figure out the efficacy of the vaccine against the South African variant without knowing the timeline of the start of subjects in South Africa.


For the people vaccinated, much of the advantage of a single dose is lost by this vaccine's 28-days judgement of effectiveness.  It doesn't seem to be effective sooner, so I'd go with higher effectiveness.

For the government (who is paying for the vaccine), there may be an advantage (depending on the cost of the vaccine & cost to administer it) to having a single dose.  The government should also weigh the cost of the difference in the number of people who get sick.   (If there are 250M people in the US, and some 50M have had COVID already, then there are 200M people yet to be infected.  With Pfizer/Moderna, 10M would be infected.  With the J&J vaccine, 76M would get infected.)





As a 65+ year old, I would MUCH prefer the 95% effective vaccines.  For younger people who have less risk, it will matter less.

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  ICU Percentages in Contra Costa County
Posted by: cardcrimson - 01-29-2021, 01:30 PM - Forum: Regional - Replies (2)

Last week, ICU availability percentage was the most important metric out there. Today, Contra Costa pulled the metric from their dashboard completely. No mention whatsoever. Glad to see that we are consistently focused. . . .

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  Would you sign your kid up for a clinical trial
Posted by: cardcrimson - 01-28-2021, 03:45 PM - Forum: Treatments & ongoing Clinical Trials - Replies (1)

Saw that Moderna is looking for kids to participate in a clinical trial to evaluate the safety and efficacy for teens. Would you sign your kid up? Apparently, 2/3's get the vaccine, 1/3 gets the placebo.

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  Novavax releases UK study preliminary results
Posted by: Snorlax94 - 01-28-2021, 03:07 PM - Forum: Vaccine - Replies (3)

https://www.latimes.com/world-nation/sto...n-uk-study

Of greatest concern — the vaccine was 96% efficacious against the original strain, nearly 86% efficacious against the new UK strain, and, in a smaller South African study, 60% efficacious against the new S African strain (among specifically HIV-negative South Africans, it did worse among HIV positive and negative S Africans).

Novavax was the most promising vaccine early on, and its (preliminary) efficacy of 96% against the original strain is the highest yet. So, I worry the other vaccines could be less than 60% efficacious against the S African strain.

I am very glad Moderna and Pfizer have begun work on a modified shot for the new mutations.

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  California to use Blue Shield for something
Posted by: M_T - 01-28-2021, 01:37 AM - Forum: Regional - Replies (2)

I'm not sure what to make of this...

News reports indicate
"Health insurance giant Blue Shield of California will be the outside administrator tasked with ramping up the state's coronavirus vaccine delivery system"

First, Operation Warp Speed was delivering (minimum 100, now I guess 120) doses to any/every distributor, as requested by the state.  There really doesn't need to be any delivery system within the state, only allocation of the limited request capacity.

Second, Blue Shield, though a non-profit, is one of the competitors who want to give as many vaccinations as possible in order to increase income (for whatever purposes).  Being in charge puts them at a considerable advantage.

Third, all this alleged confusion about how many doses went to whom is silly.  I presumed the state provided that info to the health authorities of the counties. If not, why not.  The counties ordered providers to give them test info.  Why is vaccine info different?   Texas (with more than four times as many counties as California), for one, makes it public to the world of how much goes to each pharmacy, clinic, school. or hospital.  No confusion, no distribution hidden from view.

I know California makes it complicated by supplying to "Multi-County Entities" separately from the counties.  I get the idea that Kaiser and Blue Cross are in multiple counties and patients from San Benito County may be in a Kaiser facility or (single county) El  Camino Hospital.  IMO, it would be far easier to allocate by county alone and the MCEs get it allocated to them by the patient's county after the fact.   (Go look at the 300 vaccinators for San Mateo County residents, from all over the state.)

Fourth, Blue Shield has no access to anyone's private data except their own patients.  They don't know if I have diabetes or not.  So there is no benefit from their being a provider.

Fifth, Blue Shield holds no legislative authority over anyone, at least no more than any other health company who tightens the screws on the hospitals over whether they'll pay a bill or not.  If there is a dispute, Blue Shield has no power directly.

It feels to me like more middle steps & middle men to slow things down, especially if California doesn't take advantage of direct shipments by the US Government.  More dollars on administration.

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  California & Bay Area vaccine sign-up
Posted by: M_T - 01-27-2021, 12:55 AM - Forum: Regional - No Replies

I don't know that it is anything better than following the news, but California intends to have a sign-up to get notified about vaccine availability.  (As I type this, it isn't working.)

For info about SF Bay Area vaccine sign-ups, see this news article.

You might also want to check out this crowd sourced site.

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