COVID-19 Shutdown Exit Strategy?

[RAE]

Has herd immunity been confirmed for SARS-CoV-2? I thought it was still unknown though possible.

It is not known for certain, but many virologists (including those at Johns Hopkins) think it is very likely that those who have had the virus probably have immunity from getting it again for a while........anywhere from a few months to several years. That's based on what happens when people get sick with other viruses in the coronavirus family.


It would of course be better to have a vaccine developed within the next year or two, which would get us to herd immunity much quicker. But nobody knows how long it will take to develop an effective vaccine.

 

[gwraigty]

Saw him on TV last night. He basically said that he got a LOT of grief for trying to require face masks for the general public and had no choice but cave.

There are large segments of the U.S. that just don't like being told what to do - even if it's for their own good.

I suspect he'll get some grief for treating workers and customers differently, considering his continual reminders that face coverings are to protect others and not ourselves. Well, he can change his mind as often as he likes, I guess. He's done it 3 times on just this one issue from Monday afternoon through Tuesday evening.

 

[Leo1277]

[Originally Posted by Midpack
Has herd immunity been confirmed for SARS-CoV-2? I thought it was still unknown though possible.]

It is not known for certain, but many virologists (including those at Johns Hopkins) think it is very likely that those who have had the virus probably have immunity from getting it again for a while........anywhere from a few months to several years. That's based on what happens when people get sick with other viruses in the coronavirus family.

It would of course be better to have a vaccine developed within the next year or two, which would get us to herd immunity much quicker. But nobody knows how long it will take to develop an effective vaccine.

One issue is that there are by now I believe three separate strains causing Covid-19 out there; even within the US, the dominating one on the East Coast differs from the one on the West Coast. And it's not clear that immunity against one strain implies immunity against the other.

Some versions of the common cold are also caused by coronaviruses (and also others types of viruses), but immunity does not seem to transfer across "cold" corona strains, and so after all this time, there's no vaccine against or effective remedy against the common cold. In the worst case we will be facing something like a "super cold" regarding immunity, but much more lethal and from what we see so far, even more easily transmitted. There is just so much we don't know yet.

 

[gwraigty]

Just an update on the Ohio mask vs. no mask issues. They said that there are laws that prohibit facial coverings in certain manufacturing and certain food industries for practical and safety reasons. They can't legally force someone to wear a mask who may have a health issue that would be worsened by making them wear a mask, and employers aren't allowed to ask for an explanation or proof of a health condition, so employers are going to have to take an employee's word for it that they have a medical condition and can't wear a mask. As a point of interest, businesses were split on the issue as well as potential customers.

So, at this moment, this second, facial coverings are state-mandated for employees, unless they work in industries where they're legally not allowed to wear them, or have a health condition that makes it dangerous to wear one. Customers are not state-mandated to wear a facial covering, but are encouraged to do so.

However, businesses can still choose to mandate that customers wear a mask. I'm not sure if much was said about exceptions for customers who might have health conditions. The whole thing makes my head spin with all the supposed legal exceptions.

 

[Independent]

One issue is that there are by now I believe three separate strains causing Covid-19 out there; even within the US, the dominating one on the East Coast differs from the one on the West Coast. And it's not clear that immunity against one strain implies immunity against the other.

Some versions of the common cold are also caused by coronaviruses (and also others types of viruses), but immunity does not seem to transfer across "cold" corona strains, and so after all this time, there's no vaccine against or effective remedy against the common cold. In the worst case we will be facing something like a "super cold" regarding immunity, but much more lethal and from what we see so far, even more easily transmitted. There is just so much we don't know yet.

All viruses mutate. The good news is that other corona viruses don't mutate as fast as the flu. The bad news is that immunity seems to wear off for some other reason.
https://www.npr.org/sections/goatsa...y-after-recovering-from-a-case-of-coronavirus
https://www.npr.org/sections/goatsa...ting-but-that-may-not-be-a-problem-for-humans

 

[Walt34]

They are attempting to completely block traffic for two hours to get their point across.

I've always been puzzled why these idiots who block traffic to make a point think pissing off hundreds of other people will make others support their cause. All it ever did for me was make me resolve to vote opposite of whatever it was they want.

 

[rodi]

How many of you have come to conclude this isn’t going to be a couple weeks/months event - our lives will be changed for a year or more even though we may slowly have some/many “privileges” restored?

I've been thinking about this a lot, for a while. My thinking is that even as thinks re-open a bit (a bit more retail, etc) there will be physical distancing requirements.

Face coverings will be the new normal for at least 6 months/1 year. Embrace it. Determine your own personal fashion style with it.

Schools are the big question in my household. As the mom of a Jr. in HS and Freshman in college... the fall is a big question mark. I don't see how they can go back to school as it was. UCSD (a local university) just announced that they will be doing a combo of distance/in person - but might switch to all distance for the fall quarter. My son goes to a CSU - I expect we'll hear something similar. Fortunately, he is slated for a single room in a "suite" for next term so he can do some physical distancing if he does go back to campus in the fall.

I don't see how we can re-open full bore until there is a proven, effective treatment and/or a vaccine.

 

[Sunset]

Just an update on the Ohio mask vs. no mask issues. They said that there are laws that prohibit facial coverings in certain manufacturing and certain food industries for practical and safety reasons. They can't legally force someone to wear a mask who may have a health issue that would be worsened by making them wear a mask, and employers aren't allowed to ask for an explanation or proof of a health condition, so employers are going to have to take an employee's word for it that they have a medical condition and can't wear a mask. As a point of interest, businesses were split on the issue as well as potential customers.

So, at this moment, this second, facial coverings are state-mandated for employees, unless they work in industries where they're legally not allowed to wear them, or have a health condition that makes it dangerous to wear one. Customers are not state-mandated to wear a facial covering, but are encouraged to do so.

However, businesses can still choose to mandate that customers wear a mask. I'm not sure if much was said about exceptions for customers who might have health conditions. The whole thing makes my head spin with all the supposed legal exceptions.

Could you phone the Gov'nor and ask him if a person needs to wear a seatbelt if they wear a mask

 

[REWahoo]

I don't see how we can re-open full bore until there is a proven, effective treatment and/or a vaccine.

Based on today's news about Remdesivir we could possibly have found an effective treatment. https://www.reuters.com/article/us-...uci-calls-it-highly-significant-idUSKBN22B1T9

 

[statsman]

Based on today's news about Remdesivir we could possibly have found an effective treatment. https://www.reuters.com/article/us-...uci-calls-it-highly-significant-idUSKBN22B1T9

How so?

The study showed a trend toward better survival for remdesivir - 8% of patients given the drug died, compared with 11.6% in the placebo group - but the difference was not statistically significant so may not be due to Gilead’s drug.

That's doesn't sound conclusive at all. Quite frankly, I would be fine not having to rely on a drug that is solely supported by China-sourced products.

 

[REWahoo]

How so?

That's doesn't sound conclusive at all. Quite frankly, I would be fine not having to rely on a drug that is solely supported by China-sourced products.

OK, no [-]soup[/-] Remdesivir for you!

That will leave more for those of us who want it if conditions warrant.

 

[copyright1997reloaded]

How so?

That's doesn't sound conclusive at all. Quite frankly, I would be fine not having to rely on a drug that is solely supported by China-sourced products.

They haven't claimed that is statistically significant. What is is:

The time to recovery averaged 11 days among those who received the drug, compared with 15 days for those who received the placebo.

Gilead (separately) announced a result of a study that showed a shorter dosage works as well as a longer dosage:

Gilead Sciences, Inc. (Nasdaq: GILD) today announced topline results from the open-label, Phase 3 SIMPLE trial evaluating 5-day and 10-day dosing durations of the investigational antiviral remdesivir in hospitalized patients with severe manifestations of COVID-19 disease. The study demonstrated that patients receiving a 10-day treatment course of remdesivir achieved similar improvement in clinical status compared with those taking a 5-day treatment course (Odds Ratio: 0.75 [95% CI 0.51 – 1.12] on Day 14). No new safety signals were identified with remdesivir across either treatment group. Gilead plans to submit the full data for publication in a peer-reviewed journal in the coming weeks.

Source: https://www.gilead.com/news-and-press/press-room/press-releases/2020/4/gilead-announces-results-from-phase-3-trial-of-investigational-antiviral-remdesivir-in-patients-with-severe-covid-19

The good news from this is that since the supply of the drug is limited, they might be able to treat 2X the number of patients as was previously thought.

 

[Leo1277]

They haven't claimed that is statistically significant. What is is:

Gilead (separately) announced a result of a study that showed a shorter dosage works as well as a longer dosage:
Source: https://www.gilead.com/news-and-pre...l-remdesivir-in-patients-with-severe-covid-19

The good news from this is that since the supply of the drug is limited, they might be able to treat 2X the number of patients as was previously thought.

So far these studies are just barely at the level of statistical significance to make conclusions about the aspects that are relevant, or even don't reach that level yet. A few days ago, another study of remdesivir was posted at WHO's website, only briefly and apparently by accident before peer review was completed. That study, carried out in Chinese hospitals, showed no benefits of remdesivir, neither for speed to recovery, nor for chances for survival:

https://www.statnews.com/2020/04/23...ent-show-no-benefit-for-coronavirus-patients/

We should all be aware that things are very early, all studies quoted have smallish sizes of participants, less than desirable statistics, and some aren't even properly randomized. And studies from the maker, as one of them is, should be taken with an extra grain of salt.

 

[copyright1997reloaded]

So far these studies are just barely at the level of statistical significance to make conclusions about the aspects that are relevant, or even don't reach that level yet.

I'm not saying its a done deal, but the outcomes randomized trial had 1,063 patients enrolled (some with the drug, some with placebo). That's a pretty decent sample size. I guess we will have to wait and see when the actual data gets released/peer reviewed to glean more.

 

[Leo1277]

I'm not saying its a done deal, but the outcomes randomized trial had 1,063 patients enrolled (some with the drug, some with placebo). That's a pretty decent sample size. I guess we will have to wait and see when the actual data gets released/peer reviewed to glean more.

Here is some new information on the Chinese study which was briefly posted on the WHO website. It just got published in The Lancet:

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31022-9/fulltext

The main conclusion is that up to the statistical error threshold, remdesivir has no positive or negative effect. Below the statistical error threshold, it was observed that those who got it recovered slightly faster, but also had a higher chance of adverse outcome. Here is a summary from the paper itself.

Findings
Between Feb 6, 2020, and March 12, 2020, 237 patients were enrolled and randomly assigned to a treatment group (158 to remdesivir and 79 to placebo); one patient in the placebo group who withdrew after randomisation was not included in the ITT population. Remdesivir use was not associated with a difference in time to clinical improvement (hazard ratio 1·23 [95% CI 0·87–1·75]). Although not statistically significant, patients receiving remdesivir had a numerically faster time to clinical improvement than those receiving placebo among patients with symptom duration of 10 days or less (hazard ratio 1·52 [0·95–2·43]). Adverse events were reported in 102 (66%) of 155 remdesivir recipients versus 50 (64%) of 78 placebo recipients. Remdesivir was stopped early because of adverse events in 18 (12%) patients versus four (5%) patients who stopped placebo early.

It'll be interesting how all this will play out in the long run, but so far I can't shake the feeling that this is like what my mom said, with chicken soup the cold takes 7 days, and with all the meds the doctors have it takes a week.

But the big difference is, very few die from the cold, but too many die from Covid-19; so time to recovery for the lucky ones is less important here than for the cold, what really matters is if we can avoid deaths.

 

[michelek]

I agree. I've been monitoring a number of message boards in metro ATL and very few people are eager to step out more than necessary. Fear of the virus is strong. One guy owns a small gym across the street from me and he asked on NextDoor how he can open in a way that would make people comfortable. He was sincere and wanted suggestions (after the governor's announcement last night). The overwhelming response was there is nothing he can do.

Well.. he asked nextdoor. That’s his first problem. They are the NIMBYs of everything.

 

[copyright1997reloaded]

Here is some new information on the Chinese study which was briefly posted on the WHO website. It just got published in The Lancet:

...
It'll be interesting how all this will play out in the long run, but so far I can't shake the feeling that this is like what my mom said, with chicken soup the cold takes 7 days, and with all the meds the doctors have it takes a week.

But the big difference is, very few die from the cold, but too many die from Covid-19; so time to recovery for the lucky ones is less important here than for the cold, what really matters is if we can avoid deaths.

Thanks for posting this. One of the things I've been wondering about on a number of these drugs is the importance/non-importance of early treatment, i.e. before the patient is in bad shape.

 

[MichaelB]

Thanks for posting this. One of the things I've been wondering about on a number of these drugs is the importance/non-importance of early treatment, i.e. before the patient is in bad shape.

Yes indeed. Could it be the worry about running out of hospital beds led to leaving people at home too long, leading to “too late” hospitalization when the disease had caused more damage and the odds of survival were declining?

Remdesivir was developed to treat Ebola. The preliminary results were positive but field testing proved less so. An interview I heard the other day says they concluded the initial positive results weren’t due to the drug, it was just getting treatment earlier from a better health system.

 

[audreyh1]

Yes indeed. Could it be the worry about running out of hospital beds led to leaving people at home too long, leading to “too late” hospitalization when the disease had caused more damage and the odds of survival were declining?

Well sure, trying to keep a large number rushing to the ER where they might just end up infecting each other as well as concerns about capacity.

But I think that also they thought it was the more normal type pneumonia and that difficulty breathing wasn’t as serious as it now seems to be with the silent hypoxia.

 

[Gearhead Jim]

I wanted to start another thread, but I did yesterday and it was closed because the very loosely related topic was posted here earlier?

How many of you have come to conclude this isn’t going to be a couple weeks/months event - our lives will be changed for a year or more even though we may slowly have some/many “privileges” restored? To me the stages have been:

• <LI abp="1126">It won’t be significant in the US, it’s a China issue (late Dec/early Jan) <LI abp="1127">It will hit here, but it’ll be contained (Feb) <LI abp="1128">It’s going to be significant here and we’ll be in lockdown but once we flatten the curve, we’ll start back toward normal. Hoping science will give us effective therapies. (Mar/early Apr)
• It’s going to hit the US hard, and some aspects of our lives will be changed for at least a year. There will be some new norms, some viable existing businesses will fail, and when they’re replaced it will be many years - many entrepreneurs will be gun shy. Economic recovery will take years, a “V” isn’t in the cards any more. Therapies may take a long time, there may never be a vaccine. State reopenings are going to be in fits and starts, there will be second waves. We’ll get more retail, restaurants/salons will come back modified, but large gatherings could take a long while, even if politicians give the OK, many people won’t come back until there’s robust therapies or vaccines. [We’re avid theater and concert goers, we just hope those orgs survive, it’ll probably be up to Corporate sponsors]

I don’t know why (optimism, denial, naivety), but it’s just dawned on me in the last week or so this is long term. I suspect all our POVs have evolved some.

I’m planning on a year now for anything resembling “normal,” no longer thinking just weeks/months. If it comes earlier great, but it’s fatiguing to think weeks/months and being disappointed day after day.

I'm convinced this isn't going to be over in a few months, but beyond that there are too many ways it could go very well or very badly-

If herd immunity exists, we may have more of it (undiagnosed minor symptoms) than expected. Or maybe having had the virus doesn't help at all.

Treatments like Resdesiver (sp?) and other drugs might become effective treatments. Or not.

An effective vaccine might be developed. Or not.

People might voluntarily maintain enough social distancing to slow the disease even as business starts to reopen. Or not.

Even if we have 330,000 fatalities, that's only 1/10th of 1% of our population. A lot of heartbreak and trouble, but not the end of civilization. Unless you happen to be one of the .001

 

[RobbieB]

Yes indeed. Too bad for the tenth of 1%.

Let's get back in gear.

 

[USGrant1962]

I saw a phrase on another website that struck home, they said the nation is "committing suicide by fear of death".

 

[Midpack]

Based on what I’ve read, though we’re ramping up testing quantity, it’s nowhere near the quality or utility (results take too long) needed to really manage our way out of this efficiently (prioritizing tests and contact tracing). And people and businesses lose patience every day, and most are low risk if infected. The chances of being legitimately prepared (like many Asian countries) before a critical mass of citizens just won’t wait to reopen is almost nil. So we’re going to reopen, some states/cities will get through it OK if citizens use PPE/distancing and some states/cities are going to have new, higher peaks.

We’re still behind the curve on PPE as far as I can tell also. I’ve yet to see N95 masks for sale since mid-March.

Between the lack of proactive federal coordination and Americans demand for freedom/independence (too many people steadfastly refuse to comply with even simple guidance), we’re going to fare far worse than several advanced Asian countries, Germany and a few others. We could’ve done much better, but there’s no going back now...

 

[fh2000]

Meanwhile, in Taiwan (population 24 million), they have had 0 cases for 6 days now. This is on a bus. They installed a plastic screen between each seat, much like the shower curtain.

Maybe they should do this on the airplane too, then I will be willing to fly with a full gear on.

Only the paranoid will survive.

https://images.chinatimes.com/newsphoto/2020-05-01/900/20200501004276.jpg

By the way, the name of that country is 'Republic of China', not to be confused with 'People's Republic of China'. So, you will see Chinatimes, China Airlines, etc. They are actually from Taiwan, not China.

 

[harllee]

Why can our country not do sufficient testing and tracing? Surely it is not that complicated --other countries have done a much better job. Where is the weak link in the chain on testing and tracing? History will look back on this time and say that our government/medical establishments failed our citizens on this.