COVID-19 Thread [V2.0]

[Machu Peach]

When I was a kid the big slogan was "Reduce, reuse, and recycle." We were taught that the three Rs were listed in order of importance. Reduce your consumption/waste where possible. If you can't reduce, then reuse when possible, and if you can't reuse then recycle. However it seemed to me at the time that "recycle" got the most attention.

 

I think that something similar may be happening with COVID. Masks get all the attention, however social distancing is the most important/effective. Masks to used where avoiding contact is not possible. Just like recycling doesn't make ok to be wasteful, wearing a mask does not make it ok to avoid social distancing where possible. ...at least that's what makes sense to me.

 

I've also seen it mentioned many times that masks don't protect the wearer, but do protect others. Does anyone know of a study that looks at this? Specifically, I'm looking for a scientific study that demonstrates that 1) masks don't protect the wearer and 2) do protect others.

[homer]

Not exactly.what you want but the CDC just came out with a study yesterday that says masks also protect the wearer:

https://www.cdc.gov/coronavirus/2019-ncov/more/masking-science-sars-cov2.html

[Ron Robinsons Beard]

Government/Science face-mask strategy continues to work just great!

 

Any thought of the Department of Health putting the following back on the website?

 

However, face coverings may increase risk if users reduce their use of strong defenses, such as physical distancing and frequent hand washing, when using cloth face coverings.

 

I am actually somewhat miffed that the Department of Health felt the need to say, basically, "A mask is not a cure-all. It is not advised to go do a mosh pit just because you are wearing one." Are people really that stupid?

[tmwiese55]

I liked Machu's RRR post. Makes a lot of sense. I guess some of it getting to the point where all they're emphasizing is masks is kind of because they know people are getting back out there again. Basically they know lockdown isn't happening anymore and people aren't listening combined with so many businesses/work being innocently being open again, so if you're out wear a mask. I'd agree the emphasis needs to get back to trimming things back, which it does seems some of the governors including ours have recently been pushing that way as well.

[CheezWizHed]

A lot of hype about the 90% success rate of the Pfizer vaccine, but it sounds like we are still a ways off of approval. Results weren't independently verified, the test was still at a small sample size (44k), and the people under trial haven't been tested long. Popular Science article

 

“The results are really quite good, I mean extraordinary,” Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, told The Washington Post. Other outside experts expressed similar cautious optimism. “We need to see the actual data, and we’re going to need longer-term results,” Jesse Goodman, a professor of medicine and infectious diseases at Georgetown University, told The New York Times.

 

And I find it odd that testing is basically giving people the vaccine and then seeing who gets sick later. I'm not sure what I expected (maybe checking that their blood contains what is needed to fight off COVID?), but this just seems a little odd to me. Though admitting that I'm far from any biology expert.

 

The results are based on a Phase 3 clinical trial which began back in July, enrolling nearly 44,000 people, with about half the cohort receiving the vaccine (in two doses, given over the course of a month) and the rest getting a placebo. The independent team of researchers who are responsible for reviewing the results are the only ones who know who got what. To evaluate the vaccine’s effectiveness, the researchers had to wait for enough people in the trial (in both the vaccine group and the placebo group) to catch COVID-19. This first analysis, announced today, is based on 94 participants who contracted the novel viral illness.

[Fear The Chorizo]

I am actually somewhat miffed that the Department of Health felt the need to say, basically, "A mask is not a cure-all. It is not advised to go do a mosh pit just because you are wearing one." Are people really that stupid?

 

Umm...yes they most certainly are. Far too many people view wearing masks as a way to be lax with many of the other social distancing measures that are much more effective - like simply staying away from other people and frequent hand washing, particularly in indoor or crammed outdoor public settings. See any number of Biden celebration rallies or Trump rallies. Stupidity/ambivalence knows no specific political or social affiliation when it comes to this.

 

And I've yet to see any study that says masks are effective at all at preventing infection through particle contact with eyes, which would be just as big a risk in an indoor setting with recirculated air as standing 3' away from someone with covid and breathing on each other for as long as you're inside.

 

As for the typical single layer cloth mask or neck gaiters that most people wear actually protecting them from infection due to "filtering", I just don't buy it. Even if some of the particles are filtered with the mask material, those particles are then stuck in the person's breathing zone and inches from their eyes indefinitely, with an endless supply of warm, humid air. And there are far more smaller particles that cloth fabric simply doesn't filter out. Unless a vast majority of people are changing out masks every 15 minutes while in high risk exposure environments and constantly cleaning them/themselves to remove virus-laden particles, they aren't protecting the wearer from infection.

 

Masks can absolutely limit how far an infected person projects virus directly from their mouth/nose, but even that doesn't prevent those particles from becoming airborne and circulated in a climate controlled environment.

[Machu Peach]

A lot of hype about the 90% success rate of the Pfizer vaccine, but it sounds like we are still a ways off of approval. Results weren't independently verified... Popular Science article

The article states "The results, which were evaluated by an independent committee of experts..."

 

The FDA will also review the results once they officially receive them and the FDA is free to audit the trial at any time.

 

And I find it odd that testing is basically giving people the vaccine and then seeing who gets sick later. I'm not sure what I expected (maybe checking that their blood contains what is needed to fight off COVID?), but this just seems a little odd to me.

In vaccine development we'll look at people who were infected, survived, and now have sterilizing immunity. Specifically we'll look at the various components of the memory immune response and determine which components are more common in those with sterilizing immunity than those without. Often a hard cut will be identified; "anyone with a anti-spike protein IgG titer over ____ug/ml will have protection." We call this a "correlate of protection." We say it's a correlate of protection, because we can't be sure that it's actually what's causing the protection, but we know that we is present in all people with protection. Thus it's correlates with protection, but may or may not be what's causing protection.

 

For the majority of viruses the main correlate of protection is either neutralizing or non-neutralizing antibodies. The correlates of protection for COVID are currently not well established.

 

However we do know that people who have had COVID are (with rare exceptions) protected from reinfection (for at least a certain period of time) and we also know what their anti-COVID immunity response. Thus it was decided that for a vaccine candidate to pass from phase II to a phase II trial they had to have a log fold higher COVID-specific antibody titer than patients that had recovered from the disease.

 

So yes, they've have been and will continue to look at the immune response generated by the vaccine. However, that's very a much secondary analysis. If a vaccine protects against the disease and is safe it's a good vaccine, even if the correlates of protect don't match. If vaccine does not protect against the disease, it's a bad vaccine even if it otherwise looks great.

[homer]

Nothing is 100% effective - unless of course, you stay inside your house 24 hours a day and never contact another human. A Mask cannot stop 100% of droplets or aerosols but reducing viral load is important even if you're only reducing it by 20% (I made up that number).

 

Masks reduce risk. It is as simple as that.

 

To Machu's point about focus on masks, I agree with the RRR comparison. I think masks have just become a flashpoint for most people because it's so personal. No one is gonna know if I wash my hands or not and social distancing from strangers isn't a huge ask. Telling someone to wear a mask crosses a line for a lot of folks because you can't really hide it if you don't want to do it.

[PeaveyFury]

I've also seen it mentioned many times that masks don't protect the wearer, but do protect others. Does anyone know of a study that looks at this? Specifically, I'm looking for a scientific study that demonstrates that 1) masks don't protect the wearer and 2) do protect others.

 

'Reduced benefit to the wearer in comparison to the benefit derived from protecting others from the particles expelled by the wearer' is certainly a more accurate statement.

 

Generally, recent studies (October) have been favorable in both cases, with surgical/comparable cloth masks about 67% effective in protecting the wearer:

 

https://www.nature.com/articles/d41586-020-02801-8

 

Further, they found that simple cotton t-shirt-like material can block 50% of inhaled aerosols, and ~ 80% of exhaled aerosols. Lots of additional data there as well about materials/layering, etc.

 

For additional info specifically on the 'exhaled' side, I found this article that you linked to a couple of months ago very helpful:

 

https://www.nature.com/articles/s41591-020-0843-2

[PeaveyFury]

A few final thoughts on masks from my perspective:

 

First, it really is sad that something like mask-wearing became such an absurdly political thing.

Second, A lot of the skepticism regarding masks stems (or a least that other than noted in my first point) from an early study from ~April that suggested little benefit. Of note, that study was since retracted. As with many things (i.e., Vaccines and autism), the initial headlines sometimes get latched onto and the later complete change in the story/retraction/discreditation is ignored by too many.

Third, the material of the mask does matter. As Chorizo notes, the gaiter masks are basically garbage. But studies do definitely show the benefit of cloth masks, especially multi-layered. But to the greater point from DHS, don't assume that your mask allows you to act in a way that ignores the other guidelines.

[PeaveyFury]

Sorry for a third post in a row, but I had a few thoughts on the vaccine news from this week.

 

Thanks to Machu and others for the good discussion/information on distribution and such. I think there's a lot of good news there and it is very, very exciting news and very much the light at the end of the tunnel here. There are obviously other concerns that are yet to be sorted out- i.e., does a two-dose vaccine see a high number of people that don't return for the second dose? How long does the immune response last? etc.

 

Also obviously, the big question is willingness of the populace to take the vaccine when available to them. As there is a sad amount of skepticism regarding vaccines due to discredited noise, you'll have some of the populace that will treat it with that skepticism and undue fear. And, with a large portion of the population still convinced that this virus either isn't a big deal or whatever, there'll be a large number of people that won't think it important enough to get the vaccine at all.

 

Hopefully, you'll at least have the bulk of the first part of the 'triage' largely willing to receive the vaccine (HCWs, at-risk people with significant comorbidity issues, the elderly, etc) which will go a long way, but it will be interesting to watch the distribution numbers for sure.

[CheezWizHed]

A lot of hype about the 90% success rate of the Pfizer vaccine, but it sounds like we are still a ways off of approval. Results weren't independently verified... Popular Science article

The article states "The results, which were evaluated by an independent committee of experts..."

 

The FDA will also review the results once they officially receive them and the FDA is free to audit the trial at any time.

 

Yeah, I wasn't trying to disparage the results. Based on how the article was written, it sounded like the independent committee was still under Pfizer's employment. Thus the comments about other independent review.

 

But my greater point was that there were a number of steps yet to go (i.e. further review + larger sample sizes). The press makes it sound like we would get conditional approval by the end of the year for public use. It doesn't sound like we are that close...

[Machu Peach]

'Reduced benefit to the wearer in comparison to the benefit derived from protecting others from the particles expelled by the wearer' is certainly a more accurate statement.

It's confusing to me how this evolved to "Masks don't protect you but do protect others."

 

Specifically, I'm looking for a scientific study that demonstrates that 1) masks don't protect the wearer and 2) do protect others.

Generally, recent studies (October) have been favorable in both cases, with surgical/comparable cloth masks about 67% effective in protecting the wearer:

https://www.nature.com/articles/d41586-020-02801-8

Thank you for the link. However this isn't a scientific study, it's just the author's opinions/thoughts occasionally supported by citations.

 

The citation the author uses for the 67% claim doesn't seem to include the 67% claim. Am I just missing it?

[Machu Peach]

A lot of hype about the 90% success rate of the Pfizer vaccine, but it sounds like we are still a ways off of approval. Results weren't independently verified... Popular Science article

The article states "The results, which were evaluated by an independent committee of experts..."

 

The FDA will also review the results once they officially receive them and the FDA is free to audit the trial at any time.

Yeah, I wasn't trying to disparage the results. Based on how the article was written, it sounded like the independent committee was still under Pfizer's employment. Thus the comments about other independent review.

If that's the case it's pretty sleazy to call them an "independent committee of experts."

 

But my greater point was that there were a number of steps yet to go (i.e. further review + larger sample sizes). The press makes it sound like we would get conditional approval by the end of the year for public use. It doesn't sound like we are that close...

Why do you think this is the case? I believe Pfizer has stated that they'll file for an FDA emergency use authorization before the end of Nov.

[CheezWizHed]

If that's the case it's pretty sleazy to call them an "independent committee of experts."

 

Not really. It is common (at least in other industries) to use internal independent reviews for the first pass verification. Then use external certification authorities before final approvals. For example, I can put software on aircraft for flight tests without the FAA's approval (internal independent verification only), but not for use on the general public.

 

But re-reading it, it did say not "peer reviewed", so maybe I'm reading into it incorrectly.

 

But my greater point was that there were a number of steps yet to go (i.e. further review + larger sample sizes). The press makes it sound like we would get conditional approval by the end of the year for public use. It doesn't sound like we are that close...

Why do you think this is the case? I believe Pfizer has stated that they'll file for an FDA emergency use authorization before the end of Nov.

 

I already stated this: Results to be peer reviewed and a larger sample size needed. Given the first 44k sample size started in April, I'm not sure how they would finish the larger sample size by the end of the year.

 

Does the emergency use authorization equate to doing the larger sample on the public at large?

[PeaveyFury]

'Reduced benefit to the wearer in comparison to the benefit derived from protecting others from the particles expelled by the wearer' is certainly a more accurate statement.

It's confusing to me how this evolved to "Masks don't protect you but do protect others."

 

This may be debating semantics a bit, just IMO. Indeed, my initial statement was overly simplistic and too absolute as a quick response to the original poster's comment, but the data does indeed support a much higher benefit to the person who would potentially inhale the expelled particles vs. the inverse situation, an unmasked individual expelling particles which are inhaled by a mask-wearer. But, my secondary point remains the same, especially in the context of which the original poster raised the question. I won't attempt to speak in absolute terms for the poster's motives or intention and will leave it to him to clarify if he finds it necessary, but as I initially said, I think the DHS statement is meant to clarify that mask wearing alone doesn't allow for unsafe behavior and ignoring of the other public health guidelines, and, IMO, also serves as a caution that there are numerous studies to support the reduction of exhaled/outgoing particles due to mask use, while there is less consistent data regarding the success rate of incoming filtration, which is largely dependent on the quality/material of the mask being worn. As such, they're implying that you can't view wearing your gaiter mask, for example, and expect it to be your sole preventative measure just because 'you have a mask on'. Especially in a society where many people aren't wearing masks, making even those with one on vulnerable to some degree. I think that's the real issue they're hinting at. Again, IMO.

 

As I don't want to misinterpret your inquiries on the subject, what IS your view on mask effectiveness?

[Machu Peach]

I've never heard of a internal review being referred to as an independent review in biotech, but maybe they do in other places (in biotech).

 

Our major projects all have something called an External Scientific Advisory Board (ESAB). This a panel of independent experts that are not associated with the organization. I think that's pretty much the industry standard, though I don't know if it's a requirement (or even a standard) for big pharma/biotech.

 

I already stated this: Results to be peer reviewed and a larger sample size needed. Given the first 44k sample size started in April, I'm not sure how they would finish the larger sample size by the end of the year.

 

Does the emergency use authorization equate to doing the larger sample on the public at large?

Peer review is the industry standard for publishing papers. It is not required for FDA review or approval. The FDA standards are usually much higher and more detailed.

 

Why do you think it needs a larger sample size? Is it stated that the study in underpowered somewhere?

 

An emergency use authorization would allow for public use. It is not full authorization so you'll see language like "May be effective to prevent COVID".

 

Edit: clarity

[Machu Peach]

'Reduced benefit to the wearer in comparison to the benefit derived from protecting others from the particles expelled by the wearer' is certainly a more accurate statement.

It's confusing to me how this evolved to "Masks don't protect you but do protect others."

This may be debating semantics a bit, just IMO.

To be fair "masks don't protect you but do protect others" seems to be a very common viewpoint and I'm in no way trying to single you out for saying so.

 

I would say that the difference between "masks don't protect you" and "masks do protect you, just not as much" is more than semantics, but we can agree to disagree as I think everyone's thoughts are apparent.

 

As I don't want to misinterpret your inquiries on the subject, what IS your view on mask effectiveness?

My inquiries are requests for information, there's no need to try to interpret a hidden meaning.

[PeaveyFury]

As I don't want to misinterpret your inquiries on the subject, what IS your view on mask effectiveness?

My inquiries are requests for information, there's no need to try to interpret a hidden meaning.

 

Fair enough, as I'm sure many of us are seeking information as we can.

 

But, for discussion sake: What is your view on mask effectiveness? And, what is your opinion on the validity/merit of mask mandates? As you work more closely in this area than the vast majority of the rest of us, I'm sure a lot of us are interested in your take.

[CheezWizHed]

Why do you think it needs a larger sample size? Is it stated that the study in underpowered somewhere?

 

A lot of hype about the 90% success rate of the Pfizer vaccine, but it sounds like we are still a ways off of approval. Results weren't independently verified, the test was still at a small sample size (44k), and the people under trial haven't been tested long. Popular Science article

 

“The results are really quite good, I mean extraordinary,” Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, told The Washington Post. Other outside experts expressed similar cautious optimism. “We need to see the actual data, and we’re going to need longer-term results,” Jesse Goodman, a professor of medicine and infectious diseases at Georgetown University, told The New York Times.

[Machu Peach]

Oh, I would agree completely that longer term results would be very useful to have. It becomes something of an ethical problem. Do you hold back a potentially lifesaving therapy to wait for an ideal data set? Normally a vaccine study would be followed for years before approval, but in this case that could possibly cost millions of live worldwide.

 

However you mentioned the need for a larger study and I haven't seen that the study is underpowered. I'm not saying that the study isn't underpowered or anything (I don't have access to the data), but I haven't seen anything saying it is.

[CheezWizHed]

No, I didn't say it. I know nothing about developing a vaccine. Jesse Goodman, a professor of medicine and infectious diseases at Georgetown University said it. I referenced his/her comment.

[Machu Peach]

I don't see where Jesse Goodman, a professor of medicine and infectious diseases at Georgetown University, states the need for a larger study. Does Professor Goodman have an additional quote where he talks about study size? Am I misunderstanding your statements about needed a larger study?

[FVBrewerFan]

Remember Moderna and J&J are very close to announcing results of their phase 3 findings. What happens if their findings are very similar to Pfizer? Does the FDA pick one they think is best, or do they make them all available for distribution- at least in the short term?

[xisxisxis]

Condoms are not 100% effective, but I don't see where people are running around screaming forget the condoms let's just go for it. (Although I don't live in a college town so I could be out of touch.) Of course creating a life is different then dying from an infectious disease, but both can be life changing (especially for the poor sod who doesn't survive the infection).

 

-80 degree freezers are all over the place. Maybe not in a rural medical center, but most large hospitals will have at least one. And as mentioned by Machu, dry ice and a container can work very effectively for rural locations. You aren't injecting it frozen, you just need it for long-term stability. If the vaccine isn't flying off the shelves then there's a bigger problem than can we keep it stable for a week.