When it comes to our bio-ecosystem, I'm repelled by this kind of a question as, in general, I don't believe we understand ecosystems with complex interacting parts well at all .. and are therefore not well placed to make such sweeping changes to it .. at least not consciously.
The seminal book on this (for me) has been Dietrich Dörner's "The Logic of Failure".
We've wiped viruses off the face of the planet before, and I don't think it's causing us much harm. Eradicating smallpox has apparently saved 5 million lives a year!
The question you'd have to ask is whether some low level amount of coronaviruses is important to human survival. It seems like it's not. We have certainly seen the opposite effect -- people get pretty sick when you kill off all their gut bacteria (it lets unhelpful bacteria reproduce, and the bacteria actually perform digestive functions). Unfortunately, we didn't really realize that until we developed the technology to kill bacteria indiscriminately, so I see the worry. But I doubt anyone will be harmed by having too few coronavirus infections, so I'm probably not worried this time.
I think this particular thread is debating the ethics and unintended consequences of eradicating all coronaviruses, not how possible it would be to actually do.
Just to clarify, I wasn’t looking to put anyone on defense there - so, apologies.
Off the top of my head, “How to Survive a Pandemic” by Michael Greger suggests pandemics may be an emergent, new-normal. Many of the factors which led to this pandemic are not going to be mitigated without broad, deep, and costly changes to how agriculture function. The medications used in raising and killing cattle, chicken, pigs, and etc combined with the scale of those activities act as a breeding ground for viruses which are statistically likely to become pandemics.
Not a scientist or medical person, but I believe its accepted that there is linkage of fever and cancer inhibition (because non-cancerous cells tend to cope better with environmental stresses than cancerous ones). It's not at all my field, but a very cursory search shows statements like this
Right. Some cancers can be better targeted with chemo by first stressing the body with a fast. The non cancerous cells identify the fast as a time to set up guards for harshness, but the cancerous cells do not. So the cancerous cells get hit full blast by the chemo while the healthy cells are prepared from the reaction to the fast. I would posit though that fasts are probably a better way to generally help fighting cancers than a life of yearly coronavirus infections.
But this brings up the question of whether we could create a similar response on purpose and in a controlled fashion, rather than letting a bunch of viruses do what they do in the wild?
Even syphilis was once treated by giving the patient malaria - with 20 per cent mortality rate, though. (Still better than suffering from lues in the pre-antibiotic world.)
I believe it is correct to say we eradicated the disease but we don't know if the virus died
Smallpox still exists in the form of monkeypox in the wild and as rabbitpox in labs
FDA approved a new drug to treat smallpox (only tested on monkeys and rabbits infected with monkeypox and rabbitpox) in 2018 because smallpox resurgence does remain a realistic threat and having a stock pile of at least two different vaccines that attack the virus in different ways is the only way to prevent it from becoming drug resistant
> We've wiped viruses off the face of the planet before
Only recently. Widespread vaccine use is a fairly recent phenomenon.
> Eradicating smallpox has apparently saved 5 million lives a year!
It certainly saved lives but we really don't know how much. Every estimate is off of cherrypicked data.
> But I doubt anyone will be harmed by having too few coronavirus infections, so I'm probably not worried this time.
You just said we fucked up with bacteria and then you brush off viruses.
There was a time when the scientific consensus was to snuff out every small fire to prevent wildfires. Now we realize how horribly naive that was. By preventing small localized fires, we allowed kindle wood to mass which fueled gigantic wildfires. That fires are natural and helps forests clear and rejuvenate itself.
The same thing with parents and kids avoiding food/sickness. It lead to food allergies ( some of which can be deadly ) and poor adult immune system. Now we know a bit of sickness helps strengthen the immune system and introduction to a wide variety of foods helps prevent food allergies.
The history of humanity/science/etc is we were wrong. But as long as we learn and move forward, that's what is important.
I remember one of bill burrs rants in his podcast after he watches the Ted talk about eradicating mosquitoes, he compares the arrogance of that person to a dude who proclaims he's going to rewire his homes electric connections and ends up short-circuiting everything. Perfect comparison.
We can’t even wipe out mosquitos. Just tweeted this:
> We lost the “War on Terror”, we lost the “War on Drugs”, and as long as we keep declaring war on fundamental forces of nature, we will keep losing. The only way to win is not to play.
Hopefully you aren't tweeting that from one of the many areas where malaria was endemic, prior to mosquitoes being wiped out long and frequently enough for the human reservoirs to dry up.
Look up the definition of “eradicate”, and also note that you’re talking about a parasite. The best (read: cheapest) hope for “vector controlling” mosquitos until the malaria parasite was extinct globally was probably DDT, until it was banned.
Yes, I understand that it was 'poetic'. My point is that it doesn't apply to things like mosquito control, it's just defeatism, eliminating malaria was a great thing for countries that did it, not a nuclear holocaust.
The trick is in deciding whether something is in the category of “things we can fight against and win”, or not. We probably agree that malaria is in that category. We may disagree about whether mosquitoes are in that category?
Coronaviruses are definitely not in that category.
I won't be surprised at all if a safe, effective vaccine is developed for SARS-CoV-2 and I further wouldn't be surprised if newer vaccine development methods also make it affordable to attack the occasional longstanding cold virus.
If/when we have another, more damaging pandemic, I expect the lesson about how powerful a tool social distancing is to sink in more widely (we are somewhat accidentally having a mild flu season so far; just changing attitudes about what is appropriate when symptomatic would be a benefit, you don't need to do big lockdowns to benefit).
The fact that it has never been done indicates that it will require a new approach. If the new technique we find allows us to deal with all coronaviruses in one fell swoop, so much the better.
>The problem sparks when a viral strain, normally happily living in a bat, pig, or rodent
That's the rub right there. One of the reasons we were successful with smallpox is there wasn't an animal reservoir. One virus + no animal reservoirs + good vaccine = can be successful. Multiple known viruses and strains with multiple reservoirs and no good vaccines means this will not happen.
More to the point, this isn't really what the paper was looking at all. The actual (OA) publication[1] identified common and conserved areas which could potentially be used to study and target viruses throughout out the family. This might help with human SARS-CoV2 therapeutics, but it's main benefit is showing how molecular analyses will help fight future coronaviruses.
It does not ask or answer whether we can "engineer a universal vaccine against the entire viral family" nor did it "[draw] up a scientific recipe to potentially end coronaviruses once and for all."
Currently it seems to me that the bottleneck for developing the vaccines is the time of trials. Hopefully we’ll have approved DNA / RNA vaccines in less than a year with less side effects than previous vaccines. When that happens, I guess our response time as a species for viruses can get better as well.
I've been following Moderna's vaccine from the beginning. It was developed in 25 days from first virus DNA synthesis. https://www.modernatx.com/modernas-work-potential-vaccine-ag... but it's going to take maybe a year to be approved by the FDA. All phase 3 trials are looking good. I personally would take this vaccine right now but the FDA will not allow me to do this.
How is the FDA's reputation going to hold up when they approve all these vaccines a year or more after they were created and cost the lives of millions and trillions of dollars?
The FDA had no pandemic vaccine approval protocol which could have speed up the process. They could have used challenge trials with young healthy people. I can think of a pre approved process for mRNA vaccines where the delivery methods are approved but the only thing that changes is the mRNA payload.
I blame the government healthcare organizations for a lot of the impact from covid-19. First, they were anti-mask during the first major increase in the virus and now they are being overly cautious in approval of vaccines. They are way off on their cost - benefit math.
Unlike COVID-19 which is spreading a lot in the US (due to lack of coordinated government action) and which other countries have more or less stamped out and are controlling (Japan, Korea, New Zealand, Australia, Taiwan etc.), a vaccine will actually be given to something like 80-90% of the population.
So whereas the US has currently had a total of about ~10 million cases to date, this represents about 3.3% of the total population. There have been about 200,000 deaths so far, so the US case-fatality rate is about 2% - note, the mortality rate is most likely quite a bit lower overall since it's spreading so much. This is simply deaths vs. observed cases.
EDITED(got the math off by a factor of 10 here previously - at 0.01% fatality it's not 360,000 - that said, see comments below, actually establishing that in clinical trials is not easy): Let's suppose we rush through a vaccine that turns out to cause fatal complications in 0.01% of the population, and we give it 90% of the population. Straight up - we've just killed 36,000 people. But that's assuming that the complications are binary - but COVID-19's complications aren't binary, and neither would negative side-effects be. So we might kill a bunch of people, and injure tens of thousands more seriously. Or we might have inadequately diverse trials and miss a whole population of potential negative side-effects (a classic problem in a lot of trials: university aged students with the distribution of whichever university developed the product are over-represented in samples).
You cannot rush clinical trials. To even stand a hope of getting to 0.01% risks you need a population of at least several thousand in your trial. You need to monitor them aggressively because hopefully you have good data that whatever can go wrong will be slow enough you can intervene, but...there are always risks. Clinical trials can and do go badly wrong and people involved in them are taking a selfless risk for the betterment of the rest of us - and that's a very different proposition to declaring "this'll probably be fine" and not collecting the data.
I am all for finding a vaccine with the lowest possible fatality complications. I believe we should "rush" a vaccine during a pandemic by modifying testing protocols which will ultimately save more lives by speeding up the approval time. The FDA should have done challenge trials with a healthy population to better determine the vaccine's effectiveness.
I believe the silver bullet for future pandemics will be pre-approved mRNA vaccine pathways with the only change to the specific vaccine being the mRNA payload that targets the pathogen. Then testing could be a lot more straightforward and quicker which could end future pandemics.
> To even stand a hope of getting to 0.01% risks you need a population of at least several thousand in your trial.
Phase III trials don't run with enough participants to detect 0.01% effects with any confidence. These are generally found postmarketing, like Vioxx. In terms of vaccine harm, a badly behaved swine flu vaccine caused 3 cases of narcolepsy per 100k juveniles vaccinated. This effect simply would never be seen in Phase III trials.
Finally, beyond the raw CFR we need to consider other adverse outcomes from covid: cognitive impairment following mechanical ventilation and cardiac damage are two that really worry me.
Let's suppose we rush through a vaccine that turns out to cause fatal complications in 0.01% of the population, and we give it 90% of the population. Congratulations: you just killed more people to date then coronavirus has.
Might wanna check that math, dude.
Even with your preposterously deadly made-up vaccine, you’re only hitting about one month’s worth of COVID deaths.
Corrected the post above, but frankly, leaning straight on deaths wasn't my preference (just the numbers felt like they made the point clearly there). If you don't have the data, the reality is you don't have the data - you need thousands of test cases and time and monitoring to stand a hope of establishing it's not that lethal: The Oxford vaccine trial was paused in Phase II [1] when it looked "pretty good" because an extremely rare neurological condition showed up in two subjects.
I think your math is off, if you gave a vaccine to 90+ percentage of people, say 300M, and killed 0.01% you’d be killing 30k people. This looks pretty attractive when your death toll is looking to rise to over 500k people. Eg if nothing changes until after January, 70 days , infection rate doubling every ~3 weeks, by then 300-400knew infections per day, lagging death rate of 5-6k per day, ~100k will die just in the 14 days of hard lock down assuming that happens day 1 of new president. Really hoping none of this happens and is just bad extrapolation but vaccine likely to save a lot of lives even with a 0.01% death rate.
You know I ran that through the calculator 3 times, before I posted it and did the wrong thing 3 times in a row...you're right (guess I shouldn't be posting at 3am).
I've amended the post's math - it's definitely not as hard a point, but the secondary consideration I didn't include was that it's also not an all or nothing proposition - a fatality rate from a vaccine is one thing, but even COVID-19 doesn't just have a fatality rate - it's got a much much higher "severe long term complications" rate. Which is also very much what you're looking for with trials.
Having things look good after 3 months in a vaccine trial doesn't tell you if they look good after a year necessarily - and all of this is really weighted against "a sensible response to limit the spread of the virus is possible, the US is just not doing it".
EDIT: The other possibility is that a vaccine that just straight up doesn't work very well would also make the situation worse - churn out millions of doses, get a limited amount of immunity in the recipient population, government is compelled to wind back "mechanical" spread prevention measures - and the epidemic cinders for a while and then rips through the population because everything thinks they're immune.
Regarding the effectiveness of the vaccine. A challenge trial where healthy people are deliberately infected after receiving the vaccine could very easily have answered this question. The FDA did not do this and should have IMO. I believe the UK is now taking the lead here and doing challenge trials.
I'd argue that doing that now, when we have a much better understanding of how to treat the virus, is quite a different proposition to the start of the year when we didn't.
Because if it doesn't work, you haven't had a doctor give someone something with unforseen side-effects: they injected them with a deadly virus and killed them (in the worst case).
Now we have treatments like Regeneron which the President received, which most likely made a very big difference in his fairly rapid convalescence - doing it when you have more plausible interventions if it doesn't work is quite different.
I mean all of this stuff is, relatively, going at lightning pace - if we have a vaccine early next year, that's what, 1.5 years between initial detection and immunization for a novel virus? That is breakneck pace.
Everyone who is answering in the negative here, no matter how sincere and what efforts they are making to discuss this rationally is getting downvoted. A. Why? Can we not act like this? B. Off topic, but whoever thought the downvote button was a good idea? It will always be a disagree/spite you button...wherever you find such a thing. It doesn't help. It never helps. Flag flagrant bad actors for mods to address, discuss anything else like adults.
As usual, a bunch of non-commutative human beings rewarded for hiding and not sharing their Authoritarian opinion about controlling humanity under your very ADULT response
52 comments
[ 3.7 ms ] story [ 55.6 ms ] threadThe seminal book on this (for me) has been Dietrich Dörner's "The Logic of Failure".
The question you'd have to ask is whether some low level amount of coronaviruses is important to human survival. It seems like it's not. We have certainly seen the opposite effect -- people get pretty sick when you kill off all their gut bacteria (it lets unhelpful bacteria reproduce, and the bacteria actually perform digestive functions). Unfortunately, we didn't really realize that until we developed the technology to kill bacteria indiscriminately, so I see the worry. But I doubt anyone will be harmed by having too few coronavirus infections, so I'm probably not worried this time.
- Spread by contact
- Off-the-scale virulent
- Trivial to turn into a vaccine
- Not present in animal reservoirs
Off the top of my head, “How to Survive a Pandemic” by Michael Greger suggests pandemics may be an emergent, new-normal. Many of the factors which led to this pandemic are not going to be mitigated without broad, deep, and costly changes to how agriculture function. The medications used in raising and killing cattle, chicken, pigs, and etc combined with the scale of those activities act as a breeding ground for viruses which are statistically likely to become pandemics.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4006373/
'Lower risk for cancer has also been associated with a history of febrile viral diseases.'
I am all for a controlled fashion.
I believe it is correct to say we eradicated the disease but we don't know if the virus died
Smallpox still exists in the form of monkeypox in the wild and as rabbitpox in labs
FDA approved a new drug to treat smallpox (only tested on monkeys and rabbits infected with monkeypox and rabbitpox) in 2018 because smallpox resurgence does remain a realistic threat and having a stock pile of at least two different vaccines that attack the virus in different ways is the only way to prevent it from becoming drug resistant
Only recently. Widespread vaccine use is a fairly recent phenomenon.
> Eradicating smallpox has apparently saved 5 million lives a year!
It certainly saved lives but we really don't know how much. Every estimate is off of cherrypicked data.
> But I doubt anyone will be harmed by having too few coronavirus infections, so I'm probably not worried this time.
You just said we fucked up with bacteria and then you brush off viruses.
There was a time when the scientific consensus was to snuff out every small fire to prevent wildfires. Now we realize how horribly naive that was. By preventing small localized fires, we allowed kindle wood to mass which fueled gigantic wildfires. That fires are natural and helps forests clear and rejuvenate itself.
The same thing with parents and kids avoiding food/sickness. It lead to food allergies ( some of which can be deadly ) and poor adult immune system. Now we know a bit of sickness helps strengthen the immune system and introduction to a wide variety of foods helps prevent food allergies.
The history of humanity/science/etc is we were wrong. But as long as we learn and move forward, that's what is important.
> We lost the “War on Terror”, we lost the “War on Drugs”, and as long as we keep declaring war on fundamental forces of nature, we will keep losing. The only way to win is not to play.
Cause ya know, that was pretty worthwhile.
Just because we didn't eradicate human feeding mosquitoes doesn't mean it wasn't hugely worthwhile to play the game of controlling them.
Coronaviruses are definitely not in that category.
If/when we have another, more damaging pandemic, I expect the lesson about how powerful a tool social distancing is to sink in more widely (we are somewhat accidentally having a mild flu season so far; just changing attitudes about what is appropriate when symptomatic would be a benefit, you don't need to do big lockdowns to benefit).
Neither are mosquitoes or coronaviruses for that matter.
Already the authors list is very impressive. Lots of people!
>The problem sparks when a viral strain, normally happily living in a bat, pig, or rodent
That's the rub right there. One of the reasons we were successful with smallpox is there wasn't an animal reservoir. One virus + no animal reservoirs + good vaccine = can be successful. Multiple known viruses and strains with multiple reservoirs and no good vaccines means this will not happen.
More to the point, this isn't really what the paper was looking at all. The actual (OA) publication[1] identified common and conserved areas which could potentially be used to study and target viruses throughout out the family. This might help with human SARS-CoV2 therapeutics, but it's main benefit is showing how molecular analyses will help fight future coronaviruses.
It does not ask or answer whether we can "engineer a universal vaccine against the entire viral family" nor did it "[draw] up a scientific recipe to potentially end coronaviruses once and for all."
1: https://science.sciencemag.org/content/early/2020/10/14/scie...
How is the FDA's reputation going to hold up when they approve all these vaccines a year or more after they were created and cost the lives of millions and trillions of dollars?
The FDA had no pandemic vaccine approval protocol which could have speed up the process. They could have used challenge trials with young healthy people. I can think of a pre approved process for mRNA vaccines where the delivery methods are approved but the only thing that changes is the mRNA payload.
I blame the government healthcare organizations for a lot of the impact from covid-19. First, they were anti-mask during the first major increase in the virus and now they are being overly cautious in approval of vaccines. They are way off on their cost - benefit math.
So whereas the US has currently had a total of about ~10 million cases to date, this represents about 3.3% of the total population. There have been about 200,000 deaths so far, so the US case-fatality rate is about 2% - note, the mortality rate is most likely quite a bit lower overall since it's spreading so much. This is simply deaths vs. observed cases.
EDITED(got the math off by a factor of 10 here previously - at 0.01% fatality it's not 360,000 - that said, see comments below, actually establishing that in clinical trials is not easy): Let's suppose we rush through a vaccine that turns out to cause fatal complications in 0.01% of the population, and we give it 90% of the population. Straight up - we've just killed 36,000 people. But that's assuming that the complications are binary - but COVID-19's complications aren't binary, and neither would negative side-effects be. So we might kill a bunch of people, and injure tens of thousands more seriously. Or we might have inadequately diverse trials and miss a whole population of potential negative side-effects (a classic problem in a lot of trials: university aged students with the distribution of whichever university developed the product are over-represented in samples).
You cannot rush clinical trials. To even stand a hope of getting to 0.01% risks you need a population of at least several thousand in your trial. You need to monitor them aggressively because hopefully you have good data that whatever can go wrong will be slow enough you can intervene, but...there are always risks. Clinical trials can and do go badly wrong and people involved in them are taking a selfless risk for the betterment of the rest of us - and that's a very different proposition to declaring "this'll probably be fine" and not collecting the data.
I believe the silver bullet for future pandemics will be pre-approved mRNA vaccine pathways with the only change to the specific vaccine being the mRNA payload that targets the pathogen. Then testing could be a lot more straightforward and quicker which could end future pandemics.
Phase III trials don't run with enough participants to detect 0.01% effects with any confidence. These are generally found postmarketing, like Vioxx. In terms of vaccine harm, a badly behaved swine flu vaccine caused 3 cases of narcolepsy per 100k juveniles vaccinated. This effect simply would never be seen in Phase III trials.
Finally, beyond the raw CFR we need to consider other adverse outcomes from covid: cognitive impairment following mechanical ventilation and cardiac damage are two that really worry me.
Might wanna check that math, dude.
Even with your preposterously deadly made-up vaccine, you’re only hitting about one month’s worth of COVID deaths.
[1] https://timesofindia.indiatimes.com/life-style/health-fitnes...
I've amended the post's math - it's definitely not as hard a point, but the secondary consideration I didn't include was that it's also not an all or nothing proposition - a fatality rate from a vaccine is one thing, but even COVID-19 doesn't just have a fatality rate - it's got a much much higher "severe long term complications" rate. Which is also very much what you're looking for with trials.
Having things look good after 3 months in a vaccine trial doesn't tell you if they look good after a year necessarily - and all of this is really weighted against "a sensible response to limit the spread of the virus is possible, the US is just not doing it".
EDIT: The other possibility is that a vaccine that just straight up doesn't work very well would also make the situation worse - churn out millions of doses, get a limited amount of immunity in the recipient population, government is compelled to wind back "mechanical" spread prevention measures - and the epidemic cinders for a while and then rips through the population because everything thinks they're immune.
Because if it doesn't work, you haven't had a doctor give someone something with unforseen side-effects: they injected them with a deadly virus and killed them (in the worst case).
Now we have treatments like Regeneron which the President received, which most likely made a very big difference in his fairly rapid convalescence - doing it when you have more plausible interventions if it doesn't work is quite different.
I mean all of this stuff is, relatively, going at lightning pace - if we have a vaccine early next year, that's what, 1.5 years between initial detection and immunization for a novel virus? That is breakneck pace.
My question is why are you cosplaying as a mod?