We are only in the second inning with COVID-19

[RAE]

Some interesting information and commentary in this interview with Michael Osterholm, who is an infectious disease expert.

He basically says this is going to be a long haul, and that we may only be in about the "second inning" of a nine-inning game right now. The virus will probably need to infect 60-70% of the population before we see a major reduction in its transmission. He thinks we could see 800,000 deaths (or more) in the U.S. over the next 18 months.

https://www.cnn.com/2020/04/21/opinions/bergen-osterholm-interview-two-opinion/index.html

 

[pacergal]

IMHO
This virus will be around until:
herd immunity
adequate treatment
vaccine
However long it takes, months to years, it will ebb and flow in society.
I will be staying at home more, wear mask if out, most likely not traveling for a long while.

 

[Just_Steve]

We are only in the second inning with COVID-16.

Good thing we are dealing with COVID-19.

 

[bjorn2bwild]

A vaccine in the next 12-18 months seems overly optimistic, given that an effective human vaccine against any coronavirus has yet to be developed. The special challenges are explained in this article. A few quotes ----

There are several reasons why our upper respiratory tract is a hard area to target a vaccine.
"It's a separate immune system, if you like, which isn't easily accessible by vaccine technology," Professor Frazer told the Health Report.
Despite your upper respiratory tract feeling very much like it's inside your body, it's effectively considered an external surface for the purposes of immunisation.
"It's a bit like trying to get a vaccine to kill a virus on the surface of your skin."

Your skin, and the outer layer of cells in your upper respiratory tract act as a barrier to viruses, stopping them getting into the body.
And finding a way to neutralise the virus "outside" of the body is very difficult.
This is partly because only the outer layer of cells (the epthelial cells) get infected, which, compared to a severe infection of internal organs doesn't produce the same immune response, so is harder to target.
It's hard to produce a successful vaccine if the virus isn't activating a strong immune response.

So is antibody response critical to whether or not a vaccine is going to work?
To answer this we have to go back to what we know about coronaviruses that cause the common cold, according to Professor Frazer.
"Yes, you get antibodies after a [cold] infection, and yes it lasts for a while, but it's not lifelong... sort of months rather than years," he said.
"I think it would be fair to say that the natural immunity that you get after infection from this coronavirus is probably going to turn out like the coronaviruses we've seen in the past.

https://www.abc.net.au/news/health/2020-04-17/coronavirus-vaccine-ian-frazer/12146616

 

[Dtail]

Some interesting information and commentary in this interview with Michael Osterholm, who is an infectious disease expert.

He basically says this is going to be a long haul, and that we may only be in about the "second inning" of a nine-inning game right now. The virus will probably need to infect 60-70% of the population before we see a major reduction in its transmission. He thinks we could see 800,000 deaths (or more) in the U.S. over the next 18 months.

https://www.cnn.com/2020/04/21/opinions/bergen-osterholm-interview-two-opinion/index.html

Predicts an eventual 800k deaths. Hope not.

 

[Midpack]

Unless we get very lucky with some currently unknown therapy, this is going to take a long while, inflict many deaths and economic damage, hinge largely on public safety cooperation, and there’s no way to perfectly optimize when/how to proceed.

From the JP Morgan paper shared by a Mod here, in a nutshell.

Following the herd in COVID-19 exit strategies

• Severe economic and social shutdowns are effective in stopping the COVID-19 epidemic
• But the economic and social pain is significant, and herd immunity is not being built
• Exit strategies should aim at protecting those most vulnerable, while letting everyone else get back to work

The presumed aim of public policy in the face of COVID-19 should be to allow the development of herd immunity while minimizing the pressure on healthcare systems, deaths, the economy, and social welfare as the development of a vaccine proceeds. The current policy of extensive shutdowns of economic and social activity is focused on minimizing pressure on healthcare systems and COVID-19 related deaths, but with massive repercussions on the economy (huge declines in GDP and huge increases in unemployment) and social welfare (health outside COVID-19, mental health, domestic violence). It also slows the development of herd immunity as the extensive shutdown measures have limited infection rates and thus the buildup of immunity in the population.

As countries furthest ahead in the epidemic turn toward exit strategies, planning appears focused on the gradual easing of restrictions and then seeing how it goes. If nothing untoward happens then more restrictions are eased. The problem with this approach is that it will open up the economy and society slowly, and that there will need to be repeated moves to calibrate restrictions as the epidemic ebbs and flows. A potentially better approach would be to consciously focus on age- and morbidity-related restrictions. Hospitalization and deaths are strongly related to age and co-morbidities. If mixing between the elderly and the less vulnerable younger populations can be sufficiently reduced, the economy and society can get back to work quickly, herd immunity can build, and the health care system as well as the old and vulnerable can be protected.

 

[foxfirev5]

If this is the case a lot of us are going to get rained out before the 5th inning.

 

[Midpack]

If this is the case a lot of us are going to get rained out before the 5th inning.

All deaths are tragic, but it may be a significant number but a small percentage?

 

[REWahoo]

All deaths are tragic, but it may be a significant number but a small percentage?

And only abstract and impersonal - unless it's someone close, or you.

 

[foxfirev5]

800k is significant either way. But I offer no solution.

 

[Midpack]

And only abstract and impersonal - unless it's someone close, or you.

Agreed. But thats not unique to Covid-19. Its true of every accidental death for any reason, many others have also been significant numbers year after year. We seem to accept them year in and year out - because they’re low percentages? I don’t understand that either.

It appears many are saying we’re going to be exposed sooner or later anyway. If so, we might as well reopen in stages as fast as we can SHORT of overwhelming our health care resources. By no means my original idea.

 

[REWahoo]

It appears many are saying we’re going to be exposed sooner or later anyway. If so, we might as well reopen in stages as fast as we can SHORT of overwhelming our health care resources. By no means my original idea.

I'm not in the "might as well go ahead and get this out of the way" camp as I think it is both short-sighted and fatalistic. That strategy discounts the very real possibility that over time we will find better ways of treating those who become ill and/or discover or develop drugs to reduce mortality.

I support finding an unhappy medium in reopening, one that neither the 'business as usual' or the 'hunker and isolate' supporters are completely happy about. That will probably mean we've got it as right as we can under the circumstances.

 

[Midpack]

I'm not in the "might as well go ahead and get this out of the way" camp as I think it is both short-sighted and fatalistic. That strategy discounts the very real possibility that over time we will find better ways of treating those who become ill and/or discover or develop drugs to reduce mortality.

I support finding an unhappy medium in reopening, one that neither the 'business as usual' or the 'hunker and isolate' supporters are completely happy about. That will probably mean we've got it as right as we can under the circumstances.

I wholeheartedly agree. Neither extreme view is of any real use. The best way through is somewhere in between and it will be sad.

 

[Ian S]

While true, the "there's never been a successful corona virus vaccine" claim is quite misleading since it implies that it's too difficult to make while the real reason is there's never been a deadly enough corona virus that has stayed around long enough for a vaccine to be brought to market. There actually was a SARS vaccine developed but when the SARS outbreak died away, there was no funding to proceed with the vaccine trials.

The researcher quoted in the abc.net article really only made the point that a vaccine would be challenging. Others as evidenced by the huge worldwide effort to come up with one seem to think it's quite possible and I tend to optimistically share that view. I'm also optimistic that we will come up with therapeutic drugs that will at minimum, reduce the severity of the disease. We certainly have very effective drugs for HIV which posed extraordinary challenges since it infects key components of the immune system itself. Before anyone argues that it took a long time for such therapeutic drugs to be developed, I'd argue that we have today far more powerful technology for quickly testing and developing such drugs that we had 30 years ago.

 

[Fermion]

609,000 people will die of cancer in the USA in the next 12 months.

3.8 million babies will be born in the next 12 months (actually probably closer to 4 million with the stay at home stuff)

 

[MuirWannabe]

609,000 people will die of cancer in the USA in the next 12 months.



3.8 million babies will be born in the next 12 months (actually probably closer to 4 million with the stay at home stuff)

Well, I know my daughters are contributing with two more little grandies on the way!

 

[HI Bill]

Epidemiology uses the term "basic reproduction number" (R0) to indicate how many people one infected person is likely to infect. For COVID-19, in an unrestricted population, the number is thought to be close to 4 (one infected individual infects 4 others). In first world countries, we have lowered the effective number to probably 2(?) through the use of social distancing, essential workplaces, and masks.

The concept of Herd Immunity is considered "a form of indirect protection from infectious disease that occurs when a large percentage of a population has become immune to an infection, whether through previous infections or vaccination, thereby providing a measure of protection for individuals who are not immune" (Wikipedia). I've been wondering if the often-cited 70% infection rate for herd immunity to be effective considers the "basic reproduction number". Since the R0 is high, once we return to 'normal', since COVID-19 lasts a long time on hard surfaces and longer on soft surfaces, and is spread through aerosolized saliva through coughing, I'm reasoning that herd immunity won't be effective in providing protection for those who haven't been affected. I'm not an epidemiolgist, but many of those who are seem to be using an old playbook that doesn't take into account differences in the R0 values and the spread of COVID-19.

 

[folivier]

So if someone has had a mild case of C-19 and has developed antibodies the medical professionals are not certain yet if this person has developed an immunity going forward. Possibly for a set time period but not forever.
But I'm wondering if that person catches C-19 again if their body will react the same. IOW will it be a mild case? Or a possibility of it being life threatening?

 

[Gumby]

Epidemiology uses the term "basic reproduction number" (R0) to indicate how many people one infected person is likely to infect. For COVID-19, in an unrestricted population, the number is thought to be close to 4 (one infected individual infects 4 others). In first world countries, we have lowered the effective number to probably 2(?) through the use of social distancing, essential workplaces, and masks.

The concept of Herd Immunity is considered "a form of indirect protection from infectious disease that occurs when a large percentage of a population has become immune to an infection, whether through previous infections or vaccination, thereby providing a measure of protection for individuals who are not immune" (Wikipedia). I've been wondering if the often-cited 70% infection rate for herd immunity to be effective considers the "basic reproduction number". Since the R0 is high, once we return to 'normal', since COVID-19 lasts a long time on hard surfaces and longer on soft surfaces, and is spread through aerosolized saliva through coughing, I'm reasoning that herd immunity won't be effective in providing protection for those who haven't been affected. I'm not an epidemiolgist, but many of those who are seem to be using an old playbook that doesn't take into account differences in the R0 values and the spread of COVID-19.

For herd immunity % = 1- (1/Ro) ==> if Ro is 4 for COVID then 1-(1/4) = 75%. For something like measles, which is very highly infectious and has a Ro of 12-18, you need between 92% and 95%

 

[audreyh1]

So if someone has had a mild case of C-19 and has developed antibodies the medical professionals are not certain yet if this person has developed an immunity going forward. Possibly for a set time period but not forever.
But I'm wondering if that person catches C-19 again if their body will react the same. IOW will it be a mild case? Or a possibility of it being life threatening?

Do they have mild cases that did not develop antibodies?

I know that they had some cases that didn’t develop much antibodies, but those cases weren’t mild AFAIK. It was more the individuals who had difficulty, and they might have been elderly?

In general from what I’ve read, the body has some memory about how to fight the disease.

 

[ivinsfan]

I'm not in the "might as well go ahead and get this out of the way" camp as I think it is both short-sighted and fatalistic. That strategy discounts the very real possibility that over time we will find better ways of treating those who become ill and/or discover or develop drugs to reduce mortality.

I support finding an unhappy medium in reopening, one that neither the 'business as usual' or the 'hunker and isolate' supporters are completely happy about. That will probably mean we've got it as right as we can under the circumstances.

Yes and yes and if you think the last election divided this country and made people bitter wait until this get implemented. This isn't just a US issue obviously and I expect worldwide chaos for the foreseeable future.