Coronavirus: Continuing Vigilance

[Gorth]

Somebody in South Dakota is not happy with their governments response to the outbreak... Probably going to end in some heavy handed crackdown, as these aren't some alt-right gun toting morons of the kind that Trump seems to favour. Actually, they seem way too intelligent to be Trump supporters.

 

The Cheyenne River and the Oglala Sioux have put up road blocks and checkpoints.

--

The chairman of the Cheyenne River Sioux tribe, Harold Frazier, issued a statement in response to the governor on Friday, saying: "We will not apologise for being an island of safety in a sea of uncertainty and death."

"You continuing to interfere in our efforts to do what science and facts dictate seriously undermine our ability to protect everyone on the reservation," he added.

--

Oglala Sioux President Julian Bear Runner says Ms Noem's decision "threatened the sovereign interest of the Oglala people".

"Due to the lack of judgment in planning of preventative measures in response to the current pandemic, Covid-19, the Oglala Sioux Tribe has adopted reasonable and necessary measures to protect the health and safety of our tribal members and our other residents of the Pine Ridge Indian Reservation," he is quoted as saying by the Argus Leader.

--

 

https://www.bbc.com/news/world-us-canada-52615311

 

[Raithe]

David Tennant, Patrick Stewart, and Tamsin Greig are offering homework help to any children studying Shakespeare during lockdown

Schoolchildren struggling to understand Shakespeare during the lockdown are to get tips and insights from leading actors to perform in his plays.

David Tennant, Sir Patrick Stewart and Tamsin Greig are among the big names joining the Homework Help initiative being run by the Royal Shakespeare Company.

Students with questions can email them to homeworkhelp@rsc.org.uk or share them using the hashtag #RSCHomeworkHelp on Twitter or Instagram by Sunday.

The first round of answers will be released from Monday in the form of videos and recorded messages from actors.

Jacqui O’Hanlon, RSC director of education, said: “As children and parents across the UK adjust to their new virtual classrooms, this gives us a new challenge and opportunity to extend our support and to work with artists from the RSC’s performance history. They will answer any questions young people want answered about Shakespeare and theatre generally.”

Artistic director Gregory Doran added: “Although the RSC is in lockdown and operating with a skeleton team, it is important that we continue to offer support to students, families and teachers across the country.”

The RSC is asking people to consider making a donation to its home learning programme to support this work.

[BruceVC]

10 hours ago, Azdeus said:

Would that possibly be the same person that advocated Garlic for treating HIV?

Funny you mention that, that person who played a part in that embarrassing episode of " HIV misinformation " is indeed  still around and is also responsible for being part of an utterly ridiculous Corona decision to ban the sale of cigarettes 

SA must be the only country in the world that has decided to ban the sale of alcohol and cigarettes during the lock-down   Its irritating when your government doesnt understand history and events like the failure of prohibition in the USA ....anyway this is all related to the lock-down and will end once the lock-down is over  

[MedicineDan]

It isn't a matter of whether or not we should end the lockdown.  We *will* end the lockdown in any nation with a semblance of freedom.  Yeah, just don't.  My argument is not about whether it's right or wrong.  My point is, it will happen.  Humanity is simply not possessed of the character to stay locked away from one another.  The lockdown will either end with governments taking reasonable approaches and trying to minimize exposure while allowing people out or governments will try to keep people under lockdown indefinitely and the lockdowns will crack open.  It's that simple and has been for some time.

Anyhow, to make this about me, which is my favorite topic, I had a patient from somewhere nearby some weeks back.  He was double tested negative for the 'Rona and so was only under standard precautions.  I admitted this guy who apparently had exposure for some brief time after testing negative.  Then he came to us.  I had him a total of... 3 times?  I think with no PPE other than gloves.  Guy's coughing and whatnot much of the time and, especially admitting, you really have to get up close and personal to auscultate and palpate and give a much more thorough assessment than after you know he's stable and you're concentrating on a specific system.  lol  First, the good news.  I believe he lived, although he transferred out and I have no access to info after that.  Second, more good news, it's been long enough, I either never caught it or the massive amounts of beer and booze I drink on my days off killed the nasty bugs before they could do me any harm.  :big beefy grin:

EDIT:  Removed something that could, although unlikely, have been identifying of the patient.

Edited May 12, 2020 by MedicineDan

[BruceVC]

44 minutes ago, MedicineDan said:

It isn't a matter of whether or not we should end the lockdown.  We *will* end the lockdown in any nation with a semblance of freedom.  Yeah, just don't.  My argument is not about whether it's right or wrong.  My point is, it will happen.  Humanity is simply not possessed of the character to stay locked away from one another.  The lockdown will either end with governments taking reasonable approaches and trying to minimize exposure while allowing people out or governments will try to keep people under lockdown indefinitely and the lockdowns will crack open.  It's that simple and has been for some time.

 

You make several good points, I agree that the principle of any lock-down in the majority of countries is anathema to most of us and the sooner it is over the better even though I do support the initial and strategic reasons for why the world adopted it as a preventative virus spread factor. We also have to consider the real economic impact to any country and the long term damage done to a society

What type of healthcare professional are you, are you a doctor? The reason I ask is you shouldnt be expected to treat anyone without correct PPE ...I know many people in the front line defense did treat people without PPE which I will always admire but it cost some people there lives  

Edited May 12, 2020 by BruceVC

[MedicineDan]

I'm a new nurse.   Been on the floor for just over two months.  Fun times!

I was using the correct PPE at the time. It just happened we got more info through testing.

[BruceVC]

9 minutes ago, MedicineDan said:

I'm a new nurse.   Been on the floor for just over two months.  Fun times!

I was using the correct PPE at the time. It just happened we got more info through testing.

Huge respect for anyone in the front line but especially for medical front line

Thank you for your hard work, sacrifice and risk you guys put yourselves through so the rest of us can continue to survive and get through this difficult time during the pandemic 

If I knew you in RL all your drinks and food  at out next social gathering would be on me 

 

[Guard Dog]

One Idea for Speeding a Coronavirus Vaccine: Deliberately Infecting People

Remember when we were kids, one of the neighborhood kids came down with Chicken Pox our parents encouraged us to go see them? The thinking was "better to get it now as a child than later". This is kind of like that only to harvest anti-bodies.

To tell you the truth, if contraction really did lead to immunity I'd take the two week hit and get it over with,. The trouble is that isn't proven yet. 

[MedicineDan]

4 hours ago, Guard Dog said:

One Idea for Speeding a Coronavirus Vaccine: Deliberately Infecting People

Remember when we were kids, one of the neighborhood kids came down with Chicken Pox our parents encouraged us to go see them? The thinking was "better to get it now as a child than later". This is kind of like that only to harvest anti-bodies.

To tell you the truth, if contraction really did lead to immunity I'd take the two week hit and get it over with,. The trouble is that isn't proven yet. 

I actually agree with this except I can't figure out a way that I could do it for myself that wouldn't entail a risk for at some other people.  The unknowns make it hard for people to make decisions.  The experts are all over the map, so why should we laypeople be expected to make informed decisions?  The people who could theoretically inform us have no better handle on the situation than we do.  The best of them have had several missteps.

As regards Sweden, the point isn't whether they have more deaths up front.  The point wasn't that they would have fewer deaths in March and April.  The point was that they would have more up front deaths but that they would achieve greater immunity sooner.  Frankly, I don't think it's a bad idea in that the idea of flattening the curve wasn't that you would have less deaths.  The idea is that you wouldn't have a mass of deaths that overwhelm the system in the short term.  In that regard, Sweden has succeeded.  The question which can't be answered is whether or not treatments or vaccines would make it so people would be safe in outer months which means they wouldn't need to die.  That's still an unknown.  We hope to have a vaccine soon, but the chances remain very unlikely.  Treatments aren't progressing as quickly or as well as we'd hoped.  We won't know if Sweden has succeeded literally for several months.

We will be arguing about these things for years.  History will debate them forever.  Well... nothing earthly lasts forever, but as long as our species exists at least.

[Bartimaeus]

Also, shingles sucks, and the chickenpox vaccine prevents it from ever occurring. Think I'll wait to see if there's a vaccine...

Edited May 12, 2020 by Bartimaeus

[Elerond]

1 hour ago, MedicineDan said:

The point was that they would have more up front deaths but that they would achieve greater immunity sooner. 

Is there any benefits archiving that greater immunity sooner if big sunk of those who that immunity is meant to protect are already dead because disease spread so rife?

[213374U]

The reasoning is that the same amount of people die in either scenario -- the only really preventable deaths are those resulting from overwhelmed healthcare, and that justifies measures aimed at "flattening the curve".

Herd immunity isn't meant to protect a specific segment of the population. It's simply the only way out of the pandemic situation, absent a vaccine regarding which there are no guarantees. There's virtually no chance that we'll have a vaccine ready for deployment before 2021, and even that is extremely optimistic.

edit: problem is we don't really know how immunity works so "herd immunity" may not be a watertight strategy either.

Edited May 12, 2020 by 213374U

[MedicineDan]

18 minutes ago, 213374U said:

The reasoning is that the same amount of people die in either scenario -- the only really preventable deaths are those resulting from overwhelmed healthcare, and that justifies measures aimed at "flattening the curve".

Herd immunity isn't meant to protect a specific segment of the population. It's simply the only way out of the pandemic situation, absent a vaccine regarding which there are no guarantees. There's virtually no chance that we'll have a vaccine ready for deployment before 2021, and even that is extremely optimistic.

Thanks, I just deleted my longwinded three paragraph response because your four sentences are more elegant.  Thanks for nothing!  :broad grin:

EDIT:   ...But if we cannot achieve herd immunity, which means vaccines are pretty much out of the question, then the 'rona is simply part of our lives and we'll have to accept it.  Seriously, this is the most grim scenario.  It also argues most for getting on with life and simply taking the steps to protect the at risk populations and get everyone else to something of a normal life as best as possible.

Edited May 12, 2020 by MedicineDan

[Elerond]

18 minutes ago, 213374U said:

The reasoning is that the same amount of people die in either scenario -- the only really preventable deaths are those resulting from overwhelmed healthcare, and that justifies measures aimed at "flattening the curve".

Herd immunity isn't meant to protect a specific segment of the population. It's simply the only way out of the pandemic situation, absent a vaccine regarding which there are no guarantees. There's virtually no chance that we'll have a vaccine ready for deployment before 2021, and even that is extremely optimistic.

edit: problem is we don't really know how immunity works so "herd immunity" may not be a watertight strategy either.

Herd immunity is meant to protect those who aren't immune, by having enough people to be immune for the disease that will form blockade around those people who for some reason or another can't build immunity for the disease but if all the people who need protection of herd immunity are dead, then there really isn't herd immunity just people who didn't die when disease went through the population. This with presumption that immunity last long enough to prevent second new waves of the infection.

Also I am not sure if it should be actually called flattening the curve if you achieve preventing overhelmed healthcare system by not giving intensive care for people over certain age.

[MedicineDan]

No, the idea of flattening the curve is that you spread out the deaths.  There is simply no reasonable way to remove exposure to the virus over time unless you develop a vaccine.  The realistic scenarios for a vaccine or significant therapeutics that will reduce death are beyond the time frame society can withstand these sort of lockdown measures.  An extended lockdown waiting for a vax or some great breakthrough isn't feasible.  Seriously, the idea of flattening the curve was *never* that the people killed off by the virus would be less.  On a theoretical level, the people counted as dying from the virus was always the same.  The reduction in death was from preventing the healthcare system in a certain area from being over-run.  In the United States, this is the case.  Sure, the idiotic but long praised governor of New York state made stupid mistakes, but even he had to admit that he had enough resources for the people who died.  They were, in his words, going to die anyway.

[213374U]

Herd immunity is only "meant to protect" when politicians claim it can be used as a strategy so as to make it look as if they have a plan.

Herd immunity simply means that as a certain threshold of individuals become immune, the spread is slowed or stopped because of a dearth of susceptible hosts. This makes it varying degrees of unlikely (if not impossible) that a non-immune individual will be exposed, independent of whether that individual belongs to a risk group or not. However it's not really something you can direct or target in such heterogeneous transmission scenarios, which is why the assumption is that as the infection inevitably progresses through the population, it's going to kill the same amount of people over time. That's people who would die of the disease regardless of the amount of medical resources available. Non-preventable.

NPIs are intended to slow the spread so as to avert total healthcare collapse, thus preventing additional deaths from the epidemic and other causes. Preventable. NPIs aren't meant to stop it altogether because we're too far past the point of "elimination" strategies being viable, as Zoraptor explained earlier.

If you have a scenario where you cannot give proper intensive care for people over a certain age because you are over capacity, then yes, you have failed to "flatten the curve". However, not every patient is going to get ICU treatment, corona or not, because that's a case-by-case medical decision that looks at several factors.

(and now it's me with the long winded multi-paragraph responses)

[Elerond]

Is it spreading deaths if you just let people over 80 to die instead giving them care in order to keep ICU beds free?

Even if you believe that there is no way to prevent exposure to the virus over time then trying to build herd immunity is useless and we should just hope that for some miracle disease doesn't kill all the people in the risk groups.

There is already vaccines that works for animals and their human test have started or are starting soon. So there will be vaccines in autumn given that they may not give immunization for humans, just mitigate disease and increase number of those who have minor version of it. And of course there is change that those vaccines have side effects that prevent their usage in humans. And of course it will also take time to produce enough vaccine to vaccinate everybody or even those who belong in risk groups.

On theoretical level people counted dying from the virus aren't always same, because that would mean that 100% population gets sick and there is no methods to mitigate or prevent its effects on those who are hospitalized by the disease. Corona doesn't seem to have spreading power to actually infect 100% of the population even if there isn't any preventative methods used and we have medicine and treatments that increase change that people hospitalized by the disease will survive it. So number of people dying from the disease depends multitude of factors which have more or less effect on how many people disease kills, but in any case number of deaths is not written in stone

Edit: Herd immunity principal

Common definition

Herd immunity (also called herd effect, community immunity, population immunity, or social immunity) is a form of indirect protection from infectious disease that occurs when a large percentage of a population has become immune to an infection, whether through previous infections or vaccination, thereby providing a measure of protection for individuals who are not immune

But of course like with any term people have habit to use it in different context and give it different meanings

https://academic.oup.com/cid/article/52/7/911/299077

The term “herd immunity” is widely used but carries a variety of meanings [1–7]. Some authors use it to describe the proportion immune among individuals in a population. Others use it with reference to a particular threshold proportion of immune individuals that should lead to a decline in incidence of infection. Still others use it to refer to a pattern of immunity that should protect a population from invasion of a new infection. A common implication of the term is that the risk of infection among susceptible individuals in a population is reduced by the presence and proximity of immune individuals (this is sometimes referred to as “indirect protection” or a “herd effect”). We provide brief historical, epidemiologic, theoretical, and pragmatic public health perspectives on this concept.

[sources 1-7]

1. http://physwww.mcmaster.ca/~higgsp/756/Fox_1971.pdf

2. https://www.nature.com/articles/318323a0 (paywall)

3. https://academic.oup.com/epirev/article-abstract/15/2/265/440430?redirectedFrom=fulltext

4. https://academic.oup.com/cid/article-abstract/9/5/866/479603

5. https://link.springer.com/article/10.1023/A:1007626510002

   These were clearly from same school of though as 213374U

Quote

The term herd immunity has been used by various authors to conform to different definitions. Earlier this situation had been identified but not corrected. We propose that it should have precise meaning for which purpose a new definition is offered: “the proportion of subjects with immunity in a given population”.

6. https://academic.oup.com/jid/article/197/5/643/836719

7. https://www.cabdirect.org/cabdirect/abstract/20103167361

 

Edited May 12, 2020 by Elerond

[MedicineDan]

There's a larger argument here, but my point isn't really moral.  My point is reality.  People will eventually end the lockdown in significant ways.  That's not a moral argument.  It's an inevitable one.  I have a dear friend I've known for ~40 years who was appalled when I said this months ago.  The lockdown has an expiration date.  Even if I accepted that it's entirely right to have the lockdown, the reality would still be that people will start rebelling against it in greater numbers.  If there are key things we could try, we should focus on them.  The perfect (which I don't concede is perfect at any rate) is truly the enemy of the good.

[Elerond]

Lockdowns have expiration date, at least they should have as they are meant to be temporal way to control the situation in areas where spread of disease is out of the control or ensuring control during time when countries and areas prepare methods of control that are better aimed (or at least areas under lockdown should do such preparations), but lockdowns are just extreme method of control, but not only way and not best way to control disease in long run. 

Also the Swedish strategy doesn't aim to stop or prevent disease in future, but to make future waves smaller and easier to control, so that they will cause less disruption in people's lives, but estimation models don't predict any clear long term benefits compared to strategies used by other countries I don't see it anyway good approach especially in current global environment where its benefits for economy are minimal.

[213374U]

1 hour ago, Elerond said:

Is it spreading deaths if you just let people over 80 to die instead giving them care in order to keep ICU beds free?

You are assuming that the patient is not being given ICU care a) because they are over 80 and b) it's in order to keep the bed free. That's not really how it works, except in very extreme cases, such as in Northern Italy at the peak.

 

1 hour ago, Elerond said:

Even if you believe that there is no way to prevent exposure to the virus over time then trying to build herd immunity is useless and we should just hope that for some miracle disease doesn't kill all the people in the risk groups.

As I said, you don't "try" to build herd immunity. It's just something that happens naturally in any scenario where you can't stop the spread and the disease doesn't kill 100% of the infected. So yes, "building herd immunity" is not a very good strategy, unless doing nothing is a strategy. It will happen or not depending on how long immunity lasts, regardless of what we do.

As for a vaccine being ready for deployment in autumn, there's simply no basis for that, sorry. You can perhaps speed things up and cut down the time needed from several years to just one year, but on top of completing a development process with 90%+ attrition rates, you need to set up the logistical chains for manufacture and distribution of millions of doses. An ineffective (if not defective or dangerous) vaccine can be even worse than no vaccine because it would be difficult to maintain NPIs while also declaring that the vaccine works. The flu vaccine, for reference, is only 40-60% effective. That may not be enough to achieve herd immunity against SARS-CoV2.

Whether there are treatments that can help is irrelevant to the amount of people who die in a scenario where you are not at 100% capacity, because in that scenario everyone who needs treatment will get it, and if they die anyway it will not be because they couldn't get treatment. Those deaths are non-preventable: they didn't die because they couldn't be treated -- they died because people get sick and die at the best of times. If they died because they couldn't get treatment, that is a preventable death whether they died of corona or from drinking fish tank cleaning fluid.

The problem is when you assume that we'll have a miracle or vaccine really soon. It's not strictly impossible, but it's also not very likely, and making policy based on that strikes me as foolhardy.

Edited May 12, 2020 by 213374U

[Elerond]

3 minutes ago, 213374U said:

As I said, you don't "try" to build herd immunity. It's just something that happens naturally in any scenario where you can't stop the spread and the disease doesn't kill 100% of the infected. So yes, "building herd immunity" is not a very good strategy, unless doing nothing is a strategy. It will happen or not depending on how long immunity lasts, regardless of what we do.

As for a vaccine being ready for deployment in autumn, there's simply no basis for that, sorry. You can perhaps speed things up and cut down the time needed from several years to just one year, but on top of completing a development process with 90%+ attrition rates, you need to set up the logistical chains for manufacture and distribution of millions of doses. An ineffective (if not defective or dangerous) vaccine can be even worse than no vaccine because it would be difficult to maintain NPIs while also declaring that the vaccine works. The flu vaccine, for reference, is only 40-60% effective. That may not be enough to achieve herd immunity against SARS-CoV2.

Whether there are treatments that can help is irrelevant to the amount of people who die in a scenario where you are not at 100% capacity, because in that scenario everyone who needs treatment will get it, and if they die anyway it will not be because they couldn't get treatment. Those deaths are non-preventable: they didn't die because they couldn't be treated -- they died because people get sick and die at the best of times. If they died because they couldn't get treatment, that is a preventable death whether they died of corona or from drinking fish tank cleaning fluid.

The problem is when you assume that we'll have a miracle or vaccine really soon. It's not strictly impossible, but it's also not very likely, and making policy based on that strikes me as foolhardy.

And by the way, it won't kill 100% of people in risk groups, miracle or not. Closer to 20%, at worst.

Possibility for autumn vaccine is based on information hAdOx1 nCoV-19 vaccine that developed Oxford's researcher works on monkey and Indian medical company started to produce 40 million units of it and they estimate that million units will be ready in September in case that vaccine works. Of course as said vaccine has not yet properly tested on humans it may still fail, but even it fails to offer immunity it may offer mitigation for disease.  

https://www.businessinsider.com/india-serum-institute-millions-oxford-university-vaccine-before-approval-2020-4?r=US&IR=T

Also vaccines developed by Finnish researchers goes human trials in midsummer and four Finnish medical companies have plans to produce millions of shots of it towards beginning of next year. But they are behind Oxford's researchers and they have even less to show that it would work and it is safe.

Herd immunity doesn't necessary appear when disease spreads naturally, because percentage of population who have immunity never rose high enough to cause virus to cause its own extinction, like for example herd immunity against measles without vaccines doesn't seem to happen in population, even though it spreads fast and easily and people who had it develop lifetime immunity against it. This is said to be because ~95% population needs to be immune to measles in order there to be herd immunity against it and this doesn't happen because lowering spread speed and population turnover rate, which leads periodical measles epidemics in areas where populations aren't vaccinated. And there is possibility that corona is similar as influence and SARS, meaning antibodies against disease don't last long enough that populations could form herd immunity.

Even if you can ensure that hospitals don't work in their 100%, it doesn't mean that larger concurrent patient number doesn't cause preventable deaths, because larger number simultaneous patients cause higher risk that doctors, nurses and other hospital staff (and even other patients) get infected, which increase risk of them dying compared to scenarios where number of simultaneous patients is lower. Also total number infections in population is not same when you change speed of infection spread, even when you take in account possible second, third and fourth ... etc. waves. Lower spread also makes it easier to prevent disease ever reached elderly care homes and other places with high concentration of people belonging risk groups. In Finland, death rate was 37% (11/30) in among residents of elderly care home where disease spread unnoticed to almost all the residents.

 

[Zoraptor]

I really wouldn't be putting all metaphorical eggs in the vaccine basket. Politicians kind of have to, since it's the only really feasible way they can 'win' they have to act as if it's coming. Vaccines for upper respiratory tract illnesses are notoriously problematic due to it being more or less treated as 'external' by the immune system, which is partly why (other reason is below) there are so many cold viruses and the like and you get them so often; and vaccines for ssRNA viruses are problematic too, you need a flu jab every year for example and it isn't 100% effective even then. A vaccine may well be effective for preventing any ancillary organ damage (hearts, kidneys etc) though, which would be a plus and quite possibly worthwhile by itself especially if the stroke like side effects some have noted can be prevented too. That Oxford vaccines seems to be pretty solid in theory as it is targeting a virus protein which seems to be under strong selective pressure to not be altered, but there's a lot more to it than having it work in monkeys. There are literally dozens of vaccines under development, we'd be lucky if even a handful make it through to full development let alone 'work'.

End of the day the reason we don't use RNA, let alone single stranded RNA, as genetic material because it mutates way too readily and produces far too many variations. But that is also precisely the reason so many common viruses use it, and why we typically don't have long term immunity to them. All the lovely antibodies in the world won't help if the antigen they're looking for has shifted thanks to some random UV photon hitting the wrong/ right base.

Measles isn't a good analogue for sarscov2 though, it's one of the most infectious viruses around and is for example fully airborne. You can get some idea of what the actual herd immunity level would have to be by looking at the peak R for sarscov2, iirc it's about 2.4 average transmissions per case with (approaching, not literally) minimal precautions. So if ~60% of the population is immune R will be below 1 and the outbreak will slowly die out. At least in theory. And that 60% is certainly a lot.

Edited May 12, 2020 by Zoraptor

[MedicineDan]

I'm happy to delete my response vis a vis vaccine euphoria to Zoraptor.

I'm not saying that Sweden is entirely correct in their policy.  However, I disagree with some of the assertions that it didn't work based on current straight up number of deaths or deaths per x.  They always knew that they would have relatively more deaths in the short term.  The contention is that they'd have the same number of deaths over the course of several months whether they came early or late.  Might not be true, but at least argue against *that* point.

...And, seriously, Elerond, if you want to establish a specific meaning for a term, just throw it out there.  If you want herd immunity to have one specific meaning, I'd be happy to accept it.  Frankly, I've pretty much thought the meaning you cited at the beginning of your post was the established meaning anyhow.  I'm not challenging you.  I'm sincerely telling you I'm absolutely chill to accept terms other folks offer if they have a particular definition or set of facts on which we can agree in order to have even the chance of a conversation.

[213374U]

2 hours ago, Elerond said:

Possibility for autumn vaccine is based on information hAdOx1 nCoV-19 vaccine that developed Oxford's researcher works on monkey and Indian medical company started to produce 40 million units of it and they estimate that million units will be ready in September in case that vaccine works. Of course as said vaccine has not yet properly tested on humans it may still fail, but even it fails to offer immunity it may offer mitigation for disease.  

Sure, or it may do nothing at all, or even turn out to be unsafe in some edge cases which would probably be the worst possible scenario. An Indian lab has announced that they are starting mass-production of a vaccine whose development isn't even close to complete -- they just started phase I trials in late April, meaning they still have two additional testing phases to go through, each with increasing typical failure rates. Sounds more like a sales pitch or a move to get their stock appreciated than genuine evidence that there will be a vaccine in circulation in September.  I wasn't exaggerating when I said the attrition rate for vaccine development is about 90%.

The Finnish vaccine timetable you mention is more in line with what people familiar with the process of drug development are quoting, but even then, with the caveat that efforts aren't derailed for whatever reason. So yeah, about one year, and even that will be an unprecedented achievement if it works.

 

2 hours ago, Elerond said:

Even if you can ensure that hospitals don't work in their 100%, it doesn't mean that larger concurrent patient number doesn't cause preventable deaths, because larger number simultaneous patients cause higher risk that doctors, nurses and other hospital staff (and even other patients) get infected, which increase risk of them dying compared to scenarios where number of simultaneous patients is lower.

It shouldn't. Being under capacity means that staff is able to handle their workload without increasing the risk to themselves. It means that patients can be isolated to avoid spreading the disease among themselves. It means that treating patients does not carry a risk of further spreading the disease.

In any case, you're redefining what preventable means. Or rather, going outside of the meaning it has in the whole "flatten the curve" discussion. If you want to start preventing literally preventable deaths, we may need to ban all sea, air and road travel, most foods, all sources of pollution, sunlight, hospitals, sexual relations and so on and so forth. At least until safe alternatives exist that allow for prevention.

 

2 hours ago, Elerond said:

Also total number infections in population is not same when you change speed of infection spread, even when you take in account possible second, third and fourth ... etc. waves. Lower spread also makes it easier to prevent disease ever reached elderly care homes and other places with high concentration of people belonging risk groups. In Finland, death rate was 37% (11/30) in among residents of elderly care home where disease spread unnoticed to almost all the residents.

Source? Specifically, where are you getting that "total number of infections is not the same when you change the speed of infection" from? I'm genuinely interested. From what I've read the reproduction number establishes the herd immunity threshold as Pi > 1 − 1/R0. Zoraptor used a R of 2.4 which returns a little under 60% for herd immunity. Now, R is not fixed and factors such as NPIs can affect it. So currently the number is likely lower as people are under lockdown and more or less strictly observing social distancing, but it'll go back to the "default" value once restrictions -and people- are relaxed. If all goes well, subsequent waves should be less dramatic among other things because fewer people will be susceptible. But that threshold is the same whether it's reached in six months or two years, in one go or ten. The only way to reach it without further infections is with a vaccine.

Edited May 12, 2020 by 213374U

[Zoraptor]

'Vaccine euphoria' is fine with me, probably the default position in some ways and completely understandable. One thing I've learned from games, especially games like Bridge is that sometimes you just have to assume that the particular sequence of events you need is the one that you'll get, even if you think the sequence is unlikely. If you don't get that sequence, you've lost anyway, and if you presume you won't get that sequence because it's unlikely and act accordingly then you'll lose as well. As long as proper planning is done for there not being a vaccine or long term immunity, hoping that a vaccine will come is fine. 

The fundamental problem with herd immunity as a strategy is that if it works then a vaccine should also work. In the gaming analogy it's assuming that the sequence that is needed to 'win' won't happen- except for the most important/ fundamental part of it, ie there being immunity. If you do get a quick vaccine release then herd immunity strategies potentially just killed or exposed to long term health effects a whole lot of people unnecessarily, if you cannot get a vaccine release then herd 'immunity' is itself a misnomer, as you're highly unlikely to get a long term effective immune response to a virus, but not to a vaccine based on the same antigen. OTOH, probably less direct economic effects so there may be increased capacity to fund ongoing healthcare for any subsequent outbreaks.

There are of course exceptions where circumstance or good management means that the virus can be fully controlled to eliminated or even locally eradicated so that, at least in the short term, the question of a vaccine for prevention is moot; but they are only feasible when the virus isn't already widespread.