But I don't think even that will be necessary. 90% efficiency reduces R so much, it will probably die out on its own.

The real problem is mutations that are not covered by the vaccine. If it mutates as efficiently as flu, it will be a challenge.

Covid19 would also be over if people with symptoms would just stay home. But that's clearly not happening either. We've got to be realistic about how people behave in the real world.

Mutations aren't a serious concern. Because when viruses mutate it's the strains that are more infectious and less lethal that win out.

> Covid19 would also be over if people with symptoms would just stay home.

No it wouldn't. One of the things that makes SARS-CoV-2 such a problem is that people get contagious long before they show symptoms. Similarly to for influenza and the common cold, many people get contagious without ever developing symptoms.

More than anything I suspect this is a result of allowing so much unfiltered spam calls. If you only get one unexpected, unknown call a month you will almost always answer it. If you get three a day you will almost never answer it.

We are allowing private businesses and scammers to steal the “commons” of our societal attention. We are doing a very poor job of keeping useful communications channels open: almost every communication medium people rely on for important information gets cluttered with must-ignore spam, making it decreasingly likely an important message is actually received.

I'm now wondering if it was an attempt at contact tracing. Had they simply stated what they wanted in the message I would have been pretty likely to call them back myself or answer a later call.

I have no idea where they got my cell phone number from, but the whole thing seems poorly handled at best. Anyone with legitimate business will state the nature of that business and allow for a return call. There's just so many solutions to this problem but nearly zero aligned with incentives.

Yep. That was probably about COVID. Health privacy laws prohibit even the vague mention of a condition. The caller has no way of knowing if they have the right phone number, and the last thing you want is "Attention, Rando McUltrarunner at 42 Crustacean Crest Drive, Cleveland, Ohio! You have been infected with COVID! Run, don't walk to your nearest testing facility!" on some stranger's voicemail. Or worse, "We are following up to see if you're doing well after your abortion" ending up on the voicemail or texting app of a 15-year-old girl whose parents might have access to her phone.

Source: Recently completed my company's mandatory annual HIPAA training.

It's not IT-grade authentication, but for wetware it works.

Your doctor's office can do it because you probably have an existing patient relationship, and you already filled out that paperwork on your first visit.

But in the situation of a cold-calling contact tracer, you haven't signed anything at all, so all they can say is "This is the health department and we want to talk to you."

But it would be a good idea nonetheless, it only requires to be accompanied by a serious information campaign preparing first time receivers for the surprise.

No clue how widespread this is, but I can't exactly blame people for assuming any call or voicemail they get is a scam, there are so many out there.

I can, of course, listen to every voicemail, but that's not much better than just picking up the phone when I get a spam call.

So basically the only reason I check my voicemail is to get rid of the notification on my phone

I'm sure there are bills in the works, but those same bills are likely bundled along with completely unrelated nonsense.

Of course, you may not be comfortable with giving Google access to this data...

I actively turned my voicemail off completely.

There is simply no-one who I want to talk to who would choose to leave me a voicemail if I don't answer.

Yep. I never answer unrecognized numbers anymore, and nobody I've talked to about it does, either.

Welcome to what society looks like when social trust declines. It will keep getting worse unless and until people discover that the commons actually matters and is more than something to scam and find some way to parasitically monetize.

[0] https://www.zdnet.com/article/less-than-half-in-singapore-wi...

Viral Load Peaks before symptom offset.

> Available evidence from contact tracing reported by countries suggests that asymptomatically infected individuals are much less likely to transmit the virus than those who develop symptoms. A subset of studies and data shared by some countries on detailed cluster investigations and contact tracing activities have reported that asymptomatically-infected individuals are much less likely to transmit the virus than those who develop symptoms.

http://www.emro.who.int/health-topics/corona-virus/transmiss...

Agree with the main thrust of the point but if everyone did stay home for 14 days you may well eradicate the virus. Problem of course that its economically/socially/medically impossible to facilitate a complete 14 day lockdown.

This would not be possible. There are at least several species of animals (mikes, civets, and bats) than can transmit this virus. We would need to quarantine and test, or kill, each and every one of these animals to be sure we eliminate this virus, or else it will eventually make its way back to humans.

My opinion, based on what I read, is that this will be a bit of a scourge until such time as enough people have immunity from either catching it or getting vaccinated.

Over time, as this new coronavirus makes its way through the human population, the experts it to become less virulent in general and/or appear less often. [0]

[0] https://www.statnews.com/2020/02/04/two-scenarios-if-new-cor...

https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/...

I also wonder how effective the vaccine is at preventing its receivers from even reaching that asymptomatic but already contagious stage. If "90%" is just "90% less reach symptomatic stage" then the percentage of receivers that are prevented from reaching contagiousness could be much lower.

This would basically mean that the virus is almost guaranteed to become endemic despite vaccination (unless another vaccine also removes the contagious stage quite well) and that everyone who doesn't get a vaccine will eventually test their immune system against the virus.

Natural immunity often follows a similar pattern. After a while you become susceptible to a light reinfection but the immune system will be in a very good position for a quick - but not instantaneous - victory on its second encounter with the virus. Under those circumstances, herd immunity effects fail to realize unless the first wave is so lightning fast that it fizzles out before the immune systems of early survivors (or the similarly vaccinated) fall back into standby mode.

1) When I did try to install it said I need to update to a new OS, meaning my five year old phone likely wasn't good enough. 2) My local app doesn't provide alerts to me rather it alerts government contact tracers who today stated that they are only responding to alerts regarding medical/care home workers. I am neither. 3) My phone is not with me at work, the place where I interact with the most people by far, rendering the entire scheme basically useless.

But yes, I would get a vaccine in a heartbeat.

I don't think that's correct. Pre-symptomatic phase is supposed to be about 2-3 days. I wouldn't describe that as 'long' before they show symptoms.

In the US, people are going to work (or other events) WITH positive test results. Some because they won't get paid otherwise, others because they want to make a political statement, and some because they're ... well, I dunno why...

So, yes, even having people stay home after a positive test would be helpful, because currently, they aren't even doing that.

Some health departments have taken it upon themselves to arrest people that won’t sign documents.

It’s like HOA battles, except now you can be put in jail on a whim.

Even being an common case, and will likely be overturned in courts, it’s just too risky.

Which health departments, what documents, and how many people?

And how did they get arrest powers?

http://www.wvih.com/wp1/index.php/2020/07/19/couple-on-house...

"Some health departments have taken it upon themselves to enforce quarantine on people that just tested positive." doesn't really inspire the same kind of outrage.

[citation needed]

But yes, it does require having few enough infected people to make it feasible, and places like the US and most of Europe are waaaaay beyond that point now.

If we could get high compliance with isolation of positives, the US/Europe could use mass testing to "reset" without lockdowns. Test all of Michigan across a couple days and you will identify a significant portion of the infected. Then do Wisconsin. Encourage people to limit travel during those periods and so on.

You wouldn't get to 0 in one cycle, but it would hammer the transmission rate.

For better or worse [1], complying with mass government orders is simply not part of the collective American psyche.

1. it still remains to be seen if this individualism and distrust of government is one of America’s greatest strengths, or its future downfall

I'd prefer not to get Covid19, but the real worrying thing about it is the potential for a worse disease. Say it's almost as transmissible but much more deadly. How will we respond?

I'm sure many people would do more to protect themselves, but I wonder how deadly it would have to be for some people, and how deadly would it have to be to make community minded cooperation the obvious path (this is a reasonable description of mask wearing…).

https://www.voanews.com/covid-19-pandemic/slovakias-second-r...

That is unlikely to be true. There are asymptomatic super spreaders. The fact that R0 is currently hovering around 1 is that society has greatly reduced contacts. Even in areas where social distancing is a mere suggestion, most people are not behaving completely normally (a good thing). Flights are super low, movie theater visits are super low, hotel occupancy is super low. Social distancing and contact tracing work. Better social distancing and contact tracing work better.

If only it worked that way! It doesn't, of course.

A random walk can lead anywhere in the adjacent landscape. That includes moving up in lethality without moving down in infectiousness. What you have written here is plausible-sounding nonsense; if it were true, the 1918 flu would never have occurred.

The good news is that influenza is almost pathologically mutation-prone, and coronaviruses are not.

Could you go a little deeper in this? It seems to have worked in Australia, South Korea and NZ as far as I’m aware, what am I missing?

It’s working fine again now that case numbers are negligible.

Many people are not going to say they cheated on their SOs, or went to a swing bar, or a gay pub.

> I think we can eradicate it by contact tracing.

Korea and Japan appear to have contained theirs through the use of reverse contact tracing.

The big problem in the "West" (i.e. Europe and US) is that lots of people don't engage with the contact tracing system, which makes the epidemic almost impossible to control.

Any amount of community transmission will eventually lead to an out of control epidemic, unfortunately.

Does the size of the island matter? Does the location of the island matter? What if there are multiple islands?

Look into covid numbers and you'll notice cities even in the same country that are on an island of some sort have significantly less covid numbers, such as Hawaii or Vancouver Island in Canada.

I don't see why the same strategy wasn't used in Europe or the US. Its hard to control a virus when there's a constant stream of new cases coming over the border. I suppose its way too late for that now.

The travel times quoted by that article: "London to Paris taking 2 hours 15 minutes, to Brussels 1 hour 51 minutes."

That's faster than some people's daily commutes into NYC.

The countries mentioned have had community transmission, but they use contact tracing, testing, and shutdowns to stop it.

if you say Mexico is in your definition of North America then it should include all of central america, almost all these countries have a lot of land-based trade.

In Canada we have not had any cases related to truckers, but there's a lot of them who have to do the cross-border route, as well as people who commute daily across the border. heck in Canada and the US there are a few spots where crossing the border is necessity -- the only school is in the other country, nearest hospital, the local library, a popular golf course, etc.

or places like point roberts, extremely small but extremely isolated, or Hyder, Alaska.

A primary landmass on its tectonic plate.

Plus it's connected to South America.

https://en.wikipedia.org/wiki/Dari%C3%A9n_Gap

Australia and NZ were able to control their outbreaks (even then with great difficulty in the case of my state of Victoria AU) because the populations are much smaller and the virus was not widespread when the severity of the threat became apparent.

It was pretty bad in Victoria and it was an impressive effort to get it back down. Not many places have achieved success like that. To me the key was the population and its leaders having the will to fight.

I'm talking relative terms; our numbers were 50-100/day when they realised the problem was getting bad, and up to 700/day when we hit crisis point, but that's still lower than the figures that some U.S. and European cities had even back in March/April when the world was still yet to understand what was really going on.

And yep, I think what's happened here has been impressive, but we've had some factors in our favour that other parts of the world don't have.

https://en.wikipedia.org/wiki/Crucero_Express

So once you're down to low levels of incidence in the community, given a robust well organised system, efficient contact tracing does prevent the virus from spreading in the community unchecked.

They have done very good at tracking and locking down the few cases that get out, even with very low mask use in the general community based on what I've seen. People were sensible when it mattered most.

I am not sure this is true. At least some articles I read attribute the successes in many Asian countries to aggressive contact tracing and quarantining. You don't ask people kindly to self-isolate, you move them to hotels and quarantine them. You don't ask them to remember their contacts, you aggressively investigate them using every source of data available.

I think an argument can be made that Europe simply got it wrong in the details. In order to find less invasive means of controlling covid that respect privacy we ended up limiting freedoms much more and for longer.

There is limited freedom during a lockdown, but a short sharp one can lead to almost complete normality soon after. Short and sharp or long and drawn out?

The drawn out option would seem a dubious freedom. My perspective is heavily skewed by being in NZ and reading US and UK news.

Because contact tracing seems to work very well at scale in Asia.

It's a cultural thing. Asian cultures vary dramatically between each other (don't mistake Koreans, Chinese, or Japanese for each other -it won't end well), but they have one thing in common: They have a real sense of every person is part of a collective. Maybe it's because most Asian societies are quite crowded.

The US, on the other hand, has a real sense of everyone is an individual, to the point of actually considering people that follow rules and norms to be "sheeple" (see "antimaskers").

Europeans seem to be in the middle.

The 5-HTR1A gene affects whether we more easily make relative versus absolute judgments. And this seems to be true for everything from the length of lines, to quality of life. The allele that is most common in East Asia makes relative judgements easier, in America it is absolute judgements that are easier.

Politically, having the relative form of the gene encourages more community thinking while the absolute encourages more individualism. This leaning holds within whatever society you're in. But when a culture is dominated by one form of the gene, it will naturally shift the entire society.

I learned this from pages 183-186 of https://www.amazon.com/Whos-Charge-Free-Science-Brain/dp/006... and I've wondered ever since how many of my opinions are reason (as it feels) versus genetics.

And yet, just like China, they have also beaten the virus. Meanwhile, Russia has failed on all counts.

The West has the laws on the books, and the legal precedent necessary to enforce them, when it comes to epidemics. What it lacks is the political will.

It doesn't matter how effective these measures are, or how bad an idea it is to let the virus run unchecked - under it's current leadership, states like Kentucky will never do what is necessary to get the virus under control, because these measures are anathema to it's current regime. And states like Washington won't either, because while those measures are not anathema to them, their governments are afraid of a backlash that will replace them.

This wasn't an inevitable outcome - nothing fundamentally stopped bipartisan cooperation on this point. Political expedience and the desire to own the libs did. Had the right not used the pandemic as an opportunity to grab power, and start a culture war, we wouldn't be where we are today.

And you can't blame the Democrats for choosing to make resistance to following best practices in disease control a wedge issue.

Don't equate the damage caused by 'a relief bill didn't pass because two parties couldn't agree on which pork could be added to it' and 'one of the parties is not following basic epidemic control practices'.

Sweden squashed their cases down from a massive peak without any lockdowns or masks, but with a social welfare system that supported anyone who felt even slightly sick to stay home

It works 'at scale' in Taiwan/Korea if by 'scale' you mean 'large country' but yes, it does not work when there are many infected, it's best suited for when there only small numbers and the government can keep a lid on that.

But that's entirely possible. Remember that countries have local agencies and national numbers are not everything.

Ontario is only 12M people, British Coloumbia 5M people and they have active contact tracing of literally every patient.

So with 90% effectiveness, the numbers will be brought way down, and in many areas, the threshold of cases will be low enough that contact tracing can be enacted.

So about the 50 people - we have to basically still maintain a degree of isolation, and that's entirely possible.

We don't need to tell the grocery store workers to 'self isolate' because someone came into the store with COVID that's already happening, those are low-risk events.

During social isolation, people should absolutely not be contacting 50 people.

So masks, basic social isolation at very least (no unnecessary contact) can remain in place.

I stayed at home even before symptoms, I infected 3 adults and my daughter in my house.

It was only luck that the adults showed symptoms like myself on day 3 and day 3 was a Sunday and my test results came back that day.

Otherwise, they woul have infected others just like I infected them, before I showed any symptoms.

AND gave up all human interaction. It is absurd to suggest that we should sacrifice civilisation for a virus

Also, we _are_ sacrificing civilization for a virus. Or at least 1.2 million people's worth of civilization…

> Or at least 1.2 million people's worth of civilization…

1.x million natural deaths with an average age of 82 years old, in the UK.

It's worked pretty well all over Asia.

Of course it helps to get the actual rate so close to 0 that the contact tracers are not overloaded

What if it has the contagiousness of covid but the long term lethality of hiv? The long term lethality would have low evolutionary pressure to be less harsh to its host as the implications only follow after many infectious years.

Is there anything fundamentally prohibiting the emergence of such a virus, or are we just lucky?

What if we get hit by a comet?

In South Korea it did. They now have very few cases and deaths in single digits per day.

It's worked in South Korea

Also, "hasn't worked at scale anywhere is false" - AFAIK it worked fairly well in South Korea, Japan, New Zeeland, China.

People (rightly, or wrongly) don't trust technology enough, after the reputation Silicon Valley has built and can't shed, around privacy.

I'm on an Android phone, and sure, Citizen and a local State app can do the contact tracing. But what's Citizen doing with that data? It also requires interactivity (another Silicon Valley favorite thing to do - call out for people to perform actions via alerts and notifications).

It's a lower bar for people to wear masks than to accept to use an app for contact tracing, if you were to compare the policy actions. Now, you can have the contact tracers call people, but how many spam calls do you get that you ignore? And phishing attempts? I received numerous texts from "the Democrats" with a person's name, urging me to vote, from all sorts of US numbers, and asking for a reply. To this day I don't know how real that is.

There are too many people to blame for this state of affairs, but the greed and competition for eyeballs are the definite drivers.

It doesn't. Coronaviruses have a proofreading protein which prevents significant RNA changes: https://www.cell.com/molecular-cell/fulltext/S1097-2765(20)3...

https://www.reuters.com/article/us-health-coronavirus-denmar...

Sweden already has around ten detected SARS2 outbreaks on mink farms and is planning not to cull the entire population for the above harvest cycle related reason; the survivors will have ‘more space to socially distance’ and a ‘resultantly lower herd immunity threshold’.

Dense factory farming of all kinds is a biohazard nightmare.

We keep using words like "cull" instead of "kill" or "mass murder", as though it's not killing if the animal doesn't look like us. Just because you're more intelligent or more capable than a different kind of animal, that doesn't mean that your life is worth more than theirs. And it definitely doesn't mean your life is worth millions of times more than theirs.

The woke police would like a word with you lmao...

>Just because you're more intelligent or more capable than a different kind of animal, that doesn't mean that your life is worth more than theirs

What kind of rinky dink PETA argument is this? If you have kids I hope you explain to them that in an emergency you are likely going to save the dog and not your child because "your life isn't worth more than the dog's."

https://en.m.wikipedia.org/wiki/Antigenic_shift

[1] https://advances.sciencemag.org/content/6/27/eabb9153 [2] https://www.sciencedaily.com/releases/2014/11/141104111408.h...

> In fact, there is evidence of at least seven potential regions of recombination in the SARS-CoV genome in the replicase- and Spike-coding regions, with possible recombination partners that include porcine epidemic diarrhea virus (PEDV), transmissible gastroenteritis virus (TGEV), bovine coronavirus (BCoV), HCoV-229E, MHV, and IBV [1]

> Unlike other viruses that have emerged in the past two decades, coronaviruses are highly recombinogenic. ... For coronaviruses, however, recombination means that small genomic subregions can have independent origins, identifiable if sufficient sampling has been done in the animal reservoirs that support the endemic circulation, co-infection and recombination that appear to be common. [2]

> Recombination seems to be rampant in HCoV-OC43 viruses and contributed to originate the A to E viral genotypes, as well as viruses that do not belong to these major genotypes. [3]

Unfortunately, nature doesn't "design" anything, it's just the consequence of natural selection and fitness of new generations. While the mutation rate might low compared to influenza, the mutation rate is very high compared to something like a prokaryote, enough so that there's an article entitled "Why are RNA virus mutation rates so damn high?" We've already seen a gain of function mutation creating enhanced infectivity and a recombination event involving ferrets, so it's not a stretch that we might see a new more of this in the future. Whether or not it will impact the toxicity of the virus or whether or not its susceptible to a vaccine is up in the air, but once an effective vaccine exists strong selective pressure will be placed on versions of the viruses that evade it.

[1] https://jvi.asm.org/content/84/7/3134 [2] https://www.nature.com/articles/s41564-020-0771-4 [3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7111218/

A perfect example of why we won’t be able to eradicate Coronavirus. Polio was an easier target with stronger reasons to wish it gone, and we have failed.

So the Citizen App has contact tracing. But you have to check into the app, and furthermore, do you trust some private company with the information? About you? Your location and all this ? And contact tracing via government calling you - do you trust random numbers calling you and asking you questions? No one knows when Silicon Valley (in the case of the app) wants to steal some more of your private data, and no one knows when some phisher is phishing as opposed to some volunteer calling you up for contact tracing.

There's a breakdown of trust.

Oh, and saying, 'maybe this administration' is further evidence of that. I live in a blue state, and your perceptions are, I believe, wrong, about the magic around that or the cooperation of the citizenry.

If I'm sick, I'll stay home. I wear a mask where I'm required to. That's the limit of my participation in this hysteria.

And I'm really not sure what there isn't to trust about the testing companies.

It's Silicon Valley and its entire "you signed an agreement, you belong to us" morality and "get your attention span" business model that I distrust. Well, that and phishing phone calls/texts (I seem to get those regularly, after all this time).

My belief is that contact tracing is a cultural non-starter here. There are people who protest with large, semi-automatic rifles because they don't want to wear masks inside private businesses.

There's absolutely no way they're going to trust a contact-tracing process championed by the government, even if there's no way for the government to access the data.

I suspect much of the population will continue to ignore the virus and winter weather will cause a spike that will cripple hospitals.

Maybe they should compare your throwaway account Ip with the rest of the account ips and see if this is a sock puppet account.

Select ip_addy as source_ip from account_log where account_name=throwaway4220 join account_log on ip_addy=source_ip

Ban you.

Please stop pushing your fantasy narratives and puppet accounts here please.

I'll be responding to you early to mid 2021 with a link to an article about Bidens executive order for a mask mandate.

We will get vaccines and we will come up with better treatments negating its effects, but this coronavirus is here to stay. It will be a fifth endemic human coronavirus.

Coronaviruses also have plagued humanity in the same way, for instance look up “bovine coronavirus”

"Denmark to cull millions of minks after mutated coronavirus spreads to people"

- https://www.euronews.com/2020/11/05/denmark-to-cull-millions...

This means we'll probably have to receive Covid vaccination on a regular basis along with the flu vaccine in order to maintain a permanent broad-scale immunity. At least until we have a radical new treatment for this family of viruses that can confer a "permanent" immunity - something that for now is in the realm of science fiction.

* Protection against disease means that you don't get sick. You may still contract the virus and spread it to others (the Salk vaccine against Polio works this way).

* Sterilizing immunity means that you can't even get infected, so that you can't pass the virus on to other people. It does not look like there's any information about sterilizing immunity in this press release.

Importantly, this means that even with this vaccine, the virus may still be able to spread, and only vaccinated people will be protected (i.e., no herd immunity).

Can't we still hit herd immunity as a byproduct of this though? If everyone can pass it along without symptoms, then eventually everyone will have it...

If enough other people have sterilizing immunity, the virus doesn't spread, and the susceptible people are safe.

The Salk polio vaccine does not prevent infection in the digestive tract, so you can still spread the virus, but it does prevent the virus from spreading beyond the digestive tract and causing paralysis. You could imagine something similar happening with a SARS-CoV-2 vaccine: that it would block infection in the lower respiratory tract but not the upper respiratory tract, allowing you to spread it by coughing and sneezing while never getting severe respiratory issues.

Said another way: I don't think voluntary contact tracing will work in the U.S. And I don't think you can implement involuntary contact tracing in the U.S.

If I’m wrong, PLEASE provide a .gov link and I will personally make sure that our large academic org pulls out of reverse, and into first gear!

You’re assuming 100pct of the population takes the vaccine. I’d be surprised if it’s more than 50% the first year

Less than 10% can get it I the first year.

https://www.gov.uk/government/publications/priority-groups-f...

We're still months away from all 20M (of a >60M population) people that vaccines have been ordered for being administered with them, (BBC reports 'up to' 10M doses 'may' be 'delivered' this year, i.e. 5M people max) so I suppose they still have plenty of time to decide the most effective pecking order.

Aren't you assuming 100% coverage at 90% effectiveness?

What if it's - say - only 50% coverage, at 90% effectiveness. That's not looking so good.

I'm still trying to understand why an otherwise young and healthy person would want to get take one, or more likely multiple, shots of a C19 vaccine, given the risk from C19 is so low. What's the benefit to them?

In HN-speak: how well does a C19 vaccine deployment scale?

But even if we all need to get vaccinated once a year, for a 90% immunity, that sounds manageable. So good news, if it all holds up.

What if we can? How would we do that?

So, you don't really have to find every animal. Most should be enough.

[0]https://www.ted.com/talks/daniel_streicker_what_vaccinating_...

The injectable vaccine for polio stops the symptoms, but it doesn't stop the propagation of the virus from person to person.

The oral vaccine for polio also stops the propagation (that is better) but it is a live virus that can escape and produce polio in other unvaccinated persons (that is bad).

[So the current recommendation is to use oral version when polio is endemic, the injectable version when there has been no cases for a few years, and a mix of them in between.]

Normally when you get infected you get small number of viral particles in your system. Those then hijack your system to create more, and those new particles spread to other people through sneezing etc. In time your immune system learns how to recognise and kill the virus and eventually removes it from your system.

Now let's say you get vaccinated and you get that same small number of viral particles in your system. Your immune system will already know how to recognise and kill the virus, and immediately starts doing this. It doesn't multiply in your body, so it can't spread to others either.

SARS-CoV-1 was eradicated.

> To date, the World Health Organization (WHO) has declared only 2 diseases officially eradicated: smallpox caused by variola virus (VARV) and rinderpest caused by the rinderpest virus (RPV).

> Although successful containment strategies eliminated transmission of SARS among people, the continued presence of an animal reservoir means that SARS is not yet an eradicated disease.

https://asm.org/Articles/2020/March/Disease-Eradication-What...

> ... the 2003 SARS epidemic was permanently reduced to zero as a result of deliberate efforts, requiring no further intervention methods. This is precisely the definition of eradication.

https://biomedgrid.com/pdf/AJBSR.MS.ID.001017.pdf

There is no such thing as a vaccine that floods the body with fake ACE2 proteins.

We'll almost certainly need an annual covid vaccination for the same reasons we get annual flu vaccinations - with our current medical technology we can neither rid the planet of the virus nor obtain permanent immunity.

I didn't get flu shots in the past mostly because the shot hurts more than the flu, but COVID is another animal and pretty scary. Maybe they could be combined into a single poke.

In fact we have no idea how long this vaccine or any other [of the experimental covid-19 vaccines] will last for. They've got projections out to at least a year, but uncertainty becomes too great after that. It may last quite a long time, we don't really know.

for the same reasons we get annual flu vaccinations

No. We get annual flu vaccinations because flu viruses mutate significantly and quickly, so we're always getting vaccinated against new threats. Not against threats that we've forgot how to defend against.

[edited to clarify that the uncertainty is around the experimental vaccines; for old standards, we do have a very good idea]

You're right - I should have said "periodic vaccination", not annual.

Also yeah, there's a subtle difference between why we'd need periodic covid vaccinations vs flu vaccinations. But in the end the result is the same, we'll probably need to be re-vaccinated against covid over time.

Covid isn't going away because it has a non-human animal reservoir, so it's all about a strategy to prevent it's re-emergence into the sapiens reservoir. It's possible that periodic vaccinations of the population as a whole would be overkill and we could reactively immunize smaller populations as re-infection occurs.

> There are still questions - how long does immunity last, does the vaccine work as well in high-risk elderly people, does it stop you spreading the virus or just from developing symptoms?

I'd rate the news as "vibing" on a scale of clickbait to party for the world

The trial will be complete from an effectiveness perspective once there are ~150-200 cases.

Safety is a different story and may take more time to wait for side effects.

Thanks! Misread the 94, but the n=43.5k is also misleading since they have not analyzed all of the results and duration of the study vs exposure risk is still tbd. If the 94 participants that got COVID also abided by all the other precautions, such as masks, etc, then it stands to reason that the actual infection rate in the population approximating pre-covid behaviors may also be higher.

I'm not suggesting Pfizer is up to something nefarious, just that the biomedical literature is littered with studies with N < 100 for the outcomes of interest and they don't replicate. The N > 40k in some ways is irrelevant if none of those participants have the processes in play. It's more like recruiting N >40k to get N=94 to study.

I'm also not suggesting with 90% effectiveness that there's probably no effect, just that my guess is a true value of 60% isn't outside the realm of possibility once you consider all the factors that could be in play besides the random sampling variation that's assumed by their tests.

What you're saying is the 9 is pretty close to 34 (60% effectiveness). No, it isn't. You'd need to quadruple the number of vaccinated cases to get there. Even if you double them, you're still at 80% so I'd take that as the realistic worst case.

Edit: Also, this is BioNTech's vaccine, not Pfizer's. They partnered with Pfizer as they have the facilities and scale for a massive rollout, but it was developed by BioNTech. I wish they were getting more credit in the US & UK coverage.

That's how clinical trials are done.

The SF bay area has dry ice delivery.[1] Lagos, Nigeria has dry ice delivery.[2] Bismark, North Dakota has a dry ice plant.[3] It's not hard to get.

Coolers for holding items in dry ice are about $100 on Alibaba.[4]

This doesn't look like a big problem.

[1] https://bensdryice.com/

[2] https://www.businesslist.com.ng/company/256889/greatsmith-re...

[3] http://www.dryiceweb.com/Praxair/Bismarck_ND.htm

[4] https://www.alibaba.com/product-detail/Vaccine-Carrier-Biome...

It's not a big deal for the first world, but poorer nations may hold out for future vaccines that remain stable at higher temperatures and only require a single dose.

Merck is working on a one-dose pill, but that's not expected before mid-2021.

There's micro encapsulation for vaccines.[1][2] The vulnerable active molecule can be put inside a coating that is stable in storage but dissolves after injection.

[1] https://www.academia.edu/33376119/Microencapsulation_of_Vacc...

[2] https://www.sciencedirect.com/topics/immunology-and-microbio...

Valid point, but I feel there's never been a better time for massively pushing this vaccine (after proper testing and regulatory approval, of course) to medium/low income countries.

Winter should make it much easier in managing the temperature range stability required for storing/shipping the vaccine, especially in countries around the equatorial region.

Doing it in late spring/summer will not be a good idea (assuming a better vaccine doesn't come out by then).

That's a big issue. The N95 mask shortage demonstrates that the US manufacturing industry has far less surge capacity for simple items than previously thought.

https://www.nbcnews.com/news/world/denmark-plans-kill-15-mil...

https://www.statnews.com/2020/11/05/spread-of-mutated-corona...

A more aggressive take: https://twitter.com/BallouxFrancois/status/13240857614493040...

I am yet to be reassured.

Without China cooperating and trying to save face, we don’t truly understand the origin of this virus and how it initially spread so well.

I responded to a post that said “we need to go plant based to avoid these things happening”.

Well going vegan won’t do so any good if this was released from a laboratory?

There are numerous companies which specialize in -80C transport and shipping. These containers can be used as temporary (3-7 day) storage at destinations where they do not have infrastructure.

So this vaccine can be distributed to regions with the infrastructure to store it and we can preserve vaccines with less stringent requirement for developing countries, etc.

(That's -112 F, for anyone else wondering.)

They do stability studies on these molecules, holding samples at different temperatures and measuring how much "is left" after a period of time.

This particular RNA sequence and carrier might be particularly unstable, so it require -80C if you want it to last longer than a few weeks.

In a biological context, the vast majority of RNA use falls within the 'central dogma' of DNA -> RNA -> Protein. It is merely an intermediate, albeit one with important and complex regulatory processes.

In RNA viruses and other contexts where stability is required, the RNA is stabilized by its environment, namely by associating with special proteins.

If that temperature could be obtained with dry ice, that would simplify things a bit. But AFAICT dry ice sublimates at -78.5C.

But what kind of capacity can they handle? I imagine the scale of a Covid vaccine rollout would overhelm prior existing infrastructure

Of course larger institutions already have everything in place and will get shipments with less warning (but they will also get smaller shipments since they don't have to get everyone done at once)

True but it's also a bit more complicated than that. The YouTube channel Wendover Productions has a great video on the subject: https://www.youtube.com/watch?v=byW1GExQB84 (skip to 5:01 for the talk about the cold chain).

TL;DW, there are other factors:

- Whether the hospital is able to maintain the vaccine at the required temperature (many, especially the smaller ones, don't have the equipment)

- This is medical technology and unproven options (like buying a random box off Alibaba like someone suggested) are unlikely to be used

- Pfizer (vaccine in TFA) has developed a shipment container that uses dry ice and lasts 10 days but it can only be opened twice a day, for less than a minute at a time, so facilities administering vaccines need to be able to accurately predict how many they'll administer in a given day

- Pfizer's box is only built for multiples of a thousand doses and only lasts 10 days so isn't well-suited to smaller areas that can't administer 1000 vaccines in 10 days

Since the transport cases are reusable, and don't need to be completely populated, what will likely happen in rural areas is that they'll have a case for shipment, refill it with dry ice on site, and use a second case to transport a small number of doses to the point of use. Repeat until used up, refilling with dry ice every few days at a central location (less than a week's travel from administration sites). I don't think it's going to be a major problem in practice.

The fact it's -80C means they can't prove it stable at higher temperatures.

It's already in use around the world[1], but I haven't heard of how many people gain immunity thanks to it in percentage, nor if that one also requires multiple jabs.

1. https://www.aljazeera.com/news/2020/11/3/uae-pm-and-dubai-ru...

https://www.fiercebiotech.com/biotech/sinopharm-shares-phase...

"unlike other COVID-19 vaccine trials, the study lacked a comparison arm featuring serum samples from patients previously infected with the coronavirus, complicating the task of interpreting whether the response is likely to confer immunity."

It seems that a vaccine needing a 2nd booster jab is also something that is quite common.

Anyhow, good news all around... The more viable vaccines we have, the more likely that the pandemic will be controlled sooner.

It’s a difficult problem, but a solved one.

I like your optimism, and what you said isn't incorrect about Ebola at the time, but I don't think it's correct about our current situation. How many locations globally have this level of refrigeration? Given that there would be high demand for it, wouldn't prices on any available refrigerators exceed what even the most altruistic companies and organizations could pay?

This still needs to be solved. We have a lot of entrepreneurs, investors, and engineers reading this, so let's not be hasty in hand-waving over something serious.

* The largest chilled supply chains, for things like frozen food, don't get anywhere near -80°C

* The question of what to do in poor countries is very much unsolved

On the other hand:

* Developed countries have at least some cryogenic supply chain in place, for things like fertility medicine.

* You can get a surprisingly long way with couriers transporting insulated boxes full of dry ice (or liquid nitrogen).

* The prize on offer here is absolutely huge, because lockdown is so expensive. $10 billion a day buys a heck of a lot of couriers.

This is by far not the challenge covid19 poses to the world. It wasn't when it was China's local and regional problem, and it is not after it spread out of China and became a pandemic.

Objectively, at most Covid19 causes a slight increase in the global death rate, and this is only observed during the initial spread before herd immunity kicks in. Ww2 killed about 90 million people in 6 years, while covid is bound to have killed about 1.3 million in one year.

It should be substantially less difficult than winning WWII, which again - we were capable of scaling up industrially to accomplish.

> this is only observed during the initial spread before herd immunity kicks in

When will that be? NYC's new spike is demonstrating even their enormous outbreak didn't generate enough of it.

It's a global pandemic. Order them from anyone who can make them at scale. Coordinate with the WHO to avoid silly bidding wars.

Even dry ice in coolers is low tech but gets you a lot of time considering storage for the second booster dose will be centralized.

The risk is real though. Breaks in cold chain storage have inactivated vaccines have been documented to leading to outbreaks in other disease states. Still, at this point, from my boots on the ground perspective -- so far, so good.

1. https://www.nytimes.com/2020/09/18/business/coronavirus-covi...

Surely there's got to be some existing shipping indicator to track if a shipment has exceeded the temperature limits during transit. Even just a vial filled with a liquid that freezes at e.g. -70C would work just by tipping it upside down when frozen.

- https://www.gavi.org/vaccineswork/cold-supply-hot-demand

I don't have much more on that front, but it's worth a look to see what well developed agencies are aiming at.

You could easily localize COVID-19, just make a vaccination passport. No entry to a country if you're not vaccinated.

> How many locations globally have this level of refrigeration

Almost all developer countries, urban centres, where majority of people live anyway.

At -80C?

Edit: There are hardly storage places right now for these temperatures.

https://www.youtube.com/watch?v=byW1GExQB84

> At -80C?

Absolutely. This is a solved problem.

You can buy dry ice at your local supermarket. I buy meat from a ethical farming operation that ships their product in insulated packages packed with dry ice. There's almost always dry ice left over. I made a bottle bomb out of the remainder once.

Every major medicine manufacturing company will already have had supply chains in place to deal with this for other medicines.

Storage is a red herring. It won't last more than a day in any given medical facility.

Well, as long as the temperature is under zero, all is fine - otherwise the 4 kilometers of ice under your station might pose a problem.

A breakdown scenario in a rural area could mean 1000s of wasted doses

Don't you think Western countries are ordering many thousands more doses than they actually need?

Breakdowns happen - places don't need to have perfect infrastructure in order to warrant treatment.

Once the world is open the US and UK will be happy to say that they were able to cancel some unused vaccine supply if it turns out not needed. (which will be easy - between focusing on poor countries and moving production to something else (or winding down) as they recognize the need is gone they will be willing to end those contracts not completely filled. Politically it is a money saving move.

Of course the above assumes best (or at least) case. There are many ways things can go wrong. If all approved vaccines need a booster every 6 months things will be very different. (this is an unlikely but still possible very worst case)

They should be able to put out a general announcement and get thousands to get the vaccine if they need to. A lot of people who can get off work on short notice if there is an emergency. Obviously not everyone, but thousands can be redirected to someone else on short notice. Of course this requires emergency shipments to those who should have got the original, but the breakdown would require that anyway.

I don't know what the thawing protocol is though - this is a real concern that needs to be handled. I assume those who deal with the logistics have plans and backup plans that account for all of the above.

"Once a provider receives that vaccine, it really starts the clock that the vaccine needs to be administered within five days of when it's put in the refrigerator"

Source: https://www.cbsnews.com/news/coronavirus-vaccine-distributio...

Any you get a week after thawing it to use is anyway, so you don't need the cold storage where the end user is. I don't know what the thawing protocols are of course.

Those I don't think the doc even needs a fancy cooler, if I understand correctly they need to thaw this first, by the time the individual doc gets it they need to be thawing it and then using it quick. (I don't know what thaw procedures are though)

But I think you're overlooking something rather important: Storing liquid nitrogen in a vacuum flask only keeps the liquid nitrogen cold for hours or days. It doesn't keep the thing cold that you're cooling with liquid nitrogen.

The week you get to use it is after the dose has been created. If it's brought below temperature for any length of time, it can presumably DESTROY the dosages affected by temperature.

See the current flu vaccine storage protocols, for example: https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/vac-sto...

"Regular temperature monitoring is key to proper cold chain management. Store frozen vaccines (Varicella, MMRV, and Zoster) in a freezer between -58°F and +5°F (-50°C and -15°C). Store all other routinely recommended vaccines in a refrigerator between 35°F and 46°F (2°C and 8°C). The desired average refrigerator vaccine storage temperature is 40°F (5°C). Exposure to temperatures outside these ranges may result in reduced vaccine potency and increased risk of vaccine-preventable diseases."

Source: I work in vaccines, and our company works on thermostable formulations, among other things.

This maybe _was_ the problem in the beginning of the pandemic. Now, it's in the general population and will spread even if you ban all airplanes and repurpose airports into petting zoos.

Sure some places will find total vaccination the best option, but places with out the infrastructure and money can simply do one lockdown that isn't compromised again by air travel.

China is an example that would have left the pandemic if not for the need to resume Air travel.

From what I've read it is the first large scale adoption of mRNA vaccines so the really long term risks are less known. That said, theoretically mRNA vaccines should have a lot of advantages. Later in 2021 there may be a few other options for vaccines to take as well, so I'd do some research at least.

Some links that might be relevant:

https://edition.cnn.com/2020/10/27/health/russia-coronavirus... Moderna vaccine requires storage at -20 °C Sputnik V at -18 °C; so that would be easier to handle.

https://www.ndtv.com/world-news/after-pfizer-russia-says-its... 90% effectiveness says the Russian vaccine Sputnik V

https://www.globaltimes.cn/content/1206008.shtml "No infections among 56,000 people who traveled abroad after receiving Sinopharm-developed COVID-19 vaccine"

https://www.jpost.com/health-science/hadassah-bringing-15-mi... Israel is bying Russian vaccine shots, the head of Hadassah hospital says there is quite a lot of power politics involved in the discourse (Hadassah is one of the major hospitals in Israel)

https://www.berliner-zeitung.de/wirtschaft-verantwortung/cor... (in German) for the EU some producers of COVID vaccines got an exemption clause for liabilities, they say because of very tight development schedules (says an unnamed speaker of the European Comission)

- Trial is only halfway complete.

- Preliminary results have not been peer-reviewed.

There will be no eradication of the virus, certainly not world-wide, short of multiple waves of vaccinations. Not even with one type of vaccine, but more likely more than one.

Some of the developing world might get vaccinated with a cheaper, more traditional vaccine, but later. But there is no good vreason why you can't have huge vaccination campaigns with cooling trucks at least in their bigger cities.

That makes no scientific difference, but there are a fair number of people in the US who will not use a vaccine if it is developed that way.

What did they use to stabilize the mRNA?

If they’re managing to do it with just temperature and maybe glycerol, that’s great.

If it’s RNAlater, then that’s going to have safety issues. If it’s something else, how was the additive tested for long term safety? (Vaccines like this have been in the works for a long time. There has been time for safety studies.)

Edit: RNAlater MSDS sheet: https://tools.thermofisher.com/content/sfs/msds/2012/AM7020_...

Section 2 states it is non-hazardous.

Section 4 states it is not expected to present a significant ingestion/inhalation hazard under anticipated conditions of normal use.

Finally, Section 11 indicates that the Ammonium compounds present in RNALater may be harmful, but only when they are administered at LD50 concentrations.

https://www.protocols.io/view/RNAlater-Recipe-c56y9d

https://www.nytimes.com/2020/09/18/business/coronavirus-covi...

I guess you should invest in dry ice manufacturing companies!

edit: See https://www.wsj.com/articles/pfizer-sets-up-its-biggest-ever...

Do You mean the Co2 supply chain? We make a lot of carbonated beverages; there will likely be no shortage.

So there are many reasons to think otherwise, but the simplest one is - Every single medication and vaccine that we've ever made has known side-effects. Not all side-effects are known right off the bat, and many take years to detect.

I work in vaccines, but I can't think of a vaccine that was completely recalled due to long-term safety issues of the top of my head. Most recalls happen because one lot or the other had some production issues. Certainly, vaccines are extremely safe by the time they get approved - because the approval process is careful, methodical and takes years.

However, in this case, if a COVID vaccine is approved by the end of this year or in the near-term, we won't have any long-term data, and so I do worry about those aspects, about the compounds used in the final formulation as well as the untested nature of RNA/DNA based vaccines.

A few places to do research for those interested:

https://vaers.hhs.gov/data/datasets.html?

https://www.fda.gov/vaccines-blood-biologics/safety-availabi...

As far as I recall, the high R0 of COVID-19 meant that >90% was needed for herd immunity. You then also have to factor anti-vaxxers into the equation.

It's a good stop-gap for the 90% who develop immunity, but we need a better vaccine even in developed countries.

Why am I being down-voted? Is it really of no concern?

Better answer: the vaccines are new but the individual systems used to develop them are not, and we have historical trials of a lot of the same techniques which show no long term risks. The biggest unknown has always been the risk of triggering a short-term, unexpected primary immune response that causes harm to the recipient. In the vaccines being developed, that has generally not been found to be the case, and since they're based on the virus currently infecting people we would not expect a response worse then that (which is to say: the components of vaccine use are all well studied, these are understood and safe materials).

The other issue is when we talk about "rushing" vaccine research, this does not involve shirking safety research - i.e. consider the influenza vaccine which year over year is basically a new vaccine we develop quite quickly. What it does mean is that you overlap the stages of vaccine development: normally if you have a P3-trial vaccine, you'd wait till that trial was successful before building the factory to make it. Instead, companies are being paid (or paying themselves) to build facilities and scale up production as soon as they get to the P3 trial stage - financially it's a huge risk, since what they have might not work, or might have an unacceptable risk profile in those trials - which means all the investment is a dead-loss.

This is where government steps in (and has stepped in in places): by guaranteeing the investment on getting those facilities out, it means if your vaccine works then you're ready to go and it's in production right away - as opposed to being another year to 2 years down the line while you work on manufacturing.

This is of concern. The medical industry has a history of covering up the direct know effects of their medicine, AKA poisons. That system has been know for a very long time to lead with arrogance and it sometimes takes them a very long time to pull things they know are killing people. Its just too much $$$.

See vioxx and merck, for just one example.

Personally, I doubt I will get it at all. The authorities have a very long way to go to win back my trust, after the chain of screwups over the last year.

We've seen that they will lie to us, we've seen that they apply rules to us that they themselves don't follow, and we've seen them take advantage of the situation for their own benefit.

It is a huge shame that so many people are not going to take it solely because they've betrayed our trust so many times that now that they might be doing something good, we won't cooperate.

You know how you could turn this against them to make them think twice about it? Get the Russian vaccines, or the Chinese. Yeah, do it! Suddenly they are not so keen... Now imagine if their beloved State made it mandatory to get Russian vaccines inside them. They would most likely be against it, and our votes would not be down... It is not even the votes I give a damn about, but the fact that we do not know THAT much of COVID-19 but people seem to believe the claims that we have extremely safe vaccines ready just within a few months. Yeah, they say that of the Russian vaccines, too, are you going to take it, down-voter? Would you like the State to make it mandatory for your kid to get vaccinated? I am curious.

My entire family tested positive for COVID-19, and my grandma most likely has it. None of us has/had symptoms. I do not want to get vaccinated. If you (not you, the down-voters) really care, go get vaccinated by the Russian vaccines.

My country plans to vaccinate the elderly, kids, and people with chronic diseases first, then the rest of the population. I really, really wonder how many people are going to have FORESEEABLE side-effects. I think they are also planning to make it mandatory.

P.S. I am not an anti-vaxxer, but these claims by pharmaceutical companies sound shady as heck. If they said they found the vaccine after 5 days and they claim it is super safe because 5 people did not die from it within 10 days, would it make you OK the vaccine? Come on. My problem is that. It is too quick, and too many promises of lack of side-effects, and lots of financial interest. For that I do not believe them. We (medical workers) even have to lie about people dying from COVID-19 so we (the hospital) get more funding. How about that? Governments put price control on the tests, which resulted in zero competition as it was not worth it for private businesses to continue testing. How about that?

The current understanding is that there will be likely no long-term immunity, just like the flu virus (as it mutates).

> -80 Degree Celsius storage and transport needed.

This is actually typical for vaccines storage/transportation needs. Unfortunately this will also means that it cannot be easily distributed into developing countries where supply chain requirements are largely unmet.

It could also refer to 90% reduced severity.

A 60% vaccine can reduce the severity of the illness by 40% so only 40% of the expected number end up in hospital.

"The first effective coronavirus vaccine can prevent more than 90% of people from getting Covid-19, a preliminary analysis shows."

https://www.cdc.gov/flu/prevent/misconceptions.htm

and this

https://www.cdc.gov/flu/prevent/vaccine-benefits.htm

you'll see that that's not how it always works.

> Flu vaccination can reduce the risk of flu-associated hospitalization for children, working age adults, and older adults.

Yeah, this alone is bad news.

Last year my parents got a two-dose shingles vaccine. The two doses are supposed to be separated by two to six months. My parents struggled to find their second doses in the window. Apparently there was limited supply and no one had the foresight to reserve second doses when people received their first, or even to prioritize second doses over first.

The covid vaccine will have much more demand and apparently a tighter window, and our health system isn't exactly well-coordinated right now, so I anticipate a lot of people will be unable to get the second dose with the proper timing.

Wendover did a nice video[0] on this topic month ago, explaining how UPS/FedEx/DHL/… are already massively upscaling their cold chain infrastructure. Retrofitting planes, building giant freezers in transport hubs.

[0] The Greatest Logistics Challenge Ever - https://www.youtube.com/watch?v=byW1GExQB84

One thing that I found interesting was how they identified today's announcement of the BNT162b2 vaccine candidate (back in September) as one that would require the massive investment in cold chain infrastructure. They also highlight Pfizer's engineering of a separate series of cold boxes that would keep the vaccine at temperature for up to 10 days, thereby enabling it to be shipped through standard logistics networks. Great stuff.

In the UK, the NHS are generally on top of things like this, so it should not happen in most cases.

If there are 7 billion people and 1 billion doses in the next year, it's going to be awkward.

Tldr: i have a team in a top institution. There are gaps and the news is TGTBT.

[citation needed]