We broke all records of cases, deaths, and hospitalizations today

@557 - yes, you make sense, as usual. For the benefit of others here, let's clarify some other aspects of the fascinating reproduction number known as R.

R naught or R zero is the BASIC reproduction number. This number is closer to a characteristic of the virus (although, as you know, not exclusively and not entirely). But we also talk of an EFFECTIVE reproduction number or Re, that is, what happens to the reproduction number (how many people get infected by one carrier) IN THE PRESENCE of epidemiological containment measures and lack thereof, and population behavior. Re is typically smaller than R0, once a pandemic gets going and people get scared. They tend to isolate more, avoid others, wear masks (if we are lucky enough to convince them to do so, etc.) so EFFECTIVELY the R0 number drops, becoming Re.

Or, in some situations, Re might actually INCREASE... say, you have a country where a president is utterly stupid or callous and discourages containment measures, sabotages these measures, people don't believe a virus is dangerous, and they engage in unmasked motorcycle rallies with 500,000 participants, get to political rallies unmasked, packed like sardines, or engage in massive protests. I mean, that's impossible, right? We wouldn't think that ANY serious country or politician would behave this way, right? Well, no. Certain countries and politicians do behave this way... causing the Re to spike and, say, a third wave of infection becoming WORSE than the first two waves. Sounds familiar?

Anyway, the R0 (and even more, the Re) is often expressed or estimated for a given infectious disease, as related to a geographical area, given that it varies. For example, in cold and restrained societies like Japan where everybody masks up pretty easily after the mildest symptom, as a cultural trait, a respiratory virus may have more trouble spreading, while in hot Mediterranean Italy where people are gregarious, speak loudly and close to each other, get engage in wild parties and night life, and hug and kiss-kiss when the meet, it's a field day for a respiratory virus. So the Re might be higher in Italy than in Japan.

Even in a given country or region, we often express the R as a RANGE, because even inside the same country, it varies.

Some examples:

Covid-19 epidemic in Wuhan in early 2020: 1.4 to 5.7
2014 MERS outbreak in Saudi Arabia: 0.45 to 3.9
2014 Ebola outbreak in West Africa: 1.5 to 2.5.
2003 SARS epidemic in Hong Kong: 1.7 to 3.6
1918-19 H1N1 Pandemic in the US and Europe (a.k.a. "Spanish" flu): 2.2 to 2.9
20th century measles outbreaks in the US and Europe: 12 to 18

Now, what part of the R0 is a characteristic of a virus, relatively unchangeable? A virus to be infectious needs a mode of transmission. If it is only blood-borne, people need to exchange blood for it to be transmitted (by rough sex or contaminated needles or blood transfusions) like the Hep C virus. So it's not very infectious unless humans engage in these behaviors. If it is a respiratory virus, it may be large and heavy and be transmitted only by droplets that immediately drop to the ground and travel little, or it can be small and light and be transmitted by aerosol clouds that travel far. The former will have a smaller R0 and the latter, a larger one. Then, the virus may be very fragile, or very resilient. If it is easily inactivated by sunlight it will be less infectious, outdoors. If it is very resilient and not easily destroyed by sunlight, it will get a larger R0. If it stays viable on surfaces for a long time, the R0 will be larger. If it dies out pretty fast on surfaces, it will be smaller.

So, to a certain degree, the R0 has to do with the virus itself... So, one can say that measles is inherently more infectious than Ebola and that will be generally true even in the presence of different human behaviors.

But the Re has A LOT to do with behaviors... with how humans interact with each other in different societies, and how they react to the danger of a new outbreak.

Finally, like I've mentioned already, there is the susceptibility factor. A virus can be inherently very infectious... but it if is unleashed in a population where most individuals are not susceptible to it, because they all have cross-immunity from a prevalent virus of the same family, then the contagion will peter out and the sR0 will be small because there aren't many susceptible individuals in the population for the virus to successfully infect.

You were talking about how people getting infected and surviving, decreases the number of susceptible people in a population (provided that convalescent immunity lasts). True. Some epidemiological models practice what is called the SIR model. This stands for Susceptible-Infected-Recovered. Obviously the more recovered people we get, the fewer susceptible ones we get. SIR models calculate R using several parameters, including the natural immunity pre-infection, probability of infection, contact rates, the length of the period over which an individual remains infectious, how fast they recover, and how strong the immunity after recovery is (the latter is a VERY important factor, still quite unknown for Covid-19, given that it is a novel disease).

There are also models that focus a lot on behaviors. These are called Agent-Based Models. They seek to identify agents or spreaders, that is, individuals that pass the disease onto to others, and how they interact in social settings. These models run simulations based on activity surveys, census data, mobile phone location data, information from public transportation and airlines (such as, how many Americans traveled for Thanksgiving), etc.

So, as previously demonstrated, given that susceptibility, R0, and Re affect the Herd Immunity Threshold, and given the MULTIPLE factors, which are virus-specific, environmental, biological (individual susceptibility), populational, and behavioral, that need to be factored in, Herd Immunity is FAR from a simple and static concept. Like you said elsewhere, in a neighborhood in a city (like areas of Queens) populations may be closer to it, while in other areas of the same city (like areas of Manhattan) they may be far from it.

Herd Immunity Threshold may wax and wane as well, and populations may drift above it and below it, if more people acquire immunity or more susceptible people move in (or are born, in case of endemic, generational-long agents), or susceptible but previously secluded people get tired of the precautions and start going out.

That's why it drives me crazy when an idiot like Scott Atlas who is a freaking radiologist with ZERO experience or knowledge in Infectious Diseases, Virology, and Epidemiology, runs around with the concept of Herd Immunity as if it's something we should foster by exposing more people to the virus, and something that will magically and suddenly make the problem go away. What a moron.

Then we get posters here who have NO CLUE and keep saying "I don't want a vaccine; I believe in Herd Immunity." Probably they had never heard the term before, then did hear it now that Covid-19 news are everywhere, found it cute, and started spouting it about, in order to look smart.

You said that immunity from recovered people helps the community. True. But like you have noticed and we discussed multiple times before, the price to pay may be steep. The SARS-CoV-2 is an aggressive virus that hits the endothelium, the muscle fibers in the heart, and leaves sequelae behind by damaging multiple organs like the lungs (fibrosis), the kidneys (renal insufficiency), the brain (cognitive issues, strokes), the heart (myocarditis, arrhythmias, heart failure), and the coagulation system (blood clots, DVT, pulmonary embolism), so trying to foster the exposure of Americans to the virus (like that IDIOT Scott Atlas wanted) in the hope of a quick resolution, is a very DANGEROUS path full of NASTY CONSEQUENCES, and unnecessary death and suffering (as well as a big economic hit in terms of costs of lifetime treatment of sequelae, curtailed lifespan, and decreased productivity.

 

You are asking the wrong dude. I was home February to early July. I’m self quarantined again now. Went to town a few times over the summer. And I’m not even concerned for my personal safety.

I share your feelings of consternation. This pandemic has led me to conclude I had an overly sanguine opinion of many of my fellow American’s intelligence and ability to think critically.

 

Is it a function of intelligence, though? Survival instincts exist in all of us, no matter the IQ or education.

Seems more like a failure of that survival instinct. Something about American culture has led people to believe they're effortlessly immortal.

 

Thanks for filling in the voluminous gaps I left. A good example of why you author formal research and I grow you good things to eat. The SIR model is not something I’m familiar with. That can be remedied!

 

Perhaps “gone the way of the dodo” applies. Too long in a state of relative safety?

I’d agree, but for the observation it seems the individuals most disturbed by their mortality exhibit some of the most irrational risky behavior. Anecdotal, sure, but even though I’m fully aware of the risks (including less than lethal ones) I really don’t give a rat’s @$$ if I get Covid. Yet I’m home, and those moaning about the risk everyone else is subjecting them to are masked up and on the town for hours.

Very interesting questions and I’d like to hear more of your thoughts from the outside looking in.

 

I think today if the first day in the USA where there are over 3000 Deaths. Sad! it's gotten this bad and shows no sign of stopping. Makes you wonder where it will Peak and why we're SO! friggen much worse than the rest of the World. India has 4 times the Population of the US and only 337 Deaths today if the Data is accurate.
https://www.worldometers.info/coronavirus/

 

3,045 deaths today according to Johns Hopkins, and 3,243 according to Worldometers. A full 9/11.
Absolute record either way. More than 106,000 people in hospitals, another record.
And the Pfizer vaccine is running into trouble.
I even wonder if the FDA will indeed approve it tomorrow, with the two anaphylactoid reactions that occurred in the UK today. The FDA might pull back and request more data. People had been saying "but this wasn't seen in trials" but now we've learned that Pfizer's phase 3 trial had as one of the exclusion criteria, people with a history of severe allergic reactions, so the trial doesn't prove anything about this subset of the population. Certainly the FDA may still approve it, and place a black-box warning excluding people with history of severe allergy.

We'll see. The Advisory Committee meeting is tomorrow morning.

 

India has almost 1.4 BILLION people and 337 Deaths, the USA has 332 Million and 3243 Deaths, either they are completely Cookin the Books on their Numbers or The United States and my Fellow Americans have completely skrewed the Pooch on managing this Pandemic. Hell, look at their mass Transit below, does that look like any kind of Social Distancing.

 

WTH is going on with these trials? I know we are in a hurry, but these mistakes seem amateurish. One company giving a half dose in part of their trial? Now not testing on people with severe allergies? Severe allergy is quite common these days, no? I haven’t looked into what allergies specifically these anaphylactic cases had. Do you know?

It just seems like these are mistakes that shouldn’t happen. I understand we all mess up, but this just seems odd to me. Would there be some reason not to include severe allergy sufferers in phase 3 trials? Who else may they have excluded?

Not trying to disparage vaccines at all. It’s painfully obvious they are what we need. I’m just frankly a bit flabbergasted at some of the recent revelations.

 

Just as I would rather die with liberty, or live with any tyranny. And while you may consider it petty, I consider the government telling me I have to mask up under penalty of law to be tyranny. Doubly so when you consider that many of these "laws" were not even made law by the proper methods, like having a Legislature write and approve a bill, as opposed to a Governor just pooping them out of their nether regions as he or she sit's upon their throne.

 

I don't know. I have no insider info into the Pfizer trial. Allergy of this kind exists in an estimated 6 million Americans, so yes, it's significant. Exclusion criteria exist for most trials and are a limitation of trials, which is one of the reasons why post-marketing experiences sometimes differ from trials. An example to make it understood: antidepressant trials usually exclude people with strong suicidal thoughts because the researchers don't want to be sued if someone is given a placebo and commits suicide. But then, given that suicidal thoughts often occur in people with severe depression, this excludes from the trials, people with severe depression. It is one of the reasons why, paradoxically, it's been discovered after the drugs were in the market, that certain anti-depressants can actually increase suicidal thoughts.

I guess mistakes happen when you rush. I am concerned. With more than 3 million people dying each day, it would seem like the FDA should still approve the vaccine with a warning for allergy sufferers who should only take the vaccine in a major hospital with available resuscitation and epi pens or not at all (there will be other vaccines).

Canada has approved the Pfizer vaccine, joining the UK (Pfizer), Russia (Sputinik V) and the UAE (Sinopharm) as countries with approved Covid-19 vaccines.

 

It is very likely that India is under-reporting deaths, not out of political censorship like in China, but out of a poorly equipped health system; I bet many in India die without even making it into the health system for care and for testing. Still, it is very clear that we've mismanaged the pandemic.

 

Sure, the analogy to antidepressant makes sense. But why wouldn’t they have given us a heads up about exclusions, especially knowing the inevitable backlash and negative effects on acceptance from something like this? Do the manufacturers provide this exclusion information all to physicians/public health officials up front or only after a problem develops? Should those who made the decision to vaccinate the reactive individuals share some culpability?

Absolutely. If this demographic had been included in phase 3 trials, yeh, I would not be crazy about approval. But since they were excluded I’d just take the demographic off label. Other information that may be available that would be nice to know is if the reaction reaction is being caused by the adjuvants/ carriers or is an inherent property of the mRNA. Surely there has been some independent research on that subject.

They are talking about distribution here the 13th pending approval. We have 13 hospitals with cold storage capabilities at present ready to go.

 

The usual situation is that the heads up are always given in the form of list of exclusion criteria that will figure in the published article that contains the trial results. But the thing is, given the rush and the time it takes to submit an article, get it peer-reviewed, and get it on print (next available slot) what we've seen with these trials is that they moved to an application for EUA (remember, as the name indicates, EMERGENCY Use Authorization) before the results were published. I'm sure that they submitted to the FDA their list of exclusion criteria, but it doesn't seem like the info was released in advance to the public. Like I said, the rush is making things atypical.

In my understanding, the Pfizer vaccine has no adjuvant. Usually an adjuvant is combined with a protein or polysaccharide antigen in a vaccine. In contrast, the mRNA vaccines versions are coated with a lipid (liposome) but have no other adjuvant. So yes, this allergic reaction is puzzling.

When you say "here", are you in Canada?

The FDA external advisory committee's meeting starts in 13 minutes, now... but what some fail to understand is that even if the committee recommends approval, the approval is not likely to be granted today. The FDA would still meet internally to consider the committee's advice and agree with it (if they do). The FDA is now saying that they are "working closely with our UK counterparts" to better understand the two allergic reactions. I expect delays.

 

Goodness. It seems like maybe in the future if we are going to rush we should start making the information on things like exclusion criteria more available early on, perhaps during phase 3. Maybe let physicians know so they can be the “last line of defense” for their patients.

You are likely correct. All I know is early research on human mRNA vaccines they had a hard time getting a good immune response and played around with adjuvants. (Just an example link here, it’s pay wall so not intended for anything but abstract/title use.)
https://link.springer.com/protocol/10.1007/978-1-4939-6481-9_11
In theory mRNA should be its own adjuvant but there would have to be a carrier/buffer of some kind regardless of adjuvant and who knows what that is either.

No, Nebraska.

https://nebraska.tv/news/local/gove...d0nXOfxTeXcSNqHrQY0iVXqThnte2AOscnPbf50OrNMpo

Sorry my 13 hospital claim was false. It’s eight with storage capabilities supporting distribution in 9 others currently as the plan. Should have gone to bed instead of reading the news...LOL.

Delays vs. more mistakes. A very fine line to walk. Hoping everyone brings their A game this week.

 

You might want to look into this:

https://www.fda.gov/media/144245/download

Funny enough, I see no reference to propensity to have severe allergic reactions as an exclusion criterion. I didn't read it (no time to do it now) but I used Control + Find and found only two incidences of the sequence of letters "allerg" in the entire document. Tried anaphylaxis too, no references.

 

I don’t see that such individuals were screened for or omitted from trials either. The closest demographic they claim wasn’t tested is the “immunocompromised”. Those with severe allergy aren’t typically referred to as immunocompromised, correct? Technically you could say they are, but I don’t know medical terminology that well...

Anyway, if those with severe allergy were not excluded from trials that makes things more interesting for sure.

I didn’t read the whole thing, just read sections that looked relevant in table of contents.

 

Correct. The immunocompromised are those who have conditions or treatments that blunt their immune response, such as patients who have had transplanted organs and need to decrease the rejection, or patients with advanced AIDS who don't have enough white blood cells to mount an immunity defense. This term has nothing to do with those prone to allergies, which rather indicate an immune system that reacts too strongly.

 

So, you're all about liberty... founding father's style Yes? No risk is to great so long as freedom is the goal! How's about the Federal Reserve... A private company, run by bankers, who are as we speak are illegally buying shares to prop up the stock market for the benefit of the rich who, we minions must accept as too big to fail... allegedly?

It is a far more serious issue than any mask mandate.
Anyways... Rights mean nothing without the duties entailed to their defense.

 

In discussions with several people who are Indian and have family there and have traveled around the world, both feel they both have perspectives that indicate the COVID deaths are severely undercounted.

Not just overwhelmed medical systems. In many areas, doing to the doctor or hospital are not part of their lives!

For both positive and negative ways, both would estimate that as little as one death out of ten is actually counted, including as deaths are known but are not being counted as COVID, as no COVID tests simply aren't done.

Reason have a several reasons or excuses - poverty, religious comfort with death, access, and testing are common.

But another reason medical care for very young girls and women over childbearing age are very unprioritized or simply ignored. A DMJ researcher produced an estinate that nearly 50% of these girls and older women are simply missing from medical care [ https://www.bmj.com/company/newsroo...tion-in-healthcare-access-for-women-in-india/ ]. My sources privately suggest the very low caste and poor probably fare much worse than that.

 

I bet. That is what I was thinking too. Deaths are probably undercounted in Brazil, too. These two countries are probably faring worse than the USA. But that's not a big consolation, because we are much more developed than they are.

 

Yes, I am. Shouldn't all real Americans feel the same? It's the very root of how our country came to be, it's why the Constitution exists as it does, and rugged individuality just oozes out of our very pores. Or at least, it used to.

These days, most people look at you as if you have three green heads if you start discussing what the Constitution actually means, it's no longer taught in schools (properly, anyway), and the concept of "Give me liberty, or give me death" has been replaced with "Please, mother Government, take care of me from cradle to grave for free and make sure nobody anywhere does anything that scares me... Who cares about liberty, if it interferes with meeeeee!!!"

Meh, I don't really know enough about the Fed to have a truly intelligent opinion, but what I have heard or read is not very flattering.

What duties? To wear a mask because if I don't some Karen might get scared and report me to the po-po? And because when the po-po come, they're gonna arrest me for breaking a Law that isn't even a Law?

 

Do you think you have a duty to the society that you exploit? Of course you do... we all do in our respective societies.
So I would like to know what you do in your community to help reduce the spread of infection?

 

I think I may have intimidated my debate partner... and that was certainly not my intention. I too am a libertarian... The real deal, so to speak.
As to masks, I have no issue. A surgical mask, correctly worn gives me the freedom to move through society, knowing that if I am around infected peeps, my mask and inclination to keep my distance, will reduce the viral load I am exposed to. That and the Vit D & C will keep me in good stead.

But that's me.

You, on the other hand, have a very common, psychological aversion to anything covering your face, I understand, truly!
If only there was something you could do at home, a simple to use, cheap test, letting you know if you are positive/ negative, within 15 minutes.
I am sure everyone would appreciate and use an 'at home kit'. It would give everyone the freedom to find out quickly and isolate immediately... if necessary. Now, wouldn't that be better than those monstrous car queues I see on the news?

Such tests exist, by the way. They're being used in Europe.
But Americans are not aloud to use them... It's illegal. Not too sure why that is...
Perhaps the 'authorities' think Americans incapable of performing a simple test, like the Europeans? That's an insulting proposition, though and shows no faith in their own education system. It is the most basic of tests... I need to stress that point. Perhaps they wanted to 'medicalize' the process to make money?

Quite frankly, I don't know why the power base is hiding knowledge from the people, nor do I know why they are not persuing alternatives
to masks... But they are. You are not free! Sorry...

 

For rights to mean anything at all, they must be asserted by the individual.

Those refusing to wear the silly masks are asserting their rights to stand up against tyranny.

Those wearing masks are asserting their right to do as they please, no matter how silly or irrational the behavior is.

When tyranny is abroad, submission is a crime.