Herd immunity by April?

Can't stand it? I got my first dose 2 1/2 weeks ago. I crated a thread about exponential growth in vaccinations, which is a good thing. However, what I can't stand is the people like you and the Fox News pundits who do their premature victory dance. This is not over yet, people still have to be careful. If they listen to you, many more may die.

 

This is nothing new. Vaccines often induce good T cell and B cell training, which is called cellular immunity. But when this process is triggered by a narrow vaccine, one that instead of using a whole inactivated virus for example (like the CoronaVac developed by Sinovac/Instituto Butantan), uses an mRNA targeted exclusively to a specific sequence of the virus' S protein, you may have that antigen presented by mastocytes to T cells, which will differentiate into cytotoxic T cells (that will directly kill cells that have been infected with that viral protein) and the T cells that will activate B cells into plasma cells for antibody production, again, against that S protein. So, yes, the current mRNA vaccines are doing just that. But the issue is, if viruses mutate enough and their S proteins become too different from the one the mRNA vaccines instruct the host cells to make, it doesn't matter if you have T and B cells, the response won't be great. So, the jury is still out. Yes, it does seem like at least some of the vaccines work against the new variants, FOR NOW. And not all the same way, and not all to the same degree. The Moderna showed a 6-fold decrease in neutralizing antibodies, and the Pfizer showed a 3-fold decrease, against the B.1.351 (they are both fine against the B.1.1.7; still unknown regarding the P.1). It seems like the Pfizer is still fine with the T cells regarding the B.1.351. The AstraZeneca though seems to be much worse against the B.1.351 strain. Both the Novavax and the Janssen also showed decreased protection against the B.1.351 (respectively 49% and 56%).

So, the issue is not as simple as you are thinking.

Still, yes, there is a brighter light at the end of the tunnel but we don't know yet if things will remain as rosy. More mutations could alter it all.

About the good doctor, he *is* spouting nonsense regardless of his credentials (more on this soon). Not all people with credentials are always correct. By the way, it is interesting to notice that often, when someone is supposedly an expert but issues shaky positions, that person is a professor primarily in a School of Public Health rather than a Medical School. It's also the case of a notoriously mistaken professor at the School of Public Health at Yale University. Often these people actually have no clue about Virology and Immunology and they are issuing opinions by going out of their lane, which is often Epidemiology. These optimistic "herd immunity" views often ignore fine Virology points. Now, in the case of the good doctor here, it's much worse:

Do you know what Dr. Makary's specialty is? Freaking Surgical Oncology. Not Virology. Not Immunology. Not Infectious Disease. Not Immunology. So much for his "credentials." He is simply outside of his lane.

And I've demonstrated to you, clearly, where he is wrong in his misguided evaluation of the situation in Manaus, Brazil. It's actually pathetic that he picked Manaus for his example, clearly ignoring what is *currently* going on there. What a failure!

People often get impressed by the words "Professor at Johns Hopkins" and you assume he is a "recognized expert." Sure, he is a recognized expert in Surgical Oncology, which in no way, shape, or form, qualifies him to issue predictions about the virological behavior of the SARS-CoV-2.

 

Hey, wanna see how wrong your "good doctor" is, as per another doctor, saying exactly what I had already told you? Here:

https://www.yahoo.com/news/health-experts-split-u-reach-201231282.html

This other doctor called it a "deeply flawed op-ed" and like me, also said that in Manaus, Brazil, high levels of infection against the previous variant weren't protective when the new variant hit, that T cell immunity doesn't work regarding vaccines like the "good doctor" (a surgeon) thinks, and the B.1.1.7 accounted for peak pandemics in the UK, Israel, Ireland, and Portugal.

I suggest that the "good doctor" should continue to operate on his cancer patients, and s... the f... up about Virology, Immunology, and Epidemiology.

 

As we get closer and closer to herd immunity

For Covid-19 Survivors, One Shot May Be Enough, Preliminary Studies Show
Data may mean a second dose of the vaccine is unnecessary, potentially freeing up limited supply

Covid-19 survivors who have gotten a first dose of Covid-19 vaccine are generating immune responses that might render a second shot unnecessary, potentially freeing up limited vaccine supply for more people, several new research papers suggest.
https://www.wsj.com/articles/for-co...ary-studies-show-11613903400?mod=hp_lead_pos4

And

Herd immunity could be closer than we think
https://www.hindustantimes.com/life...-be-closer-than-we-think-101611205983940.html

"There is some encouraging data on herd immunity from the clinical trials of two leading vaccines, says infectious disease doctor Monica Gandhi of the University of California, San Francisco. While the three leading vaccines have proven extremely effective at preventing symptomatic illness, two showed some hints that they limited transmission of the virus as well.

Read more at: https://www.bloombergquint.com/gadfly/the-covid-19-vaccination-campaign-should-emphasize-optimism
Copyright © BloombergQuint

"By our calculations which you can see in the nearby chart, including official positive tests, estimated additional infections, and vaccine doses, shows that roughly 40% of the US population currently has antibodies. That means we are currently over halfway to the 70% goal, and projecting vaccinations forward shows we are likely to get the rest of the way there in mid-late April as vaccines continue to do the heavy lifting"
https://www.ftportfolios.com/Commentary/EconomicResearch/2021/2/10/immunity-is-closer-than-you-think

I almost get the impression that some don't even want herd immunity until the end of the year as Biden seems to be suggesting.

 

Sorry, but as an MD-PhD with expertise in Virology and Immunology, I do not need to read lay press articles to form my opinion.

It's not that I "don't want herd immunity." It's just that lay people (and even some idiots like this oncology surgeon) run with the concept without understanding it, because it seems cute and it seems to make good common sense - but it is way more complex than what it seems. You then get idiots like Trump's advisor Scott Atlas (a freaking radiologist) who wanted to PROMOTE more infections and less testing to foster herd immunity, having no clue about the unintended consequences of this boneheaded approach.

So, it's not that I don't want herd immunity: what I don't want, is to see the concept misused, resulting in premature easing of necessary precautions that might result in additional waves and surges, not to forget, might result in more mutations given that the virus mutates more when it replicates more (it cannot mutate without replicating). And I also don't want any active pursuit of it via natural infection, for a large number of reasons.

I could spend several paragraphs explaining to you what exactly herd immunity is, how the herd immunity threshold is calculated (down to the formula that among other items, uses the s factor for susceptible population, and the R naught number which contrary to what lay people think is not written in stone and is variable), and what is heterogeneous about it, with the virological, environmental, behavioral, genetic, clinical, epidemiological, and demographic intervening factors, which are many.

Most models that do NOT take into account all of the above end up with egg on their faces.

I won't repeat it all here because I've done it extensively already. If you are interested, you can read my posts (and @557 's, pretty much the only other poster here who fully understands the concept) by performing an advanced search with the keywords herd immunity, and me and him as post authors. If you take the time to explore our posts and to read the scientific papers about it we've linked to, you may learn a thing or two about it.

Like I said already, of course I root for a combination of vaccination and natural infection to push the population's overall immunity above most points (I say most because it's variable) of the herd immunity threshold for each specific population and each specific situation, so that the pandemic peters out. Of course, after spending 40 years saving lives by exercising both direct medical care and conducting research, my goal and hope is to see the pandemic regress so that people don't die or get burdened with long-term serious sequelae.

I'm just saying, victory laps are dangerous. They tend to make people complacent. While the current steep drop in infections and deaths is very encouraging and I'm very excited about it, all that I'm saying is that we can't just think of winning battles; we need to win the war. The new variants do present a risk that might result in still another surge/wave and like the case of Manaus demonstrate, herd immunity to the previous variants of the SARS-CoV-2 may not hold in the presence of the new variants, so the jury is still out.

Right now we're involved in a race against the mutations and resulting variants of concern. We may very well win the war if we vaccinate fast and if people continue to increase percentage of mask use (especially if people use better masks and with better fit). But we may still lose a couple of additional battles if people let the guard down due to misguided articles like this WSJ one, published by an oncology surgeon who lavishly proved that he is clueless about what he is saying.

Eventually stable herd immunity that will be above the threshold for the various local and regional populations that make up the larger US population might be achieved by a combination of natural infection and vaccination. Will it happen by April? It is not impossible. But I frankly find it unlikely due to the current rapid progression of the B.1.1.7 strain. So the jury is still out. We'll see. I think it's still possible even if not by April, as long as the virus doesn't create new and even more concerning variants of concern.

In the UK, the B.1.1.7 Kent variant seems to be brunching out into still another subtype, being called the Bristol variant, which seems to share the E484K mutation with the South African variant (which makes the work of the vaccines harder) and the N501Y with the Kent variant (which makes the virus more infectious. See, the Kent didn't use to have the E484K mutation, so it was more infectious but not better equipped to evade vaccines. The P.1 from Manaus already has both, plus a third one (K417T).

The concern is, still newer variants might end up with BIGGER vaccine evasion and natural immunity evasion, as well as more infectiousness. If this happens, these new strains, like it is happening with the P.1 in Brazil, will be able to re-infect people who have already had the natural infection, as well as vaccinated people. In this case, so much for herd immunity. Get it?

And these are just the virological aspects of herd immunity. Like I said, there are many other factors.

I'll tell you what: I probably know 1,000 times more about this than the "good doctor" you quoted. I do not know how to perform oncology surgeries, though. So, if someone has a tumor and needs surgery, they should go see your "good doctor." If they need advice on Virology, Immunology, and to a certain degree Epidemiology, they should ask me instead, and they will get more precise answers.

 

So you filter your experts to only those who support your wishes......as you said "Not all people with credentials are always correct"........gotcha.

And BTW
"Vaccine efficacy was 74.9% (95% CI 41.6-88.9) after two doses against symptomatic infection from the B.1.1.7 variant, reported Andrew Pollard, PhD, of University of Oxford in England, and colleagues, writing in a pre-print not yet reviewed by The Lancet."
https://www.medpagetoday.com/infectiousdisease/covid19/91098

Pfizer COVID-19 vaccine effective against B.1.1.7 variant from UK
Research has demonstrated that the Pfizer and BioNTech COVID-19 vaccine can neutralise the B.1.1.7 variant in pre-clinical studies.

https://www.europeanpharmaceuticalr...ne-effective-against-b-1-1-7-variant-from-uk/

 

I am correct.

Now SEE IF YOU READ MY POSTS before replying because if you react with a knee-jerk without reading or paying attention, it will be hard to keep debating.

If you had paid attention you'd have noticed that I ALWAYS said that the vaccines capture quite well the B.1.1.7. Re-read post #27 and notice this:

See my very first participation in this thread, post #5:

Sorry, but you will NOT catch me in error about this. That's what I do for a living, with 40 years of experience.

If you think you can teach me something by quoting your articles regarding research, you are out of your mind. It's laughable that you produced this quote, triumphally trying to prove me wrong, when in not one, but TWO posts here I had ALREADY said the same thing.

You say that I "filter" the experts... I *am* one of them. I peer-review their papers (and they peer-review mine). Those who support my "wishes"? What wishes??? Science has no "wishes." It is what it is. I'm simply telling you the currently accepted facts (although as in all sciences, they may evolve; but what I'm telling you is the current state-of-the-art).

My credentials on this are far superior to those of the "good doctor" you've quoted (complete with a MORE relevant faculty appointment in a medical school just as prestigious as his).

You don't need to believe me. However, if you wanted to do as I suggested, and looked up my posts on this (including not only the herd immunity ones, but also my "State of the Vaccines" and my "SARS-CoV-2 Variants" threads, you'd quickly realize, like many here have already, that my expertise is real.

See this, for example, from my "SARS-CoV-2 Variants" thread, post #1 (started much before this thread):

http://www.politicalforum.com/index.php?threads/sars-cov-2-variants.584511/

Or this, from my State of the Vaccines thread, post #517 (also posted much before this thread):

http://www.politicalforum.com/index...f-the-vaccines.576983/page-21#post-1072442500

(A clarification: even the T-cell response can suffer if the S-protein drifts too far away from the one codified by the synthetic mRNA in the Pfizer vaccine; fortunately this has not happened yet - and the drift would have to be MUCH bigger - but is not excluded for the future - this is because of how narrow the mRNA vaccines are, which is an advantage for immunogenicity and strong neutralizing titers, but a disadvantage regarding mutations; a disadvantage that is mitigated by the fact that in 4-6 weeks these vaccines can be tweaked to the new variants, much more easily than other platforms).

---------------

I'll tell you what: trying to catch me in error on this or trying to teach me something about it won't get you anywhere. I'm not infallible but I'm rarely wrong about my own field, unsurprisingly. And certainly I don't know all of it and some people can teach me (as we all get to sub-specialize), but not a lay person like you, sorry (that's just a fact), and not a surgical oncologist.

I don't know what you do for a living. Certainly not Virology/Immunology... (that's pretty clear) but whatever it is, I'd respect your knowledge of it and wouldn't try to teach you about it. It's as simple as that. I don't try to teach other professionals, their own profession. I don't try to teach surgical oncology to the "good doctor." But he should not try to teach me Virology/Immunology either, or else he'll spout nonsense like he did. I'm obviously way more up-to-date to the P.1 variant in Manaus than he is.

And this is not being arrogant or elitist. It's just being factual. I don't find me special in any way as compared to other professionals. I respect the humblest ones. I mean, if my house has a water pipe leak, I don't ask for the opinion of a colleague at my hospital, my medical school, or my lab... I will ask for the opinion of a certified plumber. If there is a chemical spill in my hospital, I rely on the janitors who have been trained on how to clean it up. If one of my patients needs a blood sample, the phlebotomists will have an easier time finding the vein than I would.

But Virology/Immunology? Well, unsurprisingly, I hold my own on this one.

 

If anybody here wants a comprehensive explanation of antibody immunity and T-cell immunity against the SARS-CoV-2 and their relationship with vaccines and viral mutation, this is an excellent paper:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7802525/

 

GMA did a piece this morning since we hit another milestone. However the tone was radically different. After months of it’s ALL Trumps fault, they were reporting that “even scientists and doctors had no idea a year ago where we’d be. OH REALLY??? Scientists and doctors didn’t know but it’s TRUMPs fault. And Fauci mentioned we shouldn’t look back to what we did, but only look forward. Of course. Maybe because objectively he was wrong a few times, but again...ALL Trumps fault. All the evil Republicans not wearing masks n stuff. Meh. Damage is done. Election is over. We can deal with truth now since what’s to gain at this point??

The disgusting nature in how the entire pandemic was covered by the MSM has nailed the coffin closed on who people can trust now. Was it worth it? Demonizing 1 side for political gain? Haven’t heard yet how every Hiden is responsible for everyone that has died since he took office. How weird. What a wonderful job Cuomo did compared to Desantis. So weird.

 

Some with vested interests spend much time spreading the falsehood that herd immunity can be delivered only by Big Pharma. Their vested interests are profits for investments.

Herd immunity in varying degrees and in some locations has been with us for month.

Moderna and the others are not interested in public health, they are interested in profits.

 

We were told by Democrat voters that only a Democrat can "cure Covid"

With that said, the truth cannot come out because those in the public not attached to ABC/CBS/NBC/NPR/CNN will realize that viruses do run their course and the body builds immunity. We cannot let the truth come out now and we need it to linger so Democrat voters can use that as "proof" that Democrat votes saved the day

Nothing more important than the Democrat politics of a virus

 

Can you please cite where Democrat voters told you that only a Democrat can cure covid? Thank you.

 

read your own posts

seriously............you asked that??? Why did you vote Democrat in the last election? You will have your answer.

A question to you and if you plan on answering, please be honest

do you listen to or watch any of the below?

NPR
NBC News
ABC News
CBS News
CNN
MSNBC
Young Turks

 

Which state run non-profit pharmaceutical industry has produced a vaccine?

 

I seem to recall Biden and Harris saying the would not take the word of the Trump administration on a vaccine implying they only a Democrat could provide one. Is my memory failing me?

 

Well silly ole me to dare think anyone could ever voice a difference of opinion to your superior knowledge of Virology/Immunology even other experts, I mean you alone are the determiner of fact it seems and can back that up with your obvious talent in speaking in highly technical terms, terms I have not used since I majored in biology back in the early 1970's but never pursued it and certainly never claim even close to a parity on those technical terms with you.

So I give up but could you give me that date for herd immunity in your superior view?

 

I'm not claiming any superiority over other VIROLOGISTS. I'm simply stating the facts as we currently know them. And that's not me alone. That's an entire field of researchers, of which I'm part.

And no, what you quoted was not "other experts" - that guy is a freaking surgeon. He knows ZIP, zero, nada about virology and immunology. It's the same as calling a plumber to fix your electrical wires.

I do not claim any superiority over him on matters of surgical oncology. He shouldn't claim any superiority over me on matters of virology/immunology. Sure, people like this oncology surgeon can voice an opinion... it's just that his opinion is wrong.

-------------

Now, for your question. If you want a full answer, brace for it because it will be long.

Again, if you were paying attention, you wouldn't be asking a question I've already answered. I said, the jury is still out regarding the point where we'll consistently reach a stable herd immunity threshold across most subtypes of the American population and most geographic locations, because there are new variants that have a potential for re-infecting people who have already had the natural infection with the previous variants (so much for herd immunity, in this situation). If no variants of concern existed, then this prediction of April might have a chance. With the new variants, we don't know. If anybody tells you that the person knows it, that person will be lying to you or engaging in baseless speculation.

Furthermore, the herd immunity threshold is not the same for all populations. Like I said, it is heterogeneous. It is higher for densely populated areas, for example, such as major cities, but smaller for scarcely populated rural areas. It varies with percentage of containment measures. It varies with populational susceptibility (more on this below). It varies even with the season and relative humidity of the air. And most importantly, it varies with the specific SARS-CoV-2 variant that predominates in a given location.

That's because the herd immunity threshold is a function of the R naught number. You can have a variant with an R naught of 2.5, in a given population. For this situation the HIT will be close to 60%.

Here, let me explain how we reach this 60% number:

How many people in a population need to be immune to have herd immunity? An infectious disease that has a basic reproduction number R naught greater than 1, will get to trigger an epidemic because the contagion will keep growing. The R naught number means, each infected person infects more than one other person - the contagion will grow, while if this number is lower than 1, the contagion will peter out (going from above 1 to below 1 is called an inflexion point).

Now, it's not jus the theoretical R naught... which is called the BASIC reproduction number which is determined more by virological characteristics of the virus than anything else, but also the EFFECTIVE reproduction number R, which is in function of what other factors influence the R naught.

So to achieve herd immunity we need to somehow get the effective reproduction number R to under 1. Since R = s multiplied by R naught, where s is the proportion of the population that is susceptible, we need s times R smaller than 1. Rearranging, this gives us s < 1 / R naught.

In other words, we need to get the proportion of susceptible people in the population to under 1 over R naught.

How many people need to be immune to achieve this? If the proportion of susceptible people is s, then the proportion of people who are not susceptible, in other words immune, is 1 minus s. Now the equation becomes:

1 - s > 1 - 1 / R naught

So, now let's look at some examples of R naught and calculate the percentage of people who need to be immune for us to achieve the HIT. For an R naught of 2.5, this means that we need to get at least 1 minus 1 over 2.5 (that is, 1 minus 0.4 of the population) immune, which is 0.6, or in other words, 60%.

But get this. If you have a more infectious variant that has an R naught number of 5 for the same population, then the HIT will be closer to 80%. It will be 1 minus 1 over 5, or 1 minus 0.2, or 0.8 which is 80%.

Get it?

That's why you CAN'T calculate it until you know the R naught.

The previous variant had an average R naught of 2.5.

The newer variants have it around 5, or 5.7.

So it all depends on the percentage (or predominance) of the new variants for a given population.

Also, like I said, there are too many other factors.

In a Third World shanty town like certain parts of India or Brazil, we've seen R naughts as high as 15 (closer to measles numbers). For this situation herd immunity threshold would only be achieved by 93.7% of the population acquiring immunity.

And all of this, is only valid when we suppose a stable s or susceptibility.

Are you aware that if you have a Neanderthal gene you're less susceptible? Or if you have type O Rhesus negative blood, you're less susceptible? Or if you've been exposed to too many common colds caused by coronaviruses (about 20% of them)? Or if you've had the BCG vaccine when you were a child? Or if you have high levels of vitamin D?

So, you can see, the effective R number will ALSO vary for different populations depending on what percentage of individuals have the protective factors above.

------------

There's been epidemiological models made by people who don't know Virology. They tend to ignore all the variables I've mentioned above (and there are other variables too, but I'm not quoting them all here, or else this long post would be even longer). There are better models that have taken into account a lot of variables. They tend to be more accurate. But EVEN THE LATTER were thrown in turmoil by the emergence of the variants B.1.1.7, B.1.351, and P.1.

If you insist in having a date, I'd say that whatever we had as a prediction when all that we had was the 20G clade in the United States and the 20A in Europe (20A.EU1), you can add to it another 3 to 4 months for a new variant to take hold, do its thing, go around, and then start fading.

So, if your "good doctor" is thinking April, you can think July or August. I think it is a decent guess (but still a guess) because August will also mean a lot more vaccinated people in the US. But don't be mistaken: this may or may not be much more than a guess, depending on what happens to the new variants, and depending on whether or not still newer variants emerge between now and then, potentially even more infectious (that is, with higher R naught numbers) and potentially more able to evade vaccines or previous disease.

-------------

I hope that, IF YOU WILL ACTUALLY TAKE THE TIME TO READ AND UNDERSTAND ALL OF THE ABOVE, you'll start to get why most people who talk about Herd Immunity don't know what they are saying and don't understand how complex and variable this concept is. If you do that, maybe you'll drop the personal attacks you've been directing at me, implying that I'm some sort of narcissist who thinks nobody else is correct.

No. It's simply because I *do* know more about this than a freaking oncology surgeon. It's as simple as that, as demonstrated above. I GUARANTEE that this guy doesn't know what I'm explaining above. Why do I know that? Because if he did, he wouldn't be spouting nonsense.

@557 - care to chime in and confirm what I'm saying above?

 

@Bluesguy

Our friend @557 knows that for some subtypes of the population in certain areas of certain cities, HIT (herd immunity threshold) may have been achieved already, as we speak. For other populations in other areas, not even close. But like the case of Manaus, Brazil, has demonstrated, even when a population has apparently already achieved the HIT, a new variant may come along (like the P.1 in Manaus) and throw the whole thing upside down.

And this is to say, no, I don't ignore the opinion of others... but I do prefer the opinion of those who actually know this stuff, like 557.

 

@Bluesguy

Here is a clear illustration of how predictions of herd immunity threshold can be inaccurate when new variants hit.

This is a graph of daily deaths in one of the Brazilian states that got hit by the P.1 variant. Observe that after the pandemic peak in August, things were steadily going down until in November the rolling average numbers were as low as 1.43 deaths per day. Pretty suggestive of HIT, of a pandemic in serious retreat, right? The "good doctor" you quoted would have been delighted... predicting the end of it. But see what happened then, when the P.1 variant arrived in December, January, and February. It is looking like there, my 3 to 4 months extension is actually quite modest... it will probably take longer there for things to cool off again, more likely some 6 months at least, and that, only if the new inflexion point is reached soon. [Translation from Portuguese: Deaths by Covid-19 confirmed per day in the state of Roraima - total per day in bars; rolling average is the red line - source, media consortium based on data from the state health agency]:

re

 

@Bluesguy and @CenterField,

Bluesguy, this herd immunity thing has been frustrating for everyone. I’ve spent a lot of time looking into early case studies like Sweden and NYC and have posted quite a bit about them in the past. Neither Centerfield or I ever wanted to see herd immunity result from natural infection because of loss of life potential. That said, natural heard immunity is in part inevitable. It will make up a portion of herd immunity when it is achieved eventually by enough immune vaccinated individuals being added to the tally.

It is true the herd immunity concept has been politicized by both “sides” of this issue. That’s unfortunate. However the facts are pretty clear cut and @CenterField has provided an excellent synopsis of how the herd immunity threshold is calculated and how many (almost innumerable) factors play into the equation.

He is correct about me pointing to certain populations such as areas of NYC as having come close to or achieving herd immunity. And yes Manaus, Brazil was one as well. As he points out, Manaus has been decimated again by the variant there. Herd immunity helped them for a time, but it came at a huge cost in life and ruined lives and was only temporary.

The claim from the original article in the OP that 2/3 of Americans have been infected is unrealistic. Months ago Centerfield and I discussed this topic and I always estimated a higher percentage of cases were being missed than he. But with the high volume of testing today there is no way we are missing the numbers of cases we were then. In retrospect, knowing what we know now, he was closer to the mark than I at that time.

We shall see how fast we get everyone vaccinated. Thats kind of the determining factor now.

Without going over everything again on the technical side that’s already been presented here, I’m just going to take the opportunity to assure @Bluesguy and other skeptics that @CenterField is truly one of the experts. On PF I often refer to Doctors and scientist who are incompetent or dishonest as “experts” in parentheses to denote I don’t believe they really are experts. This is always accompanied by me presenting empirical evidence they are in error.

Centerfield is an expert without parentheses. Not only is his content sound and factual, he is honest and will not mislead you. At one point Centerfield made a clerical error in a post, accidentally typing a reported odds ratio instead of the risk ratio from a study he cited. Now the difference between the two was not statistically significant and his argument was sound based on either statistic. Furthermore there are probably only 3 PF members who know the difference. Nobody would have ever known. But he posted a stand alone post pointing out his error and went to the trouble of explaining the difference between the terms and why it matters. You can absolutely trust what Centerfield posts.

My education on human disease and pathogens pales in comparison to Centerfields. I am pretty well educated on pathogens and the immune systems of other species, mainly food animals. Lucky for me the immune systems of these animals is very similar to the human immune system so I have a pretty good understanding of what’s going on with this pandemic at the epidemiological and immunological level. I can assure you Centerfield not only knows his stuff, his posts are honest and never deceptive or driven by politics. He’s here to help people survive this pandemic. He’s offering information and advice you would be hard pressed to buy at any price in the educational or off-line medical world.

 

More than the Killing Fields Massacres in Cambodia? Greater than ISIS in SE Asia? More than the Kurds, or Kashmiris, greater than the Uighurs?

Damn, some people must really just LOVE restauranting.

It's very nice that we have these vaccines and they appear to be working, but this idea that everything can open right back up and we should all be crowding back into the bars like this was Restoration England is bollocks. We need to have cases and deaths comparable to the flu before we can even think about that

 

Thanks, buddy. And hey, I'm glad that you now see that my idea that the missed infections hypothesis was exaggerated, which I issued when nobody else including epidemiologists were noticing it, turned out to be pretty much on target.

Talking about mistakes, I said the graph above was of the Brazilian state of Roraima when in fact it's Rondônia. I mixed up the RO and the RR. RO is Rondônia. RR is Roraima. Both are Amazon Region states, but Roraima is to the north of the State of Amazonas (where Manaus is) while Rondônia is to the south. Roraima is much more scarcely populated and remote while Rondônia is more urban (and more developed) so it is a better example of the progression of the Covid-19 outbreak, anyway.

 

I haven’t kept up with Brazil and Manaus in particular. Are the reinfections with the variant similar in severity to the individual’s first infection, milder, or more severe on average?

 

Yeah, your memory is failing you. What they said is that if the Trump administration put pressure on the FDA and CDC to approve the vaccines prematurely without sufficient scientific scrutiny, they would have trouble trusting it, but if the carrier scientists were allowed to carefully look into the safety and efficacy data and approved it, absolutely they would take the vaccine (and did, actually before their inauguration). This position is flawless. There is no way to fault it.

At the time there was demonstrable pressure on the FDA, to the point that the vaccine MAKERS themselves, nine of them, issued a memorandum saying that they would not forego the safety tests (you can have an idea of how the scientists were upset about it... makers usually want the approval so that they can make money... but the pressure was so outrageous that even the makers balked at it). The FDA then established a minimum of 60 days of safety data after the second shot, to approve the vaccines (which is already generous; the usual EUA requires 6 months). The Trump Administration tried to prevent this from taking effect... but with the outcry of the scientific community, they finally backed off.

There's been several instances of undue pressure by the Trump administration. We strongly suspected it at the time and now we've seen the emails demonstrating it. The EUAs for hydroxychloroquine and for convalescent plasma were both instances of undue pressure. Neither treatment paid off, by the way. Hydroxychloroquine was a full-blown fiasco, and convalescent plasma is of very limited efficacy. The FDA has revoked the EUA for hydroxychloroquine, and has modified the one for convalescent plasma.

And no, Trump's concern wasn't one of getting these vaccines approved sooner so that we'd save lives. His concern was to score political points before the election. This became clear when he threw a tantrum when Pfizer published the efficacy data some 10 days after the election. Trump immediately twitted that the delay was designed to hurt him politically (which is absurd; why Pfizer, a large corporation that benefitted from contracts and from tax breaks, would want to hurt Trump???). And why would Pfizer delay? They were involved in a heated race to be first, with Moderna in close pursuit. The company's interest was to finish up ASAP in order to cross the finishing line first, with all the prestige and the contracts that this entails.

As usual Trump thought that it was all centered around him... ignoring that Pfizer published the efficacy data as soon as possible, but couldn't do it any sooner due to how these things work. You need to achieve what we call an endpoint, in a randomized, placebo-controlled, double blind clinical trial. The maker does not know how many infected people belong to the vaccinated arm, how many to the placebo arm (which is the point of blinding the study, to avoid bias). The independent Data Safety Monitoring Board is the one that knows who is who. So, you need a number of infections with Covid-19 to be able to reach the endpoint and open the envelopes, in order to achieve sufficient statistical power to verify if the active arm (the vaccine) significantly separate from the placebo arm.

Pfizer was proceeding as fast as they could... but they couldn't force participants of the trial to catch Covid-19. This wasn't a "human challenge" trial (where you inject participants with an infectious agent - no Human Challenge trial for Covid-19 was ever approved in the US - one was approved in the UK but with AstraZeneca). They needed to wait for natural infections. But as soon as they reached the minimum number, within the hour they notified the DSMB and the envelopes were opened. Not a day later. They couldn't do it until they reached the endpoint number. So the fact that the number was reached after the election is purely coincidental.

But no.... Trump threw a tantrum thinking it had to do with the election... as usual, Trump doesn't understand science, and like the narcissist that he is, thinks that everything is centered around him.

 

Data from Manaus are very confusing due to the complete collapse of their healthcare system. Many more people died with the P.1 wave, proportionally, but then, it's hard to know if it's because of the P.1 being more lethal, or simply because they ran out of oxygen bottles and ICU beds. It was a tragedy. Freaking Venezuela had to send five trucks with oxygen bottles because Brazil's incompetent president and incompetent Health Minister (who is not a doctor but is a military guy, given that Bolsonaro fired the previous two Health Ministers who were both doctors, because they both refused to endorse Bolsonaro's beloved chloroquine) neglected the oxygen supply and instead... tried to AGAIN promote chloroquine as remediation to the situation, can you believe it?

The scientific community believes that the P.1 is overall not more lethal (it does seem like the higher lethality was due to the inadequacies of the healthcare system in dealing with the onslaught), but is 50% more infectious, at least, if not twice as infectious. There is a hint, though, that the P.1 might be more lethal to younger people than the previous variant. Another problem is that Brazil has very meager resources in terms of genomic sequencing... so there is the notion that people are getting re-infected (and they are; which is evident by just looking at the number of new cases, in a city that had presumably already achieved HIT) but there aren't many cases for which solid genomic sequencing was done both for the first and for the second infections, to provide irrefutable proof.

Now, the Supreme Court has forwarded to the Attorney General's department (called Procuradoria Geral da União) an investigation into Bolsonaro's ill-advised promotion of chloroquine, and his idiotic Health Minister's neglect of the oxygen supply for Manaus. Segments of the Brazilian society are calling for impeachment and for criminal charges, calling it almost a genocide. It's very sad. But in the middle of this huge turmoil, it is hard to conduct unbiased research and come up with answers. This is why of the 3 variants of most concern, the P.1 remains the least studied.

See this:

https://www.news-medical.net/news/2...ified-in-Brazilian-Amazon-spreads-faster.aspx

Here you have the virological characteristics of the P.1. Observe the various mutations that it shares with the B.1.1.7 and the B.1.351:

https://virological.org/t/genomic-c...-2-lineage-in-manaus-preliminary-findings/586

As you know, the most concerning point is that this strain has both the E484K and the N501Y mutations, therefore has both more vaccine evasion/natural immunity evasion, and more infectiousness.