Wuhan Coronavirus Resource Thread

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Suraj
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Re: Wuhan Coronavirus Resource Thread

Post by Suraj »

Cyrano: take a few days off the site.

This thread is meant to serve as a focused and calm place to keep track of information and resources.

Not a place to vent and hyperventilate. We don't want to have to ban people for being very stressed out. If you're posting stuff with a lot of exclamation marks and question marks, it's a good time to step away and calm down.
Suraj
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Re: Wuhan Coronavirus Resource Thread

Post by Suraj »

Mod Note

I'm going to delete a bunch of coulda / shoulda / woulda yelling here. Come back with a time machine if you're really serious about it. Not the time for angry emotional recriminations. You're stressed. Get off the site, off the internet too if needed, and take care of your emotional well being first.
Cyrano
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Re: Wuhan Coronavirus Resource Thread

Post by Cyrano »

Suraj ji,
I can't figure out what you're saying nor why the govt is doing what they're doing wrt vaccine policy. For the sake of our people I wish you're right, those considerations matter and will indeed save lives which would otherwise be lost. Time will tell.

The biggest trap for those in positions of authority is that their credibility comes from being seen as infallible. It clouds judgement and constrains action like no other. True for doctors, scientists, ICMR, hizzoners, govts and even Modi. Our fate hangs on their ability to withstand the need for infallibility.
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Re: Wuhan Coronavirus Resource Thread

Post by Rudradev »

Is it time for the GOI to declare an Emergency?

Usually the argument against that is: if they declare an Emergency the opposition (and their pet media) will go hog-wild talking about "suppression of democracy" etc.

But in this instance, the opposition (and their pet media) have already gone hog-wild talking about how incompetent the GOI has been at anticipating and dealing with the second wave of COVID. They've been breathlessly putting out scary numbers and horrifying anecdotes and what not. In the event, they've effectively made the case that there IS a major national disaster in progress. If this isn't an Emergency-worthy situation, what is?

In the meantime we're experiencing a concerted information-war campaign against everything from vaccines to healthcare management to public-safety policies to (of course) Hindu religious practices. Some of this is actively dangerous and stands to worsen or protract the latest wave of the pandemic. There is a case to be made for the center temporarily seizing certain powers from the hands of the states and curtailing expression across multiple platforms, be they conventional media outlets or WhatsApp groups.

This is the most tenuous period of all for Modi Sarkar. Modi HAS to be seen as doing something definitive, even if it oversteps the boundaries established by our constitutional norms for ordinary circumstances, because present circumstances are clearly beyond ordinary. If greater control of medical supply chains, policy implementation and public confidence can be achieved by the centre stepping in with a more authoritarian approach, then I am beginning to think it should do so without further delay.
Last edited by Rudradev on 01 May 2021 02:48, edited 1 time in total.
Cyrano
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Re: Wuhan Coronavirus Resource Thread

Post by Cyrano »

Yes i'm stressed, who in their right mind wouldn't be? But stress has always sharpened my thoughts and spurred me into action. Has never clouded my judgement si far. But thanks for the advice.
Karan M
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Re: Wuhan Coronavirus Resource Thread

Post by Karan M »

Cyrano wrote: I'm hearing horror stories from doctor friends on the frontline that many of their fellow doctors dont understand the covid treatment protocol from ICMR. They are being asked to first kill immune response using steroids and then give Remdesivir (which in another form costs 1 dollar/dose) to stop virus replication. Meanwhile the millions of virus copies invest liver, lungs, kidneys and kill the patient unless he is very lucky. Cytokine storms are not seen in current variants. So ICMR protocol itself is outdated wrt ground reality. Most doctors brave as they are werent trained for this many are clueless and are making fatal mistakes not knowing why and how they are killing patients, even themselves or their relatives if they're sick and in hospital. Thats why the bodies are piling up. One of my doctor friends MD, cancer specialist and immunologist, 25 yes experience, was on phone yday. I called him to wish on his birthday. He said the above and broke down crying. He was in his hospital toilet. Left me speechless.
I think you or whosoever informed you about the protocol has misunderstood it. ICMR protocol is as of 21 April 2021.

Link

Mild disease - the inhaled steroids are given after 5 days because by then an overactive immune response may have started. Claiming overactive immune response isnt seen is fairly inaccurate. Twitter/social media is full of doctors reporting them and BRF doctors have reported it too.
Therapies based on low certainty of
evidence
➢ Tab Ivermectin (200 mcg/kg once
a day for 3 days). Avoid in
pregnant and lactating women.
OR
➢ Tab HCQ (400 mg BD for 1 day f/b
400 mg OD for 4 days) unless
contraindicated.
❖ Inhalational Budesonide (given
via Metered dose inhaler/ Dry
powder inhaler) at a dose of 800
mcg BD for 5 days) to be given if
symptoms (fever and/or cough)
are persistent beyond 5 days of
disease onset.
Moderate-Severe disease
2. SpO2: 90% to < 93% on room air

3. Any one of:
1. Respiratory rate >30/min, breathlessness
2. SpO2 < 90% on room air
Indicates lungs are already affected by the cytokine storm
Anti-inflammatory or immunomodulatory therapy
➢ Inj. Methylprednisolone 0.5 to 1 mg/kg in 2 divided
doses (or an equivalent dose of dexamethasone) usually
for a duration of 5 to 10 days.
➢ Patients may be initiated or switched to oral route if
stable and/or improving.
Anticoagulation
➢ Conventional dose prophylactic unfractionated heparin
or Low Molecular Weight Heparin (weight based e.g.,
enoxaparin 0.5mg/kg per day SC). There should be no
contraindication or high risk of bleeding.
Monitoring
➢ Clinical Monitoring: Work of breathing, Hemodynamic
instability, Change in oxygen requirement.
➢ Serial CXR; HRCT chest to be done ONLY If there is
worsening.
➢ Lab monitoring: CRP and D-dimer 48 to 72 hrly; CBC,
KFT, LFT 24 to 48 hrly; IL-6 levels to be done if
deteriorating (subject to availability).
Note the reference to treating the cytokine issue when this situation has already started. No anti-virals mentioned.

Remdisivir is mentioned here:
EUA/Off label use (based on limited available evidence and only in specific circumstances):
➢ Remdesivir (EUA) may be considered ONLY in patients with
o Moderate to severe disease (requiring SUPPLEMENTAL OXYGEN), AND
o No renal or hepatic dysfunction (eGFR <30 ml/min/m2; AST/ALT >5 times ULN (Not an
absolute contradiction), AND
o Who are within 10 days of onset of symptom/s.
Recommended dose: 200 mg IV on day 1 f/b 100 mg IV OD for next 4 days.
o Not to be used in patients who are NOT on oxygen support or in home settings
➢ Tocilizumab (Off-label) may be considered when ALL OF THE BELOW CRITERIA ARE MET
o Presence of severe disease (preferably within 24 to 48 hours of onset of severe
disease/ICU admission).
o Significantly raised inflammatory markers (CRP &/or IL-6).
o Not improving despite use of steroids.
o No active bacterial/fungal/tubercular infection.
❖ Recommended single dose: 4 to 6 mg/kg (400 mg in 60kg adult) in 100 ml NS over 1
hour.
➢ Convalescent plasma (Off label) may be considered ONLY WHEN FOLLOWING CRITERIA ARE MET
o Early moderate disease (preferably within 7 days of symptom onset, no use after 7 days).
o Availability of high titre donor plasma (Signal to cut-off ratio (S/O) >3.5 or equivalent
depending on the test kit being used).
The above two are the only anti-virals.

So clearly, there is a lot of nuance and thought that has gone into this.

Unless you are a medical professional with frontline CV awareness you shouldn't be second guessing and spreading misinformation about the protocol.
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Re: Wuhan Coronavirus Resource Thread

Post by Karan M »

Cyrano wrote:Remdesivir seems to be an extremely questionable drug if not a total hoax.

https://www.francesoir.fr/societe-sante ... remdesivir

I remember a report on this drug was published by Lancet just before EU approval and was retracted right after

Under its previous name Veklury the same drug was sold at à fraction of the price.

Why is ICMR still recommending Remdesivir/Veklury ??
Remdesivir is prescribed under a very specific set of circumstances as it is the only anti-viral available. Doctors who have used it have provided anecdotal reviews stating a limited amount of effectiveness. AIIMS clearly mentions "EUA/Off label use (based on limited available evidence and only in specific circumstances)".
Karan M
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Re: Wuhan Coronavirus Resource Thread

Post by Karan M »

Cyrano wrote:Yes i'm stressed, who in their right mind wouldn't be? But stress has always sharpened my thoughts and spurred me into action. Has never clouded my judgement si far. But thanks for the advice.
Your judgment has been impaired sir. Above post with regards to the ICMR protocol was exactly that. You don't have all the information at hand and went off half-cocked based on one anecdotal account.
Karan M
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Re: Wuhan Coronavirus Resource Thread

Post by Karan M »

Rudradev wrote:Is it time for the GOI to declare an Emergency?

Usually the argument against that is: if they declare an Emergency the opposition (and their pet media) will go hog-wild talking about "suppression of democracy" etc.

But in this instance, the opposition (and their pet media) have already gone hog-wild talking about how incompetent the GOI has been at anticipating and dealing with the second wave of COVID. They've been breathlessly putting out scary numbers and horrifying anecdotes and what not. In the event, they've effectively made the case that there IS a major national disaster in progress. If this isn't an Emergency-worthy situation, what is?

In the meantime we're experiencing a concerted information-war campaign against everything from vaccines to healthcare management to public-safety policies to (of course) Hindu religious practices. Some of this is actively dangerous and stands to worsen or protract the latest wave of the pandemic. There is a case to be made for the center temporarily seizing certain powers from the hands of the states and curtailing expression across multiple platforms, be they conventional media outlets or WhatsApp groups.

This is the most tenuous period of all for Modi Sarkar. Modi HAS to be seen as doing something definitive, even if it oversteps the boundaries established by our constitutional norms for ordinary circumstances, because present circumstances are clearly beyond ordinary. If greater control of medical supply chains, policy implementation and public confidence can be achieved by the centre stepping in with a more authoritarian approach, then I am beginning to think it should do so without further delay.
We are likely already at the phase where GOI estimates situation will stabilize. May 4-8 per the latest model per some reports. Declaring an emergency countrywide at this point may be counter-productive.

Delhi, UP, Bihar need the maximum effort, an emergency like proclamation may be useful there. IA has been given sweeping powers for pandemic assistance. They may be roped in too, if situation doesnt abate.
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Re: Wuhan Coronavirus Resource Thread

Post by chanakyaa »

Keeping the doom and gloom SM posts/news aside...

If I'm reading the data correctly, the data from Covid19India.org is very encouraging. Assuming the testing and data recording has kept pace, the weekly rate of growth appears to have slowed down considerably. It was stubbornly high between April 8 - 17th at approx. 7.3%. Between April 18th thru 23rd weekly case increases declined below 6% and after April 24th the rate of growth is below 3%. Yes, case count is increasing but the first order derivative is slowing...
darshan
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Re: Wuhan Coronavirus Resource Thread

Post by darshan »

Donation to PM-CARES Fund
https://www.dalailama.com/news/2021/don ... cares-fund


Thekchen Chöling, Dharamsala, HP, India - In a letter to Prime Minister Narendra Modi today His Holiness the Dalai Lama wrote:

“I have been following the continuing challenge that the Covid-19 pandemic has been posing across the world, including in India, with concern.

“At this critical time, during this alarming Covid-19 surge, I have asked the Dalai Lama Trust to make a donation to the PM-CARES Fund as a token of our solidarity with fellow Indian brothers and sisters.

“May I take this opportunity to express my deep appreciation for all the efforts that are being made to tackle this devastating pandemic, especially by those courageously working on the frontline. I pray that the pandemic threat will end soon.”
Cyrano
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Re: Wuhan Coronavirus Resource Thread

Post by Cyrano »

Karan M wrote:
Cyrano wrote:Yes i'm stressed, who in their right mind wouldn't be? But stress has always sharpened my thoughts and spurred me into action. Has never clouded my judgement si far. But thanks for the advice.
Your judgment has been impaired sir. Above post with regards to the ICMR protocol was exactly that. You don't have all the information at hand and went off half-cocked based on one anecdotal account.
Hope you read the link I posted as well. I'm not a doctor so my judgement on a drug doesnt arise. Perhaps thé doctors who post here can tell us how they see ICMR's protocol being applied on the ground, and including Remdesivir in there is causing more harm since the "nuances" are not being understood by doctors on the ground, than any good it does. Someone I trust and respect, a topper through out and well regarded by his peers was very critical about it. Thought it was worth sharing given the endless panic striken enquiries on where to get it and the rampant price gouging going on.
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Re: Wuhan Coronavirus Resource Thread

Post by Mort Walker »

Rudradev wrote:Is it time for the GOI to declare an Emergency?

Usually the argument against that is: if they declare an Emergency the opposition (and their pet media) will go hog-wild talking about "suppression of democracy" etc.

But in this instance, the opposition (and their pet media) have already gone hog-wild talking about how incompetent the GOI has been at anticipating and dealing with the second wave of COVID. They've been breathlessly putting out scary numbers and horrifying anecdotes and what not. In the event, they've effectively made the case that there IS a major national disaster in progress. If this isn't an Emergency-worthy situation, what is?

In the meantime we're experiencing a concerted information-war campaign against everything from vaccines to healthcare management to public-safety policies to (of course) Hindu religious practices. Some of this is actively dangerous and stands to worsen or protract the latest wave of the pandemic. There is a case to be made for the center temporarily seizing certain powers from the hands of the states and curtailing expression across multiple platforms, be they conventional media outlets or WhatsApp groups.

This is the most tenuous period of all for Modi Sarkar. Modi HAS to be seen as doing something definitive, even if it oversteps the boundaries established by our constitutional norms for ordinary circumstances, because present circumstances are clearly beyond ordinary. If greater control of medical supply chains, policy implementation and public confidence can be achieved by the centre stepping in with a more authoritarian approach, then I am beginning to think it should do so without further delay.
The health care system is beginning to collapse in many cities and states and municipalities with poor governance are showing. There is a lot of FUD out there and even on this forum statements like 5x or 10x underreporting of deaths are being doled out which does not pass the smell test. Some don't even understand how the center and states are funded and operating with ignorant comments like "it's all taxpayer money anyway".

It is absolutely shameful for the western press, and DDM to follow, to highlight mass cremations. Cremations are the most effective way for handling the dead to prevent further disease and is tied to many millennia of Hindu religious rites. These same people would never make fun of rental trucks in NY stockpiling bodies for weeks and then showing mass burials repeatedly.

If anything, an emergency to shut down foreign SM platforms is needed, but I don't think it's possible.

My criticism of the central government, MoHFW + ICMR, is that DNA sequencing of the virus in infected patients is very low, and is something very needed to keep track of variants. Something like 0.05% is being done, but even the US fails at it with 0.18%; however, that is more than 3 times of what we're seeing in India.
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Re: Wuhan Coronavirus Resource Thread

Post by darshan »

Hopefully they do follow on study after the wave about the effectiveness of this.
Gujarat Govt to distribute Ayurvedic and Homeopathic medicines:CM
https://www.deshgujarat.com/2021/04/26/ ... dicinescm/
...
As per the guidance given by the Chief Minister to strengthen the distribution system of these Ayurvedic medicines up to the district-taluka and village level, a strategy has been formulated to distribute it to the masses through Talatis, Sarpanchs, Asha-worker sisters and service organizations.
...
Poly Herbal Formulation AYUSH-64 Found Useful In Treatment Of Mild To Moderate COVID-19 Infection: AYUSH Ministry
https://swarajyamag.com/news-brief/poly ... h-ministry
AYUSH 64 comprises of Alstonia scholaris (aqueous bark extract), Picrorhiza kurroa (aqueous rhizome extract), Swertia chirata (aqueous extract of whole plant) and Caesalpinia crista (fine-powdered seed pulp). It is extensively studied, scientifically developed, safe and effective Ayurveda formulation. This medicine is also recommended in National Clinical Management Protocol based on Ayurveda and Yoga which is vetted by National Task Force on COVID-19 Management of ICMR, the release said.
Suraj
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Re: Wuhan Coronavirus Resource Thread

Post by Suraj »

Mort Walker wrote:My criticism of the central government, MoHFW + ICMR, is that DNA sequencing of the virus in infected patients is very low, and is something very needed to keep track of variants. Something like 0.05% is being done, but even the US fails at it with 0.18%; however, that is more than 3 times of what we're seeing in India.
The Covid super model development team (Prof. Vidyasagar and Prof.Agrawal) also mentioned that lack of data (or delays thereof) on hospitalizations vs cases among other things affects their modeling fidelity and requested more regular updates. They are currently projecting a peak around May 4-8.

As chanakya points out, there's a significant moderation in active case count over the past week. It still remains positive, i.e. the curve will have a positive slope, but will drop to 0 next week based on current projections, and then the curve drops. That will happen when active cases go negative as recoveries outpace confirmed cases.

One of the interesting things is that unlike all others we're having a wave even as high risk group is building substantial vaccination cover.

9% of population is >60 according to population pyramid. That is ~120 million. The latest 8pm PIB data shows 52 million of them (43%) have at least first dose, which dramatically cuts or eliminates mortality risk. They may get Covid, but they are one less person who will end up in an oxygen bed. The 45-60 group numbers ~190 million and 52 million of that group (27%) also has at least one dose.

These are substantially higher numbers than any other place that had a major wave. The wave took hold late March. Here are the vaccination counts:
March 15: 31.7 million
April 1: 67.5 million
April 30: 155 million

So we've done ~125 million vaccinations through essentially the significant part of the wave to date, and 88 million in April. This has a significant impact on transmission. I'm looking for the paper on this - vaccinated people are much less capable of transmitting Covid than actually getting it themselves. Vaccines may fail to prevent breakthroughs but keep viral loads down so much that transmission is significantly weakened. This is also why those with at least one dose get only mild Covid even if they're otherwise very high risk and near sitting ducks otherwise.
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Re: Wuhan Coronavirus Resource Thread

Post by darshan »

More and more leaders need to step up and keep this going. This is the most effective way to deal with any misinformation for the base of pyramid.
Request to get Vaccinated Against Coronavirus
https://www.baps.org/News/2021/Request- ... 19688.aspx
...
On behalf of HH Mahant Swami Maharaj, Pujya Swayamprakashdas Swami (Pujya Doctor Swami) has appealed to everyone to follow all disciplines necessary for our protection against the virus.
..
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Re: Wuhan Coronavirus Resource Thread

Post by disha »

It is difficult to cut through anxiety and doom and gloom scenario. I myself in my panic would find it difficult to listen to any logical counter-point.

Still, several states are managing it well. Gujarat for example has been adding 1000 beds per day on an average since last month. The case count in Maharashtra is trending down.

Here is the google URL on Maharashtra https://news.google.com/covid19/map?hl= ... id=US%3Aen

Here is the report on Gujarat https://timesofindia.indiatimes.com/cit ... 316624.cms
In an interview with TOI on April 18, CM Vijay Rupani has said the state has increased it's Covid-19 bed capacity from 41,000 on March 15 to 78,000.

He said the state is set to add 8,000 oxygen beds on war footing in 10 days.
I am trying to find Orissa on the map. Last checked Odiyans are Indians too. They are also having a second wave.

https://odishatv.in/odisha-news/covid-1 ... urs-537320

And they are marching along forward.

In Telangana, story seems to be different. The wave seems to be flat! But more importantly check the news https://indianexpress.com/article/citie ... e-7290291/

In the above link there are two hospitals mentioned (TIMS & Gandhi Hospital). I have nightmares of Gandhi hospital and would not go there even if my life depends on it, but TIMS, I can still draw a layout of various facilities in TIMS even now.

And neither of the above have the drama that is being pulled by the Media in the NCR.
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Re: Wuhan Coronavirus Resource Thread

Post by Rudradev »

The sequencing of viral genomes has prognostic value, but doesn't really help a lot once a flare-up has started.

What is a "mutant" strain of the virus? Essentially, it is a virus with DNA alterations that affect the amino acid sequences, and hence the structure and function, of one or more of its 29 viral proteins. Mutation-carrying variants that become widespread do so by natural selection, because their mutations give them advantages relative to the original viral DNA sequence. For example the variant B.1.1.7 has a total of 17 mutations, of which 8 mutations in the spike-protein encoding region may confer certain advantages to the virus in terms of entering cells it wants to infect.

Fine. So for argument's sake, let's say COVID B.1.1.7 gains a total score of (+8) from its suite of mutations. If the resources had been spent on sequencing a large number of COVID-positive samples in the December-February timeframe, we might have noticed that the trend in COVID-positive people who carried this B.1.1.7 variant was headed upwards, and we might have been able to predict a higher chance of the current flare-up, since there was obviously a new variant around that was better at infecting cells. Better, that is, by our arbitrary factor of (+8). Then maybe we could have imposed stricter mask rules, social distancing, and other restrictions preventatively to try and avoid the flareup.

On the other hand: a vaccine trains the immune system to respond to many dozens of epitopes-- immune recognition sites-- distributed across multiple viral proteins and domains (sections of proteins). So we might say the immune system of a vaccinated person has augmented its score by (+100) at least, and potentially far more than that.

While these "score" numbers I'm throwing out are laughably unscientific, they do illustrate a general idea that is true: taking a vaccine puts humans far ahead of the game compared to the advantage that B.1.1.7's suite of mutations give the virus (+8, per our arbitrary schema).

So in general there's not much sequencing can tell you once a flare-up is already in progress. You can detect B.1.1.7 and potentially other variants as well, but by the time you have a situation like India is in now, the variants are already well established in the population and it's too late for additional preventative measures to be of help. If one has limited resources, it makes vastly more sense to spend them on developing and distributing vaccines (as well as other life-saving therapeutic equipment, oxygen, hospital infrastructure etc) than on sequencing.
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Re: Wuhan Coronavirus Resource Thread

Post by Mort Walker »

While I agree there isn't much sequencing of the virus can tell once a wave is in progress, it will tell you of the efficacy of the vaccines. Yes, the vaccine puts you ahead, but how far ahead? The last thing we want is low efficacy of a vaccine on a predominantly mutated virus causing the wave.
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Re: Wuhan Coronavirus Resource Thread

Post by Suraj »

Question for the medical experts, or those who know - in the latter case please try to buttress explanation with reference:

What is 'efficacy rate' ?

It sounds dumb but this term is heavily misused. Even companies misuse it. Pfizer and Moderna who did their trials before major variants were visible, have high efficacy. Not much data appears available of their updated efficacy numbers with newer variants.

More interestingly, efficacy percentages state one number (somewhere between 50-90+% and then say 'near 100% protection from hospitalizations and death.

So, literally what does it mean ?

If vaccine has efficacy against variant X, does it mean:
1. Except for <1% breakthrough cases you won't get the virus ?
2. You may get it but the won't be severe
Ditto for where efficacy against variant Y isn't good . Lack of efficacy means:
1. You have no defense against getting it, but vaccine still protects you from hospitalization ?
2. No efficacy means your chances are same as anyone unvaccinated.
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Re: Wuhan Coronavirus Resource Thread

Post by Rudradev »

Mort, my point is that mutations may alter a handful of characteristics for the virus to become better at infecting people. But the vaccine-- ANY vaccine-- trains the immune system to recognize and attack the virus from a huge number of different axes. There is no way that the virus' natural evolution (in terms of disguising itself against the immune system) can keep up with the number of advantages that taking a vaccine gives the immune system. Natural molecular evolution is simply not fast enough to keep up.

Here's a review of the variety of different epitopes that the immune system can recognize in SARS-CoV2. https://www.nature.com/articles/s41577-020-00480-0 All things considered, the spectrum of epitopes (immune recognition sites on the virus) is vast... my +100 number was almost certainly too low by 2 or 3 orders of magnitude. A vaccine will amp up the populations of immune cells that can specifically recognize and act against SARS-CoV2 via all these epitopes.
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Re: Wuhan Coronavirus Resource Thread

Post by Rudradev »

Suraj:

I'm not a medical doctor or epidemiologist, but here's a piece from Lancet on your question.

Code: Select all

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(21)00075-X/fulltext
The mRNA-based Pfizer1, 2 and Moderna3 vaccines were shown to have 94–95% efficacy in preventing symptomatic COVID-19, calculated as 100 × (1 minus the attack rate with vaccine divided by the attack rate with placebo). It means that in a population such as the one enrolled in the trials, with a cumulated COVID-19 attack rate over a period of 3 months of about 1% without a vaccine, we would expect roughly 0·05% of vaccinated people would get diseased. It does not mean that 95% of people are protected from disease with the vaccine.


If we vaccinated a population of 100,000 and protected 95% of them, that would leave 5000 individuals diseased over 3 months, which is almost the current overall COVID-19 case rate in the UK. Rather, a 95% vaccine efficacy means that instead of 1000 COVID-19 cases in a population of 100,000 without vaccine (from the placebo arm of the abovementioned trials, approximately 1% would be ill with COVID-19 and 99% would not) we would expect 50 cases (99·95% of the population is disease-free, at least for 3 months).
Moreover:
A vaccine will not prevent you from getting infected by the virus. It only trains the immune system to recognize and respond to a viral infection once it has occurred. In most people, a robust and early response to the presence of virus by the immune system means the virus will be less capable of infecting cells (and, more importantly, affecting the biology of blood coagulation once it is in the body: most of the deaths caused by COVID seem to occur as a result of distributed intravascular coagulation of blood, which is why e.g. ventilators were not of much use in saving lives).

So yes, it is about how ill (or dead) you will become once the virus enters your system. If your immune system deals with the virus efficiently it won't have as much opportunity to create havoc.

The secondary implication of vaccination is that if a person becomes infected, but (thanks to the vaccine) is able to rapidly eliminate the virus from his/her system, he/she then does not pose an infection risk to others.
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Re: Wuhan Coronavirus Resource Thread

Post by disha »

Rudradev wrote:A vaccine will not prevent you from getting infected by the virus. It only trains the immune system to recognize and respond to a viral infection once it has occurred.

In most people, a robust and early response to the presence of virus by the immune system means the virus will be less capable of infecting cells (and, more importantly, affecting the biology of blood coagulation once it is in the body: most of the deaths caused by COVID seem to occur as a result of distributed intravascular coagulation of blood, which is why e.g. ventilators were not of much use in saving lives).

So yes, it is about how ill (or dead) you will become once the virus enters your system. If your immune system deals with the virus efficiently it won't have as much opportunity to create havoc.

The secondary implication of vaccination is that if a person becomes infected, but (thanks to the vaccine) is able to rapidly eliminate the virus from his/her system, he/she then does not pose an infection risk to others.
Very well put Rudradev and highlighting some important parts from my perspective.

In BRF lingo, the vaccine trains your soldiers to deal with bakis. The bakis will still infiltrate and infect you, but the soldiers are now trained to recognize them and deal with them.

Of course if you are not strong and are not able to marshall enough soldiers, you will get overwhelmed if the bakis show up in substantial numbers. Just because your soldiers are now trained does not mean you test them by putting them in harms' way purposely.

That's one another reason why even after getting vaccine people must not behave like a superman and jump out and about. If one wants to truly feel like a superman, well don a cape and wear red underpants over blue trousers.

I had cousins who after first jab went party hopping. :roll: Now all of them are scared and anxious. Pendulum swung very fast to the other side.
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Re: Wuhan Coronavirus Resource Thread

Post by disha »

Suraj wrote: So, literally what does it mean ?

If vaccine has efficacy against variant X, does it mean:
1. Except for <1% breakthrough cases you won't get the virus ?
2. You may get it but the won't be severe
Ditto for where efficacy against variant Y isn't good . Lack of efficacy means:
1. You have no defense against getting it, but vaccine still protects you from hospitalization ?
2. No efficacy means your chances are same as anyone unvaccinated.
Rudradev already answered. For me baki analogy works and hence put that out.

And again no medical expert and putting it out based on my understanding:

Q1. Except for <1% breakthrough cases you won't get the virus ?

A: You will get the virus. That is if you move around where the virus can enter your system, you will be infected with virus. Just that your immune system is now trained to eliminate it before they become a nuisance. If they are eliminated to a very high degree, you will not shed enough virus to infect someone else. And that stops the transmission.

The breakthrough cases are because the immune system is not sufficiently trained. Or the virus load is so severe that the symptoms show through. In this case, you may transmit enough virus to infect someone. At the same time you may recover with mild symptoms since your immune system fought back. This stops you from ending up in hospital. Or even if you end up in hospital you may not end up in ICU.

Q2. You may get it but the won't be severe
Para 2 above.

Ditto for where efficacy against variant Y isn't good . Lack of efficacy means:
1. You have no defense against getting it, but vaccine still protects you from hospitalization ?

Statistically it has been explained by Rudradev. In terms as I understand, the immune system in certain (100-efficacy) population is not trained well or not trained at all, that when challenged that population will not elicit an immune response.

So if you take the numbers from Rudradev's example, the vaccine did not train immune system properly to recognize and/or fight back properly in those 50 people who show disease symptoms. Of course there is the part where if the virus load is so huge that no matter what, the immune system finds it difficult to overwhelm the virus that the virus gains upperhand. This is generally the case for health care workers. Since they will be constantly challenged and hence they need to keep their protections up.

2. No efficacy means your chances are same as anyone unvaccinated.

If it is zero efficacy, it would fail the phase 2 trial itself. It is easy to remember as follows:

0. Vaccine candidate shows promising results on certain models (monkeys, chimps, armadillos, mammalian cells in petridishes ...)

1. Phase 1 trial of a vaccine: Check if it is safe on humans. If unsafe, reject. And what is the immune response? If there is none, reject (or come back if it is safe and a different dosage is required)

2. Phase 2 trial of a vaccine: Check if it really works. Given the most effective dose. And without serious contraindications.

Generally Phase 2 is divided itself. Since effective dose might be different from one group to another. Hence you will have 2a/2b etc. For example, you may find that the vaccine really works, requires that 1 litre of it has to be injected, and the side effects are severe. Vaccine gets rejected.

3. Phase 3. Already it is established that it is safe. Already it is established that it generates immune response in a small group. How efficient it is given the dose? Sometimes multiple phase 3 is conducted given different doses. For vaccines with boosters, different schedules can be determined.

If Phase 2 comes with flying colours, Phase 3 and emergency use can be approved like done for Covaxin.

Take example of the TB BCG vaccine. TB vaccine is inefficient in preventing pulmonary TB (the cough, cough, blood TB) still every baby in India is given a jab of BCG. Why? Turns out, the TB vaccine is 70-80% effective in preventing TB Meningitis among children.

Again the efficacy of TB vaccine is variable. The cause was not explained recently till an Indian found out that TB lives in stem cells. (I digress)

The efficacy numbers come out in Phase 3. Here is where the Chinese SinoVac failed. If you are going through the entire exercise of mass vaccination and introducing supply chain issues and injecting something poisonous (adjuvants) into human and still find that 500 will be infected (see the numbers above by Rudradev), why bother with the whole costly exercise?

That is why, I do not consider both Sinovac and Sputnik as effective vaccines. The first one even Chinese CDC admitted is useless. For the later, since it is like CoviShield, one can argue that it be allowed under emergency use and true efficacy determined in Indian population and setting.
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Re: Wuhan Coronavirus Resource Thread

Post by sanjaykumar »

Mort, my point is that mutations may alter a handful of characteristics for the virus to become better at infecting people. But the vaccine-- ANY vaccine-- trains the immune system to recognize and attack the virus from a huge number of different axes. There is no way that the virus' natural evolution (in terms of disguising itself against the immune system) can keep up with the number of advantages that taking a vaccine gives the immune system. Natural molecular evolution is simply not fast enough to keep up.


The potential problem with defined epitope vaccines eg cloned, mRNA, is the restricted potential targets. Hence India's Covaxin may be superior and may yet save the planet, if mutations release the Wuhan virus from Pfizer/Moderna vaccines efficacy. I am not sure about J&J, difficult to find out how much RNA sequence they used.

One of the problems with both malaria and HIV vaccines (also influenza) has been that they mutation rate has done precisely this-natural evolution has kept a pace ahead of vaccines.
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Re: Wuhan Coronavirus Resource Thread

Post by disha »

Sanjay'ji, take the case of TB (and malaria and HIV as well), is that the bacteria, virus have different phases and hide differently.

HIV hides in plain sight. Right in to the DNA of human cells and remain dormant. If no part of immune system recognizes HIV as an infection, how will you train the immune system?

Again take the analogy of baki. Bakis are recognized infiltrators and hence the immune system can be trained to respond to it. But HIV are the urban naxals that have infected the very immune system and they stay unrecognized as infiltrators. So how can you train your immune system to fight against urban naxals?
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Re: Wuhan Coronavirus Resource Thread

Post by sanjaykumar »

HIV integrates into the genome but the genes are expressed. That is how it multiples and causes T8 lymphocyte depletion etc.

The proteins it produces act as potential targets for the immune system. If it integrated silently like a transposon, it would escape immune surveillance. There are mechanisms to defend against transposons as well but they are not T and B lymphocyte dependent.
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Re: Wuhan Coronavirus Resource Thread

Post by Mort Walker »

This was posted sometime back on this thread. The genomic epidemiology of the novel coronavirus:
https://nextstrain.org/ncov/asia?c=num_ ... r=location

Efficacy is important from the indian context. Because of so many cases of people who received their first dose of the AZ, then got infected and became very sick, it does tell us something. As stated above, BB Covaxin may actually have more efficacy in these strains compared to AZ.
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Re: Wuhan Coronavirus Resource Thread

Post by Philip »

If you realise that the true villain of the CV pandemic, read " China Virus",is the PRC winning WW3 as some westerners have been saying, then one should realise that what the PRC has done to India in 2020/2021 is a repetition of what it did to us in '62.
The last time it was Pandit Nehru,brought to his knees and ill-health by it, this time PM Modi the victim.He hasn't "shown the knee",as we can see from Galwan,etc., but the entire country is reeling,struck down by this most perfidious, diabolic act of genocide against India
by a Godless nation.

We should reject ALL gestures of relief aid from the PRC and ramp up our economic war against the PRC by a total ban of import of its products.We must rid ourselves off the drug of dependence upon China for manufactured products,full stop.

In the meantime,it is past weeks since a national health emergency should've been declared with the establishment of a core team,task force that includes Oppn. reps,state reps with the armed forces in charge of all production of CV pharma products and responsible for all logistics and deliveries to states. The confusion in Delhi, blame game between centre and states has brought out the SC to weild the whip. It is still not too late to declare a Health Emegency and swiftly and seamlessly act to improve the critical situ and finally tame CV. The China Virus pandemic is far more lethal to the nation's well-being and future than all the wars we've fought since Independence.

PS: With shortages of Remdesvir, whose efficacy is questioned by many med. experts abroad,Ivermectin is an alternative being used in the west.
Last edited by Philip on 01 May 2021 11:14, edited 4 times in total.
Karan M
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Re: Wuhan Coronavirus Resource Thread

Post by Karan M »

Cyrano wrote:
Karan M wrote:
Your judgment has been impaired sir. Above post with regards to the ICMR protocol was exactly that. You don't have all the information at hand and went off half-cocked based on one anecdotal account.
Hope you read the link I posted as well. I'm not a doctor so my judgement on a drug doesnt arise. Perhaps thé doctors who post here can tell us how they see ICMR's protocol being applied on the ground, and including Remdesivir in there is causing more harm since the "nuances" are not being understood by doctors on the ground, than any good it does. Someone I trust and respect, a topper through out and well regarded by his peers was very critical about it. Thought it was worth sharing given the endless panic striken enquiries on where to get it and the rampant price gouging going on.
You have one anecdotal account and you are using it to conclude AIIMs and that "Drs on the ground" are not aware of the issue and ICMR/AIIMs protocol is somehow out of date etc.

AIIMS has already addressed the misuse of the drug in question and how it may be used. Kindly watch this.
https://www.youtube.com/watch?v=4IQxVNUveCQ

Watch this as well, regarding which medicine has to be given when. Note what he says about steroids. I am extremely surprised that your friend is unaware of these details. Literally most frontline Drs dealing with CV are. Even PHC Drs in resource constrained states are following a gradual and sensible protocol, without access to fancy medicines and facilities in metros. There may be exceptions but they are unlikely to be common unless there are quacks used by desperate folks who abuse medicines and prescribe them willy nilly. AIIMS and ICMR cant be held responsible for these folks.
https://www.youtube.com/watch?v=5hqcHnubKQk
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Re: Wuhan Coronavirus Resource Thread

Post by Cyrano »

First thing I see today - video report of Modi visting gurudwara for festival. He and all around him are wearing masks, but no social distancing in a fairly crowded indoor place. Touching floor, other stuff with bare hands, hand sanitiser not visible. The whole visit voiolating 3Cs having crowds, close contact, confined spaces, would have lasted 15-20 mins I'm assuming. If this is what everyone is doing, then cases will continue to rise.

I would have liked him (and every person with media following) to use such opps to exemplify the behaviour everyone is being told to follow.

Dont blame the media if this video gets criticised at home and abroad on a day when 400,000+ cases are reported.

Voila the video:
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Re: Wuhan Coronavirus Resource Thread

Post by Suraj »

Thanks for the responses on efficacy rate !

Vaccination data today should be interesting . Friday ended with 2.75 million for a total of 155 million vaccinations.
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Re: Wuhan Coronavirus Resource Thread

Post by vera_k »

India's Serum Institute plans to start vaccine production outside India
The Serum Institute of India, which manufactures the AstraZeneca (AZN.L) COVID-19 vaccine, is planning to start vaccine production in other countries as it struggles to meet supply commitments
Poonawalla said last week that the Serum Institute would be able to raise its monthly output to 100 million doses by July, later than a previous timeline of end-May
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Re: Wuhan Coronavirus Resource Thread

Post by Zynda »

Me thinks SII is saying that we will open another production line outside India, the output from which can be used to fulfill export commitments while most of output from Indian lines will be for domestic consumption. Question is, is SII using 3,000 cr grant they got from GoI to set up these international lines? I think SII had already borrowed money from banks etc., for outside line and recent GoI grant will be used for Indian lines onlee. One criticism is that GoI should have pumped money back in Feb itself for plant expansion...the fire in Jan end was gonna affect vaccine production in the long-run.
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Re: Wuhan Coronavirus Resource Thread

Post by chetak »

this is what the khujliwal govt is doing in dilli

shutting down units capable of manufacturing oxygen in and around dilli and blaming the Modi govt for the shortage of vaccines.


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chetak
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Re: Wuhan Coronavirus Resource Thread

Post by chetak »

As always, use with caution, and consult a doctor prior to making any decisions based on this


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Karan M
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Re: Wuhan Coronavirus Resource Thread

Post by Karan M »

Cyrano, no more posts on the AIIMS/ICMR protocol please. As your friend has concerns he should take it up with them directly.

Please watch the videos first and improve your understanding, you will realize the topics you have raised have already been addressed by the AIIMS/ICMR and hence your concerns about the protocol are misplaced. You posted one link around Remdesivir and asked whether AIIMS folks are aware of it. Didnt bother watching the video where the Director mentions the multiple clinical trials around Remdesivir and why their protocol specifies it and how it is meant to be used.

Claiming that steroids are expected to be given from the very beginning etc - no, they arent. The protocol clearly mentions this.

That cytokine storm isnt occurring (no, it continues to be a huge risk factor and Drs use a variety of diagnostic and clinical methods to determine whether it is the case). Link

So since you keep claiming your friend said all this is an expert and has valid views, it appears his views may have been more nuanced, than what you are posting, and he should contact ICMR directly and address his concerns with fellow subject matter experts. That should be the way forward.
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Re: Wuhan Coronavirus Resource Thread

Post by Zynda »

Don't know how accurate this site is but good resource for folks in 18-44 age group to find if vaccination slots have been opened up/available in their city (who don't want to log in to Co-win & enter OTP etc :))

https://under45.in/
AshishA
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Re: Wuhan Coronavirus Resource Thread

Post by AshishA »

When will the slots open for 18-45 age group?
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