There has been an avalanche of news in the past 24 hours. Too much to really cover. A bit...
- All but 4 states have recorded cases. (Let's be real, the other states have them too, they just don't know it yet because of testing) Yesterday it was 6.
- Multiple states have closed schools for the entire state, some for 2 to 3 weeks. The list of states is growing so I won't list them.
- CDC chief agreed to have free coronavirus testing at Congressional hearing, but let's see if it happens. Of course testing is exceptionally difficult still.
- Disneyland, Disney World, Universal Studios Hollywood, Universal Orlando Resort closing their parks within the next several days (though some areas outside of the parks will not close as of now)
- Some cruise ships have stopped operating for a period of time. (Princess Cruises, Viking, Virgin Voyages)
- Games in most sports leagues postponed (NBA, NHL) or canceled (NCAA Basketball. PGA has canceled at least some of the upcoming events. Some with no fans. (NASCAR) Sounds like XFL is canceled rather than postponed. A long time until the NFL comes back, but many teams making statements about reducing travel and some closing their offices to people right now. Here in the Tampa Bay area we have the Grand Prix of St. Petersburg this weekend, but it will be run without spectators.
- Many, many colleges having courses online for now.
- Release of some major movies being delayed (No Time To Die, Fast and Furious 9, Mulan, The New Mutants, A Quiet Place Part II, Peter Rabbit 2)
- Broadway performances canceled in New York City
- Some of the late night shows, which tonight went on without an audience, will no longer have new shows starting either tomorrow (The Tonight Show and Late Night on NBC) or Monday. (Late Show on CBS)
I go over some of the entertainment industry because some people will no longer be going out and they may wonder about what's on television. And more importantly, I think knowing about how much is changing helps people understand the seriousness of the situation.
Life is changing. The next few weeks are going to get uglier and uglier when it comes to the spread of this virus, with the number of cases growing exponentially, as well as the death toll. At some point, I think every single American in the United States at some point is going to be told to stay home, likely for an extended period of time. I don't think we're going to see anything like martial law. American's aren't going to accept what China did. We're going to be more along the lines of what Italy is doing. What is happening in Italy is going to happen here. In terms of the lock down in Italy, I really hope we see that here.
The problem is, it's here and it's spreading in the community. It hasn't seemed bad because when you see an exponential spread, it doesn't look like much when you only have a few cases. We're at the point now where the numbers will climb rapidly. It's spreading and while they are trying to slow the spread right now, somewhat dramatically in some regions when it comes to what the U.S. is used to, it won't stop it. We will at some point need to do what China, Italy and some other countries did. When the number of cases and deaths become too much, when hospitals are too overrun like they are in Italy that doctors have to make difficult choices on who to treat, and who not to, we will need to have people stay home. If everyone mostly stayed home for a few weeks, the spread would slow dramatically. We could get to a point like China, where things would open more again. Then they could start to try tracing the infection better again. Hospitals would not be overrun then. You wouldn't see exponential spread that quickly had the number of cases in the millions, or even in the many tens of millions in the U.S. China took extreme action though. We wouldn't mandate people stay home like they did. We would be more like Italy, where grocery stores and pharmacies are open but most everything else is closed now. I don't know what it's going to look like here. How will supplies get to stores? We're going to have to have some things open. Doctors, nurses, EMTs, police, and the fire department will still need to operate. Some grocery stores and pharmacies. We'll need gasoline. We'll need food to get to stores. I have no idea if the country is ready for this.
We may see multiple periods where people are asked to stay home. Each time it would slow the spread dramatically until it perhaps got out of control again, where tracing the people that infected people came into contact with is again not manageable and it gets out of control again. This might be life for 1 to 2 years until a vaccine is widely available and many people have received it. I don't know much about how a vaccine like this would work.
I found an article from the Los Angeles Times about that. I'll include it in full at the bottom of the page if you can't see it here:
https://www.latimes.com/science/story/2020-03-12/why-does-it-take-so-long-to-make-a-coronavirus-vaccine
We don't know how this virus will act during the summer, though we can look to see how it is spreading in the Southern Hemisphere right now.
I went to a few grocery stores tonight and bought more canned food. Toilet paper was gone, because naturally that's the most important thing. I was watching a late night show that talked about how people are panicked over toilet paper in the bathroom when what else is in the bathroom? A shower. Cleaning supplies were rather picked over. Bread was low at Aldis. They had a lot of milk and eggs. They still had lots of canned food. I bought another 12 cans.
Publix was busy. Aldis wasn't. I went to Publix around 8pm. There were only three people checking people out. They added a fourth eventually, but the lines were long. Some people were social distancing. Some were not. No one with masks, but one person had gloves. I watched that person and what did he do? He rubbed his face while wearing them. My dad used the cleaning wipes many stores had and I carried hand sanitizer with me too. It was hard to stay away from people though. Some aisles were crowded. As more and more people get it, it's going to be more and more important to distance yourself in crowds like that when you have to go shopping at times.
I was just watching Dr. Sanjay Gupta, from CNN, and he was talking about washing your hands. You need to do that for 20 seconds, making sure to get between your fingers. He mentioned that a lot of people might forget to do their thumbs. You have to make sure to get those well too.
You have to try to remember to keep your hands washed and/or use hand sanitizer. Don't touch your face! If you see someone you know doing it, point it out. You can't touch your eyes, nose or mouth if your hands are not clean.
As a reminder, try to get medication in advance if you can. Some people won't be able to. It's something you might want to look into.
Good luck to everyone. Try to stay safe and don't go out as much, if at all, unless to work and to get food. It won't be too long before everyone is going to really need to stay home.
I know younger people don't have as much to worry about, if they don't have a condition that puts them at higher risk, though there is still a higher risk of death for younger people than for the seasonal flu. But they definitely still get it. If you live with someone who is older, and/or has a condition that puts them at higher risk, consider the fact that if you get it you could put them at risk, even if they stay home. If they live in a retirement community or nursing home, you may want to not visit them during this period. Or if so, don't touch them. Keep your hands clean. Try not to touch things where they are. If they live with you, you have to be careful. Younger people should be trying to not get it so that we don't pass it on to people more at risk. That's my personal concern. I had a sore throat for a week that has gotten better in the last few days and I practiced trying to stay away from my dad so I didn't get him sick, if I was sick. It might have been allergies, though I've never had that kind of reaction before. (though I get some weird allergic reactions sometimes even though I only know I'm allergic to oak)
I did want to mention that blood banks are going to be running low. (https://www.redcrossblood.org/ or whereever you want to donate) I have donated blood for 20 years, but in January I decided to pause donating for awhile. I have to take a lot of iron to give blood and I found out a year ago that while I was boosting my hemoglobin level enough to donate, my global store of iron (ferritin) was really low. I took a lot of iron, and still donated blood, and at my yearly physical in January I found my ferritin level had only rebounded back to 14. The lab work said it should be 38-380 ng/mL. I was getting calls from my local blood bank about donating blood and had seen on TV too about them being low. I also wanted to point out that if you donate blood a lot, you should really have your ferritin level checked. But if you can people should donate blood, though this period is going to be really tough with people not going out as much. Maybe the healthy people who aren't going to be around older people for a period of time might be willing to donate still. There will be periods soon where they are desperately in need of it.
Map from New York Times of cases:
https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html
Still has county level data for U.S.
Their coverage:
https://www.nytimes.com/news-event/coronavirus
"We are providing free access to the most important news and useful guidance on the coronavirus outbreak to help readers understand the pandemic. The articles on this page are available if you have a New York Times account."
John Hopkins map only has state level data now:
https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6
Los Angeles Times
Why will it take so long to make a coronavirus vaccine that can prevent COVID-19?
By AMINA KHANSTAFF WRITER
MARCH 12, 20205:08 PM
Nothing can stop a global outbreak in its tracks better than a vaccine. Unfortunately, creating a vaccine capable of preventing the coronavirus that causes COVID-19 will probably take at least a year to 18 months, health officials say.
"That is the time frame," Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told the House Oversight and Reform Committee this week. Anyone who says they can do it faster "will be cutting corners that would be detrimental."
While there are about 10 vaccine candidates in the works - and at least one of them could begin clinical trials in April - it would still take about three more months to conduct the first stage of human testing and another eight months or so to complete the next stage of the trial process, he added.
New vaccines require copious research and time-consuming testing that can cost hundreds of millions of dollars. There's no guarantee of success, but even if everything goes well, the final product might not hit the market until after an outbreak has subsided.
Here's a look at how vaccines are made and why the process takes so long.
How does a vaccine work?
Your body has a multi-pronged defense system for recognizing and combating dangerous invaders: your white blood cells. There are several types, each with a different purpose:
- Macrophages engulf and then eat pathogens or cells that are dead or damaged. They leave behind identifying fragments of the invading microbes. These fragments are called antigens.
- B-lymphocytes produce antibodies that recognize and bind to those antigens. If a pathogen with those antigens shows up in the blood stream again, those antibodies can mount an attack.
- If those pathogens are already hiding out inside your cells beyond the antibodies' reach, T-lymphocytes can attack those infected cells.
Your immune system has to go through this process each time it encounters a threat from a new virus or bacterium.
A vaccine provides a shortcut. Essentially, it helps your immune system learn to recognize a specific threat by tricking it into thinking it's under attack. Then it can produce the antibodies it needs without having to face a real infection.
Are all vaccines the same?
Nope. The Centers for Disease Control and Prevention describes several types of vaccines:
- Attenuated vaccines, like those for chickenpox and measles, use a live virus or bacteria that has been intentionally weakened so that it can't cause serious disease in a healthy immune system.
- Inactivated vaccines, such as the one for polio, use germs that have been killed. They typically don't provide as much immunity as attenuated vaccines, so they may require boosters over time.
- Toxoid vaccines, including the DTaP vaccine for diphtheria and tetanus, use weakened versions of the toxins created by invading bacteria to teach the body how to fight the pathogens.
- Subunit vaccines, such as DTaP's whooping cough component, only use fragments of the virus or bacterium they protect against.
- Conjugate vaccines teach the immune system to fight bacteria that try to disguise their antigens in the long chains of sugar molecules that form the walls of bacterial cells.
What do you need to know about a virus to create a vaccine?
The immune system learns how to fight a virus by studying its face - the outside of the particle, including those telltale antigens. So a vaccine needs to give your body a snapshot of that face.
One classic technique involves injecting a person with a killed virus. Another uses live viruses that have been grown and deliberately weakened, typically by removing specific genes in their RNA or DNA.
Both of these strategies take some time, and scientists worry that if they use them on novel viruses, they may not behave the way researchers predict, said Dr. Kathryn Stephenson, who runs the clinical trial unit at Beth Israel Deaconess Medical Center's Center for Virology and Vaccine Research.
Another option for scientists is to reconstruct that snapshot using information from a virus' genetic code, which may be made of either RNA or DNA.
Nowadays, researchers can get started fast. Scientists in China made the coronavirus' RNA sequences available on Jan. 10, and many labs began working toward a vaccine the next day, Stephenson said.
Once you know that, is the rest easy?
Hardly. Designing the vaccine is just the first step. Then it has to be produced.
There are many different vaccine-making platforms, each with its own set of advantages and disadvantages.
"What would make a great vaccine for coronavirus is one that you can make quickly and one that would provide long-lasting and effective immunity," Stephenson said. "Those are not always the same thing."
For example, a vaccine based on the virus' genome can be made quickly, in perhaps a month or two, but it may be harder to manufacture in giant quantities.
Another option is to take the virus' genetic snapshot and put it into a different virus for transport. When introduced into the body, the so-called viral vector vaccine enters cells, prompting them to produce huge numbers of this snapshot for the immune system to see. These vaccines take longer to make - say, six to eight months - but they can be scaled up more readily.
"A lot of us are working on both of those," Stephenson said.
How are vaccines tested?
Before a vaccine candidate is approved for use, it must be proven safe and effective in a series of trials that are monitored by the Food and Drug Administration.
The first step is to show that it's safe in preclinical studies. These can be conducted in vitro (using cells in a laboratory dish) or in vivo (using an animal as a stand-in for humans). Finding the right animal for testing can be a challenge, said Robert Grenfell, director of health and biosecurity at CSIRO, Australia's national science agency, but scientists working on a vaccine for the new coronavirus won't have to start from scratch. The new virus shares much of its genome with the coronavirus that caused the 2003 outbreak of severe acute respiratory syndrome, and some Australian researchers already have been studying the SARS virus in ferrets.
Then clinical trials in humans can begin. Phase 1 trials are small, usually with a few dozen closely monitored participants. The main goal here is to make sure the vaccine is safe. Phase 2 trials typically enroll hundreds of patients to expand the safety assessment and allow scientists to dig into the body's immune response. Phase 3 trials can enroll thousands of people, typically with some of them randomly assigned to get the vaccine and some getting a placebo.
This process can take years under normal circumstances. In an emergency, it could be sped up dramatically.
The big sticking point is often the Phase 3 trial. In an epidemic, many study volunteers may not want to risk getting a placebo instead of the vaccine, Stephenson said.
Researchers faced this dilemma during the Western African Ebola outbreak that took off in 2014. The virus had a mortality rate of about 40%, making people desperate for the still-unproven vaccine. So researchers employed a novel experimental design that involved vaccinating people with varying degrees of separation from an Ebola patient and using computer models to help determine if the vaccine had had an effect.
"I think people learned from that that there are ways to be creative," Stephenson said. A creative solution may be needed when a coronavirus vaccine is ready for Phase 3 testing, she added.
How good does a vaccine need to be in order to gain approval?
The FDA wants it to be both safe and effective - in other words, it has to protect enough people with as few unwanted side effects as possible. But exactly what qualifies as safe and effective may depend on the disease in question.
For some perspective: Stephenson, who also studies HIV, said that researchers would be very happy if they could come up with an HIV vaccine that protected 50% or so of those who got it. On the other hand, for a highly contagious virus like measles, a vaccine would need to work in almost everyone to establish herd immunity, she said.
David Weiner, a molecular immunologist who directs the Wistar Institute's Vaccine and Immunotherapy Center, said a successful coronavirus vaccine wouldn't have to be 100% effective.
"I would like us to see it work in the majority of people," he said, but "if it worked in 50%, 50% is a big improvement over 0%."
Once a vaccine is approved, is the hard part over?
Definitely not. The labs that create a successful vaccine probably won't be the ones that are able to scale up - they'll need a dedicated manufacturer for that part. And many companies may be wary of investing the resources it takes to manufacture a new vaccine when the epidemic could end before there's a chance to bring it to market, Weiner said.
"Big Pharma is afraid to go in because the outbreaks end and they lose all the money they put in," he said. That's why the Oslo-based Coalition for Epidemic Preparedness Innovations, or CEPI, has stepped in with funding to help shepherd some of those efforts, he added.
One of the big technical challenges in large-scale manufacturing is quality control, Stephenson said.
"Every vaccine has its own particular issue," she said, but "the manufacturing challenges mainly have the most to do with safety precautions and making sure that when you're done, the vial of vaccine has in it what you say it has."
Who would get the vaccine first?
This can be a difficult question when there's a limited amount of vaccine and a whole lot of demand.
Since older adults appear to be most at risk from COVID-19, it's likely that health officials would focus on them first, Stephenson said.
Medical professionals - who are both at high risk of exposure and are needed to care for those who are sick - would likely be a priority as well.
"Front-line healthcare workers are usually one of the first groups you vaccinate because you need your workforce in place," she said.
Vaccines are often less effective in older people than they are in younger ones, and this could affect the way that a vaccine is administered. A vaccine might be given in multiple doses, or an adjuvant might be added to it to boost the immune system's reaction to it.
How can I protect myself until a vaccine is available?
The CDC suggests some common-sense ways for people to protect themselves:
- Avoid close contact with people who are sick.
- Wash your hands often with soap and water for at least 20 seconds.
- If you can't find soap and water, use an alcohol-based sanitizer with at least 60% alcohol.
- Avoid touching your eyes, nose and mouth.
- Stay home if you're sick.
- Use a tissue when you cough or sneeze and then throw it away immediately.
- Clean and disinfect frequently touched objects and surfaces.
- Use a face mask if you show symptoms of COVID-19 so you don't infect others. (The masks are not recommended for healthy people who are just generally trying to protect themselves against infection.) |