Coronavirus

[Caracal]

I think we are making different points.  We (not you and I) went from "Surfaces are the thing to worry about" (apparently not so much) to "It's transmitted in droplets, so six feet is sufficient to separate", to "It's an aerosol, so it can hang in the air".   The message shouldn't be "It doesn't do this", it shoulb "we don;t know it to do that".

Also, when I read up on HVAC issues, I get HVAC experts saying "it won't go through the HVAC system, as it isn't an aerosol."  So, when I read that it IS, that makes me question the assurance we just received.

Right, but I think we are back to the the terminology problem. That thread pointed out that basically there is a continuum from large droplet to aerosol. So, just because the virus might technically be spread by aerosol in some situations, doesn't mean that it can, in normal conditions, infect people through HVAC systems.

The broader point is that the things to worry about are the most common routes of transmission, not very unusual ones. The patterns of spread show pretty clearly that the virus spreads through indoor,  crowded spaces and close contacts for prolonged periods of time.

[FishProf]

I don't disagree with what you wrote.  But it raises the question (which I am not qualified to answer): If this is just semantics, why are there scientists calling for the WHO to change its stance, and (invert the question) why is the WHO reluctant to do so?

At my school, they are acting as if transmission is primarily through contacts, and secondarily through droplets, and NOT AT ALL via aerosols.  It won't (probably) pass through filtered ventilation systems, but what about crowded hallways?  Or even uncrowded hallways if it hangs in the air.

[Cheerful]

Many newer buildings have windows that do not open.  How did that ever make sense?  Certainly a shame now.

[Stockmann]

The very first smallpox vaccines sometimes killed people (https://www.bbc.com/news/uk-england-leicestershire-50713991) - obviously smallpox also killed or maimed many people, but the early vaccines were "safe" only in comparison with an extremely dangerous pathogen, much more dangerous than covid. Older flu shots often produced a reaction severe enough that it was dubious whether people who tended to get severe reactions were better off, individually, getting the flu shot or taking their chances with the flu. Covid is not the flu (neither is it smallpox) but there is precedent of new vaccines having genuine dangers. I'm sure normal modern approval processes are more stringent than those in Victorian Britain (or even those around when the flu shot first came out), but these aren't normal circumstances. The scenario I personally fear is someone I don't trust (like China) exporting corona vaccines to my country and basically being asked to have faith in "my" government's "seal of approval." For that matter, I wouldn't trust that my government refusing to approve a vaccine would be evidence-based, either.
Or putting the probabilities another way, very crudely: if the death rate from covid is 1%, then any treatment with less than 1% chance of killing the patient is worthwhile, in principle. If you're well under 60 and in good chance, your chance of dying from covid is in principle well below 1% so treatment is worthwhile only worthwhile if the chance of it killing you is still less than of covid killing you. But for a vaccine, to make it worthwhile generally the chance of it killing you must be less than chance of getting covid times chance of dying of covid given you have it - and that's assuming 100% efficacy in preventing death due to covid. I'm well below 60 and in good health, and everyone in my household is taking fairly stringent precautions. 

[Caracal]

I don't disagree with what you wrote.  But it raises the question (which I am not qualified to answer): If this is just semantics, why are there scientists calling for the WHO to change its stance, and (invert the question) why is the WHO reluctant to do so?

I don't understand much about the details, but it actually seems like a very familiar sort of academic dispute. There's this term, or idea, or theory that people invest a lot in. In this case, "Aerosol," but it could be "agency" or "postmodern" or something else. Then you have various disputes about the term and its meaning. There are legitimate real issues involved, but sometimes those actual issues get lost in fights over what exactly the term means and whether it is being correctly applied. I can think of lots of examples in my own field where increasingly arcane disputes over whether something is x or y have gotten in the way of trying to understand what was actually happening. 

[Caracal]

The very first smallpox vaccines sometimes killed people (https://www.bbc.com/news/uk-england-leicestershire-50713991) - obviously smallpox also killed or maimed many people, but the early vaccines were "safe" only in comparison with an extremely dangerous pathogen, much more dangerous than covid. Older flu shots often produced a reaction severe enough that it was dubious whether people who tended to get severe reactions were better off, individually, getting the flu shot or taking their chances with the flu. Covid is not the flu (neither is it smallpox) but there is precedent of new vaccines having genuine dangers. I'm sure normal modern approval processes are more stringent than those in Victorian Britain (or even those around when the flu shot first came out), but these aren't normal circumstances. The scenario I personally fear is someone I don't trust (like China) exporting corona vaccines to my country and basically being asked to have faith in "my" government's "seal of approval." For that matter, I wouldn't trust that my government refusing to approve a vaccine would be evidence-based, either.
Or putting the probabilities another way, very crudely: if the death rate from covid is 1%, then any treatment with less than 1% chance of killing the patient is worthwhile, in principle. If you're well under 60 and in good chance, your chance of dying from covid is in principle well below 1% so treatment is worthwhile only worthwhile if the chance of it killing you is still less than of covid killing you. But for a vaccine, to make it worthwhile generally the chance of it killing you must be less than chance of getting covid times chance of dying of covid given you have it - and that's assuming 100% efficacy in preventing death due to covid. I'm well below 60 and in good health, and everyone in my household is taking fairly stringent precautions.

Nothing that approaches any of those numbers would ever be seen as acceptable. Look, skepticism is fine if you have actual evidence to back it up. If a vaccine became available, but only the US approved it and other countries expressed reservations, or if lots of trustworthy experts said they didn't trust the data about its safety, I would obviously have to think about it. However, that's really different from just uninformed skepticism where you just say that you generally would not trust a hypothetical vaccine, despite the fact that the vaccine would go through extensive trials and there are clear protocols in place to make sure it would be safe.

I also just don't fundamentally don't understand the point about taking precautions. I'm taking a lot of precautions too. and I'm resigned to the fact that I'm going to have to for quite some time, but I'd like to stop. I want to go see family, go to a baseball game and have people over for dinner. That doesn't mean I'd take a vaccine that I actually thought was dangerous, but I just don't understand being quite so risk averse when the alternative is living a much less full life.

(Obviously, this doesn't apply to people who actually could be at greater risk from a vaccine because of a medical condition.)

[Anselm]

Many newer buildings have windows that do not open.  How did that ever make sense?  Certainly a shame now.

I work in a an older building where the windows used to open but now they are kept permanently shut.  They added some piece of metal on the outside window ledge that stops the window from swinging open.  Maybe this was meant to save on heat or air conditioning but now it does not look to good.

[Puget]

The very first smallpox vaccines sometimes killed people (https://www.bbc.com/news/uk-england-leicestershire-50713991) - obviously smallpox also killed or maimed many people, but the early vaccines were "safe" only in comparison with an extremely dangerous pathogen, much more dangerous than covid. Older flu shots often produced a reaction severe enough that it was dubious whether people who tended to get severe reactions were better off, individually, getting the flu shot or taking their chances with the flu. Covid is not the flu (neither is it smallpox) but there is precedent of new vaccines having genuine dangers. I'm sure normal modern approval processes are more stringent than those in Victorian Britain (or even those around when the flu shot first came out), but these aren't normal circumstances. The scenario I personally fear is someone I don't trust (like China) exporting corona vaccines to my country and basically being asked to have faith in "my" government's "seal of approval." For that matter, I wouldn't trust that my government refusing to approve a vaccine would be evidence-based, either.
Or putting the probabilities another way, very crudely: if the death rate from covid is 1%, then any treatment with less than 1% chance of killing the patient is worthwhile, in principle. If you're well under 60 and in good chance, your chance of dying from covid is in principle well below 1% so treatment is worthwhile only worthwhile if the chance of it killing you is still less than of covid killing you. But for a vaccine, to make it worthwhile generally the chance of it killing you must be less than chance of getting covid times chance of dying of covid given you have it - and that's assuming 100% efficacy in preventing death due to covid. I'm well below 60 and in good health, and everyone in my household is taking fairly stringent precautions.

Nothing that approaches any of those numbers would ever be seen as acceptable. Look, skepticism is fine if you have actual evidence to back it up. If a vaccine became available, but only the US approved it and other countries expressed reservations, or if lots of trustworthy experts said they didn't trust the data about its safety, I would obviously have to think about it. However, that's really different from just uninformed skepticism where you just say that you generally would not trust a hypothetical vaccine, despite the fact that the vaccine would go through extensive trials and there are clear protocols in place to make sure it would be safe.

I also just don't fundamentally don't understand the point about taking precautions. I'm taking a lot of precautions too. and I'm resigned to the fact that I'm going to have to for quite some time, but I'd like to stop. I want to go see family, go to a baseball game and have people over for dinner. That doesn't mean I'd take a vaccine that I actually thought was dangerous, but I just don't understand being quite so risk averse when the alternative is living a much less full life.

(Obviously, this doesn't apply to people who actually could be at greater risk from a vaccine because of a medical condition.)

+1
If you have to go all the way back to the first smallpox vaccine to find an example of vaccines actually being dangerous, you should already have your answer. The problem is no amount of data will convince some people to re-evaluate their assessments of risk. Even if you are very, very careful, your risk from COVID will be MUCH higher than any risk from an approved vaccine.

Moreover, a vaccine doesn't have to be 100% effective to help-- the flu vaccine is only partly effective even in years where they guess right about the strains that will be circulating, but it still both reduces cases and reduces severity of illness for those who do get sick. Moreover, even partial immunity at the population level cuts down on transmission, protecting those that otherwise would get sick even with the vaccine, or who can't or won't be vaccinated. Those that refuse to be vaccinated for non-medical reasons are effectively free-loading on herd immunity.

I wish I could say that I'm surprised to see vaccine resistance from well-educated people here, but we know from pre-pandemic data that a sizable chunk of vaccine hesitant people are precisely upper middle class, generally liberal, people who are well-educated in non-science fields. This is why some of the lowest vaccination rates (and subsequent measles outbreaks) are in places like Berkeley. Another big chunk are right-wing evangelical Christians-- their reasons are quite distinct, but there are likely some similarities in terms of science skepticism and distrust of authority. The psychology behind this is complex-- there's an interesting review paper about it here:
https://pubmed.ncbi.nlm.nih.gov/29611455/

The bad news is that there is little evidence that interventions that have been tried have been successful in changing peoples minds. We see evidence of that in the back and forth here as well. The one thing that does seem to help somewhat is emphasizing social norms for vaccination. If we consistently spread the message that vaccination is what most people are doing, to protect the most vulnerable of their family, friends and neighbors, that may help some.

[Vkw10]

I'm enjoying the debate. When we have a vaccine that has passed FDA testing, I will ask my doctor to administer. Based on my experience with her, she'll review the CDC vaccine schedule for people with my health conditions, then administer if appropriate. I look forward to that day. In the meantime, I am assuming that I need to take precautions for a minimum of 18 months.

[spork]

I take any and all vaccines I can get my hands on. Flu. Pneumonia. Japanese B encephalitis. If I remember correctly, I've been vaccinated for measles three times after the initial two-dose MMR sequence I had as a child -- because lab research and epidemiological data kept indicating that the last vaccine I had received was not effective enough. I'm non-responsive to the hepatitis B vaccine, which is bad news.

I'm enjoying the debate. When we have a vaccine that has passed FDA testing, I will ask my doctor to administer. Based on my experience with her, she'll review the CDC vaccine schedule for people with my health conditions, then administer if appropriate. I look forward to that day. In the meantime, I am assuming that I need to take precautions for a minimum of 18 months.

Unfortunately not all physicians are, um, competent in this area. I went to a nearby Ivy League university family medicine clinic for Shingrix when it hit the market (already had received zostavax several years prior), thinking it would be quick and simple. Nope. After I told the resident what I was there for, and explained my risk factors (nasty case of chicken pox at age 21, chronic immune disorder, etc.), all she did was look at the CDC webpage, while I was thinking "I did that myself at home, you idiot." She then informed me that because I was 49, not 50, she would not administer the vaccination. As soon as I left I called one of my regular physicians and said I needed him to write a scrip for the vaccine so I could get it injected at CVS, which he did. First and last time I went to that clinic.

[evil_physics_witchcraft]

My sibling had the virus and seems to be recovering (fingers crossed). Unfortunately, sib's spouse may now have it and is immunocompromised due to medication.

[Hegemony]

The way things are going, with all kinds of chaos and lack of coordination, particular in the U.S., I would be surprised if regular people could get the vaccine early on anyway. The distribution will be haphazard and subject to all kinds of pressures from people who want to keep it for their city or state or friends or whatever. I wouldn't be surprised if many thousands, perhaps millions, of people had already tried it out before I get an opportunity to get my hands on it.

I think perhaps an alternate route back to safety will be if/when they develop uniformly effective treatments. Right now they're just treating symptoms, except for the one drug that seems to improve prognosis about 5%. I envision this situation as like the early days of AIDS — or really of any disease — in which the initial stages were horrific, but eventually science got going and reduced the mortality rate drastically, and for some diseases almost wholly.  I think in five years, this will be a much less lethal disease.

I do hear lots, and lots and LOTS, of people saying, "Oh well, the fatality rate is under 1% unless you're in a small category of vulnerable people or over 60!"  Well, lots and LOTS of us are over 60 (and some of us with compounding vulnerable factors even apart from that), and not ready to fold up our tents and die yet. I'm getting really allergic to people who write off older folks as incidental and expendable.

[pgher]

Many newer buildings have windows that do not open.  How did that ever make sense?  Certainly a shame now.

I work in a an older building where the windows used to open but now they are kept permanently shut.  They added some piece of metal on the outside window ledge that stops the window from swinging open.  Maybe this was meant to save on heat or air conditioning but now it does not look to good.

Our building has an old half and new half. In the old half, the windows have rivets on the handles, but at least some of the rivets have mysteriously disappeared.

At a former institution, there were a couple windows in a stairwell that were painted open. That was a cold stairwell in the winter!

[Caracal]

I envision this situation as like the early days of AIDS — or really of any disease — in which the initial stages were horrific, but eventually science got going and reduced the mortality rate drastically, and for some diseases almost wholly.  I think in five years, this will be a much less lethal disease.

Probably, but only because by that time most people would have been exposed. Apparently, one possibility is that while full immunity to this doesn't last that long, people who previously got it are going to have moistly mild cases. It might  just become another cold virus. Without a vaccine, getting to that point isn't going to be very pleasant.

[mamselle]

Delivery methods and uncertain attenuation of the viral matter were a part of the problem for early vaccines (late 18th c.), and before that, for inoculations (1720s were the first in both the UK and the colonies).

Smallpox was carried in vials for the more elaborately supplied folks, like Jenner and Waterhouse, who shipped their samples across the Atlantic to each other.

But on the frontiers, it was often on a string that had been passed through the pustules of those whose sores had opened and were running.

Tetanus was one of the more severe complications from this less-than-ideal (or sanitary) method, but it was also possible that either no "active matter" was in the pus itself, or too much was.

Titrating out the right concentrations is something that is more easily done today.

But the issues and complications today are still not non-negligible.

So, yeah, 12-18 mo. sounds about right to me.

M.