Wuhan Coronavirus Resource Thread

[Mort Walker]

Thank you.

[Amber G.]

^^You are welcome. Interestingly the following article also adds to what we have been discussing ..

A nice article in MIT's Technical Review about both Moderna and Pfizer vaccines reporting at least 90% efficacy in early trials.
https://www.technologyreview.com/2020/1 ... effective/
As it may require subscription here are some excerpts:

More good news: US drug company Moderna announced today that early trials of its covid-19 vaccine show that it is 94.5% effective. The news comes hot on the heels of a similar announcement last week from Pfizer, which reported that its own covid-19 vaccine was more than 90% effective. With covid-19 having killed 1.3 million people worldwide—more than 245,000 in the US alone—these results bring a glimmer of hope amid the gloom.

How it works: Like Pfizer, Moderna is developing an RNA vaccine. These work by injecting a piece of genetic material into a person’s body that contains instructions for how to create the spike protein, the signature mechanism the coronavirus uses to invade its victim’s cells. Once the vaccine is injected, a person’s body will use those instructions to create its own version of the spike protein. When the immune system spots these proteins, it mounts defenses against them that will also repel real viral intruders in the future.

Numbers game: Given the global crisis, both companies are hoping that the FDA will rush through its approval process. But before this happens, independent number crunchers will need to look at the results again. Pfizer’s 90% score is based on a trial of more than 40,000 in which 85 out of 94 people who got sick had not been vaccinated. Moderna’s score comes from a trial of more than 30,000 in which 90 out of 95 people who got sick had not been vaccinated. Moderna also reported that all 11 severe cases in its trial were in the non-vaccinated group; Pfizer has not released equivalent figures.

High hopes: Both companies acknowledge that the results might change as more people in the trials get sick. We also do not yet know how long immunity will last or if the vaccines stop people from spreading the virus as well as preventing symptoms. Despite these caveats, the results have exceeded expectations. “I had been saying I would be satisfied with a 75 percent effective vaccine,” Anthony Fauci told the New York Times. “Aspirationally, you would like to see 90, 95 percent, but I wasn’t expecting it. I thought we’d be good, but 94.5 percent is very impressive.”

Mass production: Moderna says that it will be able to produce 20 million doses—earmarked for the US—by the end of the year. Pfizer is making 50 million doses available worldwide in the same time frame.

Not over yet: These quantities may sound big, but we will need many billions of doses before vaccines can beat back the virus on a global scale. Manufacturing and distributing these vaccines would be a vast undertaking at the best of times, let alone when the world’s economies and supply chains are already reeling from the pandemic. RNA vaccines need to be kept cold: Pfizer’s needs to be kept at -94 °F, though Moderna’s, which seems to be stable at -4 °F, can be kept up to a month in a normal fridge. Both vaccines also require two shots taken a few weeks apart to work.

Given these obstacles, having two vaccines in the running and two companies ready to manufacture them makes the future look that much brighter.

[Vayutuvan]

Okay this is very good news!
...

Here are some views of Dr. Ezekiel Emamnuel on prioritizing access to nCV vaccines.

https://jamanetwork.com/journals/jama/f ... le/2770684

Prioritizing people older than 65 years without high-risk medical, work, or housing vulnerabilities, as WHO and NAM suggest (for phase 2), is ethically and legally more complex. Because early death correlates with disadvantage, prioritizing all patients 65 years and older is likely to exacerbate disadvantage.6 For instance, 30% of all non-White COVID-19 decedents are younger than 65 vs only 13% of White decedents.7 Although the risk of death from COVID-19 increases 7-fold between age 50 and 80, these estimates do not control for health conditions or exposure in residential settings. Prioritization should recognize that a healthy older person who can shelter in place is at different risk from a medically vulnerable older person in crowded housing.

Prioritizing all individuals 65 and older also conflicts with preventing long-term complications and preserving future life. The average life expectancy of an 80-year-old man in the US is 8 years, whereas that of a 50-year-old man is 30 years.8 Such a prioritization is also less likely to prevent indirect harms, because advanced age reduces likelihood of working in high-transmission settings or being an essential caregiver. Differences in vaccine efficacy could also be relevant to harm prevention: for example, if vaccine efficacy declines sharply among individuals older than 80, “shielding” them by vaccinating their contacts may be preferable. Legally, the use of age 65 as a threshold for vaccine access seems inconsistent with prior Department of Health and Human Services guidance against strict age cutoffs for ventilator prioritization and organ transplantation.
...

If I understand right, they are arguing for prioritizing young and people with high "residual life expectancy".

I have no objection to or rather support healthcare workers, education/childcare service providers getting first priority. But this is going a little too far I think.

Another paper with Dr. Emanuel as the lead author.

https://www.nejm.org/doi/full/10.1056/nejmsb2005114

Covid-19 is officially a pandemic. It is a novel infection with serious clinical manifestations, including death, and it has reached at least 124 countries and territories. Although the ultimate course and impact of Covid-19 are uncertain, it is not merely possible but likely that the disease will produce enough severe illness to overwhelm health care infrastructure. Emerging viral pandemics “can place extraordinary and sustained demands on public health and health systems and on providers of essential community services.”1 Such demands will create the need to ration medical equipment and interventions.

Rationing is already here. In the United States, perhaps the earliest example was the near-immediate recognition that there were not enough high-filtration N-95 masks for health care workers, prompting contingency guidance on how to reuse masks designed for single use.2 Physicians in Italy have proposed directing crucial resources such as intensive care beds and ventilators to patients who can benefit most from treatment.3,4 Daegu, South Korea — home to most of that country’s Covid-19 cases — faced a hospital bed shortage, with some patients dying at home while awaiting admission.5 In the United Kingdom, protective gear requirements for health workers have been downgraded, causing condemnation among providers.6 The rapidly growing imbalance between supply and demand for medical resources in many countries presents an inherently normative question: How can medical resources be allocated fairly during a Covid-19 pandemic?
...

[Vayutuvan]

Since Dr. Atul Gawande is on the task force, some of you might find this interview interesting as it gives some insight into his thinking and what he would do policy-wise. The interview is quite wide-ranging.

https://www.medscape.com/viewarticle/815241_1

[Cyrano]

In a world of super specialisation, a generalist free thinker like Gawande is the right type of guy to deal with Covid which seems to defy conventional medical knowledge.

[IndraD]

90-95% efficacy based on how many patients? That is where the catch is. What I gather is in phase 3 30,000 + were given vaccine and wait and watch game followed, some of them acquired nCV infection, how team has to go back to data base and identify who amongst them had the proper nCV vaccine and who had placebo or meningococcus vaccine, apparently effectiveness claims are based on sample size of 30-35 patients.

[IndraD]

folks with knowledge of pharma trials, is there a 'placebo' arm in human trials of vaccines ?
IOW, are there people in the study who do not recive the vaccine candidate but are exposed to COVID ?

The number which *many* are reporting 94.5% comes from 85/90 (which actually rounds up to 94.4% ( ) is not a "hard" number etc.. btw..(Any way the numbers come from:

what statistical thuggery is this! Or are we missing something?

[Cyrano]

Are all trial participants systematically exposed to Covid, I mean both the vaccinated and the placebo group ? How are they exposed to Covid? The answer to this is critical to understand what this 95% actually means.

[Amber G.]

Are all trial participants systematically exposed to Covid, I mean both the vaccinated and the placebo group ? How are they exposed to Covid? The answer to this is critical to understand what this 95% actually means.

There is no deliberate process to "expose" --- just living in the real world with pandemic.
(BTW, this is really not that much different than "user trials" of say hand washing or mask uses - or many other vaccines in the past - as far as statistical methods are concerned).

[vijayk]

Are all trial participants systematically exposed to Covid, I mean both the vaccinated and the placebo group ? How are they exposed to Covid? The answer to this is critical to understand what this 95% actually means.

I think when you have 30000 people randomly given placebo and vaccine, the expectation is there are enough people from both groups exposed.

[Mort Walker]

So how does a placebo work for a vaccine? After getting the injection is there a psychological aspect where the patient thinks he’s been vaccinated and can resume risky behavior?

[vijayk]

So how does a placebo work for a vaccine? After getting the injection is there a psychological aspect where the patient thinks he’s been vaccinated and can resume risky behavior?

Guess so... they will be informed of the risks that he may not be getting vaccine and even the guy in the clinic who is injecting has no idea what it is.

[disha]

So how does a placebo work for a vaccine? After getting the injection is there a psychological aspect where the patient thinks he’s been vaccinated and can resume risky behavior?

No. They are told not to run risky behaviour, and they will be released back into the community.

If the community prevalence is 5%, then 5 out of 100 will likely get it. Hence if 10000 people are 'vaccinated' and released then at least 500 are likely to get it. Out of 500 if 250 got placebos and 250 got vaccinations and all of the placebo group report infection virus and only 25 in the vaccination group report, then the efficacy is 225/250.

Now if the prevalence is 2% then only 200 are likely to get it! That is why 1000s are given vaccinations so that there is some comparable numbers.

That is why additional measurements like community prevalence, tracking of all subjects whether placebo or not matters.

There is the matter of ethics too. Are you going to withhold vaccination and give a placebo from say >60 years who have 3x the mortality of say <10 years old? That is why Phase 1/II studies are in place to measure its safety. So that when vaccination is given out to >60 years in larger numbers in phase 3, the vaccination should not cause more harm!

Again this is simplifying a lot. But it helps to think in simple terms to digest the information that is thrown at us.

Here is another thing, if vaccinations are successful in Phase 3, what are we waiting for? Can young first responders start getting the vaccines? Can categories of superspreaders be identified and given the vaccines?

[vera_k]

Suspect they are waiting to verify the lack of adverse events across age groups. A vaccine can still fail if a few people suffer adverse events. Dengue vaccine was the most recent example where this came into play.

[Primus]

So how does a placebo work for a vaccine? After getting the injection is there a psychological aspect where the patient thinks he’s been vaccinated and can resume risky behavior?

No. They are told not to run risky behaviour, and they will be released back into the community.

If the community prevalence is 5%, then 5 out of 100 will likely get it. Hence if 10000 people are 'vaccinated' and released then at least 500 are likely to get it. Out of 500 if 250 got placebos and 250 got vaccinations and all of the placebo group report infection virus and only 25 in the vaccination group report, then the efficacy is 225/250.

Now if the prevalence is 2% then only 200 are likely to get it! That is why 1000s are given vaccinations so that there is some comparable numbers.

That is why additional measurements like community prevalence, tracking of all subjects whether placebo or not matters.

There is the matter of ethics too. Are you going to withhold vaccination and give a placebo from say >60 years who have 3x the mortality of say <10 years old? That is why Phase 1/II studies are in place to measure its safety. So that when vaccination is given out to >60 years in larger numbers in phase 3, the vaccination should not cause more harm!

Again this is simplifying a lot. But it helps to think in simple terms to digest the information that is thrown at us.

Well explained Disha Ji.

Simply put, this has been completely unprecedented in the annals of vaccine development. A typical vaccine from 'proof of concept' phase to actual rolling it out after phase 3 trials and FDA/Govt. approval takes 15-20 yrs and costs over $1billion.

Regardless of your political affiliation, credit must be given to the government to have gone on this at Warp Speed. Remember, we only found out the genetic sequencing of the virus in January of 2020, and thus, to be able to produce a vaccine that supposedly works in less than 11 months is simply unbelievable. It is a testament to the ingenuity, determination, courage and technology humanity now possesses. It required the government to basically indemnify the Pharma companies against any financial losses and any litigation. That too is a first. The administration pulled out all the stops to make this happen. I believe all the involved agencies and all the governments around the world agreed to make this the biggest priority, above everything else.

Just like with other common illnesses like Rotavirus, once you have a vaccine, you do not 'expose' the participants (both placebo and non-placebo recipients) deliberately to the infecting agent. You just tell them to live a normal life as they would and then assess how many actually get infected as Disha Ji has pointed out above.

The biggest challenge that remains with the mRNA vaccine, esp Pfizer's is that the vaccine is easily destroyed above a certain temperature and is also very fragile generally. The storage, distribution, final delivery is going to be a problem since this has never been done before. Moderna has come up with a different combination of mRNA and delivery vehicle that allows storage at much higher (albeit still requiring a freezer) temperatures.

When the other vaccines become available in the future things may change dramatically, but mRNA was the first in line as it is the easiest to develop and mass produce.

Here is another thing, if vaccinations are successful in Phase 3, what are we waiting for? Can young first responders start getting the vaccines? Can categories of superspreaders be identified and given the vaccines?

Our local hospital has already sent out emails to everyone asking who is interested. Problem is, if people still avoid getting the flu shots every year (I know several physicians who refuse it), it is going to be difficult to get everyone to take an as yet not fully known vaccine. It often takes many years and many millions of uses before all the side effects become obvious. If one adverse effect happens in say, 1 in 100,000 people it will take that many patients to discover it, and even then it may not be reported by all who get it unless it is very serious. Add to this the suspicion and negative publicity over the politics of it (being called the Trump Vaccine), does not help at all.

I don't know that you can easily identify 'superspreaders', only after the fact, by that time they are already immune themselves, it is their 'contacts' that need to be protected.

[Mort Walker]

Poonawala of Serum institute of India is sceptical of cold vaccines requiring storage at -80C.

[Primus]

Poonawala of Serum institute of India is sceptical of cold vaccines requiring storage at -80C.

Even in a rich country like the US, it is a major challenge to keep the vaccine or anything else at this temperature. Would be far more difficult in a resource-challenged country.

[vijayk]

https://twitter.com/__ice9/status/1327607059202912256

ice9
@__ice9
·
Nov 14
Latest ivermectin COVID-19 RCT:

Enormous mortality reduction in severe COVID-19: crude relative risk ratio is 0.1.

Also reduced mortality to zero in mild cases and led to faster viral clearance.

To date, every single study on ivermectin in COVID-19 has been highly successful.

[Vayutuvan]

Is Researchsquare similar to https://arxiv.org/? If so, we better wait for a peer-reviewed publication. arXiv has a lot of good pre-print material but still has quite a few bad papers in more objective areas like Mathematics and CS. Some papers contain wrong proofs or non-theorems shown as theorems.

[dsreedhar]

This pandemic has enabled the overhaul of the age old vaccine platform. Moderna, Novavax, Inovio and a few others having been working on new cutting edge platforms for vaccines since atleast a decade on SARS, bird flu, ebola etc. Finally they got enough funds and support to bring it to fruition.
Instead of using inactive virus and time consuming egg-based manufacturing like in the case of flu, now it is upgraded to mRNA, DNA, VirusLikeParticle (nano) etc which is much faster in mass producing and hopefully much safer and effective.

[Amber G.]

FWIW: Let me make some important comments. I am trying to present the current understanding of India and US scientists who I respect. Official announcements/papers from GoI have been quite good, so people may like to look at that -- of course other reputable sources should be consulted - I am trying to brief.
Hope this is useful:

- There are more that 200 vaccines candidates in various stages - several are already in phase 3 clinical trials.
- There are *many* candidates in India and US (apart from Pfizer and Modena) in time frame of next few months.
- In order for the FDA to approve a vaccine, however, not only do these clinical trials need to be completed—a process that typically involves following tens of thousands of participants for at least six months—but the agency also needs to inspect production facilities, review detailed manufacturing plans and data about the product’s stability, and pore over reams of trial data. This review can easily take a year (or more).

- For several months now FDA (and it's equivalent in India) has been considering criteria for initially deploying a covid-19 vaccine under an emergency-use authorization, or EUA, before the FDA has all the information normally required for full approval. At least a few of the manufacturers currently in phase 3 trials have publicly stated their intent to request an EUA. Pfizer plans to do so later this month in light of the exciting preliminary results for its vaccine.


-EUAs allow the FDA to make unapproved products available during public health emergencies.

- The FDA’s Vaccines and Related Biological Products Advisory Committee, a group of outside experts who advise the FDA on vaccines, met for the first time to discuss covid-19 vaccines on October 22. Some committee members questioned whether the FDA had set the bar for a vaccine EUA high enough. Members also expressed several important concerns about authorizing a vaccine through an EUA. (In US there is less transparency and lot of silly literally shouting by Trump on scientists which makes things complicated - much better synergy in India).

(One concern is that once a vaccine is authorized in this manner, it may be difficult—for ethical and practical reasons—to complete clinical trials involving that vaccine (and thus to collect additional safety data and population-specific data for groups disproportionately affected by covid-19). It could also hamper scientists’ ability to study other covid-19 vaccine candidates that may be “better” in various ways than the first across the finish line).

*****
Another big factor - most important in my view is related to public trust.
As they say - vaccines works *only* if people get them (in large numbers). Even if it is highly effective in theory, its ability to control the pandemic is very limited. and it's a very serious issue.

Data from the Pew Research Center show declining trust in a covid-19 vaccine across all genders, racial and ethnic categories, ages, and education levels, with many people citing safety and the pace of approval as key factors in their skepticism. Infighting and wild tweets of Trump did not help.

(At present both Pfzir and Modena are seeking the FDA’s advice to address these issues.. I suspect that soon we will know more. But hydroxychloroquine debacle - pressuring FDA with EUA - did not help)

Now since the vaccine trial data are promising enough to warrant giving some people pre-approval access to a covid-19 vaccine, the FDA may use mechanism called “expanded access.”

It is important that public trust a covid-19 vaccine enough to seek out the first wave of authorized vaccines, but that trust must be resilient enough to withstand potential setbacks: protection below 100% (and perhaps below 50%), significant side effects (or rumors of them), and possible recalls. That level of trust takes time to rebuild if it has been eroded.

Last I heard, even many large hospitals may not have cold storage capacity and have to build it for Pfzer. In India Modi and his scientific advisers also have fairly promising scenarios for vaccines...

Meanwhile situation in USA is quite bad. We have 250,000 deaths and this may go to 300,000 fairly soon. My home state issued Mask mandate but they are spending al the energy to impeach the Governor to issue such warning. Trump's task force is still not sharing data with other scientists - (today's meeting).

Added later: Following some of the DST scientists (GoI) is very informative.
Today they said that Pfizer will apply for EUA and it may get approved tomorrow and being ready to get distributed widely.

[disha]

Primus'ji, thanks for the kind words. Identifying categories of super spreaders is actually doable. For example, schools are open in Europe and the kids are *not* showing up as vectors of coronavirus. Religious communions have been a source of super spreader. Bars and gatherings in closed spaces seem to spread more, then persons working in those bubbles can be identified first. Again if we can study which categories were super spreaders we can then identify persons in that categories and list them up for vaccinations.

Amber'ji, a very humble request. Please present your data. But not the politician. No politician in US has come out smelling like roses in this pandemic.

California has announced another lockdown. The initial lock down was "flatten the curve" and we had good Seven (7) months where governors of big state could have added infrastructure to handle the incoming load. Instead of partying at french laundry with CMA who are lobbying on behalf of CA physicians (without mask if I may add), the New Awesome Newsome Gavin (Again for 2022) (NANGA for 2022) could have taken a leaf out of Andrew Cuomo. So what if parents and their kids and teachers froze around in NY for 5 hours. So what if most of the deaths in NY occurred in senior centers and they are funding Cuomo's campaign.

In the meantime an antibody tests costs upwards of $100. Can the state, the insurance and the individual pay their shares and get a test done? It helps. If one tests positive for antibody, let them continue with their livelihood. Otherwise take appropriate care.

My point is very simple, lives do matter. Livelihoods also matter. Can there be a balance that can be achieved? If HCQ is a good prophylaxis, ensure that it is available. Ensure tests are available. And if you still end up getting it, yes go to an indoor stadium where the beds are available and appropriate facilities are already setup. Remember, CA and NY had *seven* (7 months) to set it up.

Meanwhile, a coronavirus infection is indeed leading up to lasting immunity. https://www.sfchronicle.com/health/arti ... 737951.php

And in NY, the number of people in ICU is 10% of the peak in April. https://www.syracuse.com/coronavirus-ny/

[saip]

After almost two months, India's active cases have INCREASED by around 500. I hope this is not a trend. The seven day average is still negative. CA has actually more cases than India.

[saip]

Don Trump Jr has tested positive and President's personal attorney Guiliani's son (who is also President's assistant) also tested positive. The Senator Rick Scott from Florida too tested positive. All these people were mocking people wearing masks.
Rudy Guiliani too has self isolated himself because of his exposure to COVID19

[disha]

^That's okay. The recovery rate is getting better. It could be that more of the younger population is now catching it and recovering from it. Indicating that this virus is fatal to elderly and people with co-morbidities.

Also the management in India and other asian countries seem to be better than in Europe and US and Latam. Epidemiologists and virologists need to study this. Already trends are that HCQ as prophylaxis and BCG vaccine is helping the disease burden remain comparatively mild. Add in UV and the herbal teas.

Here is a very morbid outcome of the disease. It takes out the elderly and the ones with co-morbidity. This frees up the population to actually put its resources into productive use! Expect the global economy to bounce back rapidly. More so India than other countries!

Post-pandemic, I will not be surprised if India becomes the driver of global growth, peace, prosperity and security.

[SriKumar]

I think everyone has to take precautions from getting infected and/or passing on the infection to young people or elderly people.
Elderly people are humans too, and being old or having co-morbitidies makes it even more incumbent on the younger people to not get infected/not pass it on. And there are plenty of people over 40 who have comorbidities like BP, diabetes liver issues, heart conditions etc.
Both groups are arguably more in need of protections/prevention relative to young people.

[disha]

I think everyone has to take precautions from getting infected and/or passing on the infection to young people or elderly people.
Elderly people are humans too, and being old or having co-morbitidies makes it even more incumbent on the younger people to not get infected/not pass it on. And there are plenty of people over 40 who have comorbidities like BP, diabetes liver issues, heart conditions etc.
Both groups are arguably more in need of protections/prevention relative to young people.

Vehemently agree.

There is pandemic fatigue setting in and if it is recognized can new ways be adopted to ensure that pandemic fatigued persons can still follow safety guidelines while not getting enmeshed into ego issues?

[nandakumar]

After almost two months, India's active cases have INCREASED by around 500. I hope this is not a trend. The seven day average is still negative. CA has actually more cases than India.

Yesterday the TV channels that have a tendency to show the Central Government in a poor light were going to town on this. You would think watching these channels there is nothing else happening around the country or the world. The fact that the Gujarat Government had imposed night curfew was the perfect icing on the cake for them. As for as fresh infections are concerned the numbers have been hovering around sub 50,000. That has been on a declining trend. So I don't know what has changed. May be people are taking a little longer to recover?

[Cain Marko]

Post-pandemic, I will not be surprised if India becomes the driver of global growth, peace, prosperity and security.

Dishaji - could you please elaborate on this in some detail - what makes you inclined to think in this manner? Atmanirbhar? Note that China seems to be the only country that has come out on top after its "gift" to the world.

[sudarshan]

A week or two after Navratri, I pointed out the trend, that the drop in daily infections and death rates in India, had hit a pause button. It started declining again about a week or two after that. Now it's a week after Deepavali, and the trend is in the upwards direction again. As I mentioned earlier, the scientists who came up with the Supermodel were right to be concerned about the festive season, and reckless behavior during that time. I even mentioned the example of my extended family, and all the horrifying things they were seen doing on video, during their Navratri bash. I believe the scenes would have been similar all over India. Much of the rise after Navratri was in the Delhi/ Punjab/ Haryana/ UP region.

There's still Karthik poornima, then Makara Sankaranti. Hope for some better sense among people.

About fatigue - people are just going through the motions of masking and distancing. They need constant reminders. I saw one guy (first-hand) pull his mask forward, reach within with his hand, and scratch his nose. People also hand masks to each other, which means the guy wearing it is wearing a mask which has been pawed by somebody else. Like that joke of the guy who, when faced with a terrorist wielding a syringe of HIV, laughs in the terrorist's face and lets himself be injected - because, you see, he's wearing a condom inside his pants! People seem to think having the mask on is some kind of superpower shield, they forget how to behave responsibly with that mask. They don't see it as something which can be contaminated. I guess they think of it as a cross, an amulet, a bulb of garlic or whatever to keep the vampires away. Quaint and charming - and dangerously delusional.

Seeing the pattern of rise and fall, I'm starting to conclude that each rise in each country, is a direct response to some kind of super-spreading event in that country. The rise seems inexorable, but then the fall starts without warning, and is pretty abrupt too. Like the infection hits a brick wall and suddenly runs out of steam. In the US it seems to have been the protests and the rallies. In France and Europe in general - beach-going crowds. In India - festive season.

[saip]

Still, I see a flatenning of the new cases at -5000 a day. At one point there was a steep decrease of almost -18000 a day. Too good to continue. Now, I hear there will be Tungabhdra Pushakaralu where hundreds of thousands will congregate (over 10,000 govt officials are on duty) over 11 days from Nov 20th to Dec 1. Hope that does not become a super spreader in andhra pradesh and telengana.

[Zynda]

Does India has any plans of purchasing Moderna's vaccine, at least for HCWs? With storage requirements of Moderna not as stringent as Pzifer, it would be better suited for India. But I assume that 80% of initial vials of Moderna's vaccine will be for US and the other 15% probably for EU and the rest for other countries. So even if India places order now, it may be months before stocks are available for India.

It seems like a couple of days ago, Dr. Harsh Vardhan stated that vaccine in India will be available in 3-4 months i.e. end of March 2021. Not sure if he meant, by March 2021, it will be available for general public or India will start vaccinating in another 3-4 months. All these timelines are confusing because SII says that India will have 100 million doses by end of Dec 2020 (?).

I know first in line are HCWs (along with VVIPs), followed by front line workers (throw in celebrities, HNWs, aam aadmi with connections) and 3rd in line it seems are aged folks.

Sputnik-5 Ph-3 trials in India are expected to be concluded only by March 2021. With Covaxin & Zydus's vaccine still long way off, India it seems like placing its bets solely on Oxford/SII (at least initially).

Also I do hope that synthetic antibodies being developed by Regeneron & Eily Lilly becomes successful and is available for public consumption ASAP.

Edit: Wanted to add something to what Amber G said i.e. willingness of people to get vaccinated. To the limited people I speak, many are skeptical of receiving Russian as well as Indian developed vaccines. However, they are receptive of Oxford & American developed vaccines.

[Cain Marko]

A week or two after Navratri, I pointed out the trend, that the drop in daily infections and death rates in India, had hit a pause button. It started declining again about a week or two after that. Now it's a week after Deepavali, and the trend is in the upwards direction again. As I mentioned earlier, the scientists who came up with the Supermodel were right to be concerned about the festive season, and reckless behavior during that time. I even mentioned the example of my extended family, and all the horrifying things they were seen doing on video, during their Navratri bash. I believe the scenes would have been similar all over India. Much of the rise after Navratri was in the Delhi/ Punjab/ Haryana/ UP region.

There's still Karthik poornima, then Makara Sankaranti. Hope for some better sense among people.

About fatigue - people are just going through the motions of masking and distancing. They need constant reminders. I saw one guy (first-hand) pull his mask forward, reach within with his hand, and scratch his nose. People also hand masks to each other, which means the guy wearing it is wearing a mask which has been pawed by somebody else. Like that joke of the guy who, when faced with a terrorist wielding a syringe of HIV, laughs in the terrorist's face and lets himself be injected - because, you see, he's wearing a condom inside his pants! People seem to think having the mask on is some kind of superpower shield, they forget how to behave responsibly with that mask. They don't see it as something which can be contaminated. I guess they think of it as a cross, an amulet, a bulb of garlic or whatever to keep the vampires away. Quaint and charming - and dangerously delusional.

Seeing the pattern of rise and fall, I'm starting to conclude that each rise in each country, is a direct response to some kind of super-spreading event in that country. The rise seems inexorable, but then the fall starts without warning, and is pretty abrupt too. Like the infection hits a brick wall and suddenly runs out of steam. In the US it seems to have been the protests and the rallies. In France and Europe in general - beach-going crowds. In India - festive season.

Perhaps Sankranti and Marriage season won't be so bad because many of the festivities happen outside? one reason touted for the possibility of increasing numbers in the US is the onset of winter and the need to stay indoors during cold weather.

[SriKumar]

I think everyone has to take precautions from getting infected and/or passing on the infection to young people or elderly people.
Elderly people are humans too, and being old or having co-morbitidies makes it even more incumbent on the younger people to not get infected/not pass it on. And there are plenty of people over 40 who have comorbidities like BP, diabetes liver issues, heart conditions etc.
Both groups are arguably more in need of protections/prevention relative to young people.

There is pandemic fatigue setting in and if it is recognized can new ways be adopted to ensure that pandemic fatigued persons can still follow safety guidelines while not getting enmeshed into ego issues?

The only thing I'll say is that as and when new ways are determined, they can be adopted by everyone. Till such time that the new methods arrive, the pandemic is still going on. The only choice we have is to follow or not follow the existing/currently available ways that we know to be effective in slowing or stopping the spread.

[Amber G.]

Don Trump Jr has tested positive and President's personal attorney Guiliani's son (who is also President's assistant) also tested positive. The Senator Rick Scott from Florida too tested positive. All these people were mocking people wearing masks.
Rudy Guiliani too has self isolated himself because of his exposure to COVID19

Interesting .. till recently (only a few weeks ago) Jr was claiming 'numbers are down to “almost nothing”. (Check out the video : .

Apparently it is not a "hoax" ..
Sad and evil part is: even after Herman Cain's death, Chris Christie s weeks in ICU..and at least 800+ deaths (30,000+ cases) directly contributed to just a few of Trump's events (without masks etc) some true believers are still clue less - point it that it is all "political game"..

Just today Ohio's state legislator are trying to impeach the Governor (because he issued Mask mandate and night "curfew" - which many sherifs are refusing to enforce)..death threats are still being issued against scientist like us..

[Amber G.]

A week or two after Navratri, I pointed out the trend, that the drop in daily infections and death rates in India, had hit a pause button. It started declining again about a week or two after that.keep the vampires away. Quaint and charming - and dangerously delusional....

To add: I am very happy that data is looked up and followed pretty closely and overall situations seems to be under control in India. Apart from some few local lockdowns/curfews etc .. nothing big/wider intervention is required.

There was another mathematical model (mainly by physicist Verma from IITK) I was interested in.. projection in next few months is quite consistent with the "super" model followed by GoI - in all it seems, for India we are seeing the cases dwindle down to almost zero by end of February. (even without counting Vaccines). India still have to be vigilant as other parts of the globe the situation will be different so outside travel etc may still need to be monitored.

In USA situation is quite bad. Hopefully the admin start listening to scientists soon..If this non-sense continues, as most projections project, next few months will be very bad.

I will put some thoughts about impact of vaccines in US in later post(s).

[Amber G.]

Few comments about "politics" in USA.

First time in its 150+ year history premier journal Scientific American endorsed a US presidential Candidate (Biden) and criticized Trump in no uncertain terms. (Scientific American Endorses Joe Biden
We’ve never backed a presidential candidate in our 175-year history—until now (worth reading the article)

Another prestigious magazine which never talked about "politics" Science also did the same. So did Nature.
And New England Journal of Medicine.

More than 80 Science Nobel Laureates (many dozens Physics Laureates and dozens in Medicine), (See for example :https://physicsworld.com/a/nobel-laurea ... president/ (worth reading the arguments). ... Top computer scientists etc..

This is because there is no = = when it came to Trump and others as far as handling the virus is concerned.
(Just like criticizing Hafiz Saeed for terrorist activity is not "politics". Criticizing Trump for absolutely horrendous handling of the situation should *not* be dismissed as "politics").

[Amber G.]

Dr. V. K. Saraswat, (Member NITI Aayog (S&T) and former Secretary, DRDO) in conversation with Prof . Ashutosh Sharma ( Secretary DST, also a IITK distinguished prof) moderated by Nidhi Kumar (DD).

"The other side of Pandemic"

We could all benefit by their keen and deep insights.

On: November 28, 2020 (Wednesday) at 4 pm (Indian Time) on the multiple links below.
(I Think Ms. Nidhi Kumar has done a good job of interviewing the scientists - she lets the scientists speak)
On India Science channel. Youtube link: youtube dot com / c/ IndiaScience

[Amber G.]

To keep in perspective - here are four charts - countries are chosen for personal reasons. All data normalized (cases / million people).

Date: Nove 21, 2020
Confirmed cases / million.


Confirmed Deaths:


CFR:


Share of tests which are positive"

[Amber G.]

On another news - I was glad to see Stanford and Hoover Institute (conservative) both came out pretty strong and said in no uncertain terms how Scott Atlas (Trump's chief adviser on Covid) is unscientific, wrong and dangerous. Stanford Faculty Senate passed resolution that strongly condemns. "Atlas’s behavior is anathema to our community, values, and our belief that we should use knowledge for good. ..

Hope soon we will have professionals at the leadership driving US fight.