If a vaccine **doesn't** come within 12-18 months, then what?

The Quarantine Zone
1

Based on a very depressing conference call with a Pharma manufacturer client. Unlike what some people have said in other threads, regulators and industry aren’t the biggest stumbling bloc. They have relaxed or waived safety regs, signed blank cheques and said that whatever the scientists need or want, they will get it. The industry is already prepping, on the call, my client’s executives said they would happily make the vaccine (if and when it comes) at a loss.

That sounds hopeful, but its not. 12-18 months is an estimate, but it could be as much as 5 years! :eek:

Just what is the backup plan if a vaccine does not come? Continue the lockdown indefinitely? Unrealistic. Let it burn through until enough have been exposed and developed immunity or at least some resistance? We already are seeing First World countries prepping mass graves, just what will 6-12 months of this entail?

Plague of fucking Justinian maybe?

2

My cousin the virologist says that some anti-viral drugs, such as Tamiflu are showing some effect against it. The trick is, you need to take them before you are in the midst of symptoms.

She says if we can start testing anyone who has been in contact with someone known to be infected, and immediately start giving these kinds of anti-virals to the people who test positive, but have not yet shown symptoms, we can prevent them from ever becoming very sick.

3

Yes, if we don’t get a vaccine in the near term it will be months and months of variations on lock-downs, stay-at-home, border health checks, and so on. And if neither vaccine or treatment emerges it may go on until we actually do get herd immunity.

Yes, we have mass graves. We have to do something with the deceased.

Yes, we may have more mass graves. More cremations. More deceased in cold storage. That’s sort of a feature of pandemics.

My only consolation is that this could have been SOOOOOO much worse than it is. Really, some of the historic plagues had fatality rates 10 or more times this one.

4

If there’s no vaccine, eventually almost everyone will be infected, and the disease will remain in the human “pool” forever. If the human population is 7 billion and the death rate is 4%, we’re looking at about 280 million deaths. The death rate would probably increase because some people would die to lack of available ventilators.

This is a huge exaggeration. From Wikipedia…

We’re looking at a death toll of less than 4% for COVID-19. The death toll is actually less, because many infected people don’t show symptoms and never get tested.

5

Even if an effective vaccine is found, what are the chances manufacturing can be scaled up to meet the needs of the human population? China and India alone would require billions of doses. Vaccines would probably be rationed out to those on the frontlines, vulnerable populations, and nationally important people such as scientists and politicians. The masses may get a share of the vaccines slowly over many months after the vaccine comes about.

It is depressing, but I think herd immunity acquired after the virus rampages through a large percentage of the population is the only thing that’s going to stop this pandemic.

6

Or maybe this could be like HIV and AIDS?

Aids, which was also devastating and had a massive death toll at the beginning, started maybe 30 years ago and their still is no vaccine. However they have drug treatments that can cure it plus they know exactly how its being transmitted.

So maybe they will develop a treatment?

7

The disease can probably be contained, but not stopped, with a good enough testing infrastructure. That would involve something like screening a large portion of the general population to monitor for new outbreaks, all travelers through major points of entry, and of course anyone with potential symptoms. For any case that comes up positive, the infected individual can be quarantined, and any close contacts can also be tested and quarantined if necessary. If done well enough, this could mean there are constantly a lot of new outbreaks, but they’ll be small and mostly isolated - within the capacity of hospitals to treat cases, and at a risk to the public not much greater than other common diseases and accidents.

The barriers to this are more political and logistical than technical. We have accurate tests right now, and many rapid point-of-care tests are in development. The bigger challenge will be getting an effective, large-scale, coordinated public health campaign going. That means distributing tests and PPE to where they’re needed, sharing information effectively, and hiring and training enough people to do the necessary testing. And, most challenging of all, coordinating the campaign between state public health agencies and the federal government.

8

For something like this, treatment is mostly going to be in hospital when it gets serious - like the flu. The vast majority can ride it out.

If there’s no vaccine they’ll just keep testing at a high level. Even if a vaccine does come within a year, I suspect our social distancing and business closures will be significantly lessened by then if not completely gone. We aren’t staying in lockdown until then, no way.

9

Isnt there an effective treatment by getting a blood transfusion from a person who has recovered and has antibodies?

10

Not yet. Something like that would be a bit of a stop gap measure as the donated antibodies don’t last long.

11

No, there is still no cure for HIV. What there are, are two very effective treatments. One treats people who are infected by lowering their viral load to “undetectable by current methods of testing,” but not absent, because if the person stops taking the drugs, their viral load zooms to AIDS levels fast.

The second drug is a preventative, but while it is very effective, it does not work 100% of the time, and it is not without side effects. Also, for some reason, it does not seem to work well when the transmission is vaginally, so it is not effective for women with infected male partners.

The drug is called PrEP, and it’s a daily pill, which is prescribed only for people in high risk categories. They still are told to use barriers (condoms), but PrEP is very effective, because it has two chemicals in it: one interferes with the enzyme transcriptase, that allows HIV RNA to convert to DNA, and the other interferes with the ability of the RNA to replicate as RNA-- it “confuses” it, for lack of a better term, and its parts get put together wrong, so the first generation “born” in the potential host are not viable.

PrEP turns the person taking it into an extremely hostile host for HIV-- so hostile that HIV dies without infecting a single T-cell.

Well, like I said earlier, Tamiflu appears to work for COVID-19, but you have to catch it early. The problem is, that in the case of COVID-19, when symptoms have shown up, in most cases, it is too late for Tamiflu.

If we could test everyone we know has had contact with COVID-19+ people, and give Tamiflu to each one who tested positive, before any symptoms showed up, we could prevent lots and lots of illnesses.

So, we would want to simply test healthcare workers on something like a weekly basis, just as a matter of course, and test anyone living with someone who came up with the illness, plus anyone the person notified who chose to come in, like an office mate, the person’s dentist, barber, or tailor, or any other worker who did something that required closer than social distance, up to and including physical contact.

This means, of course, manufacturing and distributing lots and lots of tests, and lots and lots of Tamiflu.

It might even mean that we would need to pass some kind of law allowing people who could present a positive test to buy a single series of Tamiflu without a prescription. Then, we wouldn’t need a Doctor, NP, or PA to administer the test. RNs, LPNs, and even nursing assistants could be trained to administer it-- or maybe even home health aides. Those are credentials people have to earn, even if they don’t endow the holder with much, they still could give someone something to sign off on a positive test with (ie, “Jane Smith, HHA”), so you could look up Jane Smith in a database.

It would still have to be behind the counter, and the pharmacist would ahve to see the test before giving it out. If we started selling Tamiflu off the shelves, even if we limited it to one series per person, per two-week period, or something, it wouldn’t stay on the shelves, and pharmacies would have lines around the blocks, preventing people from getting their insulin and other necessary medicine in a timely manner.

Anyway, yeah, there are investigations into treatments happening.

12

At some point you’d have more mandated testing and hard quarantines. I think the idea that “the American people will never put up with it” will change, or is maybe a fiction anyway, after repeated issues and incidents. If it keeps breaking out repeatedly, they will put up with an effective solution to get on with their lives.

13

I agree testing is the way past this, and the sooner widespread testing for the antibodies (meaning, one has already been exposed to the virus but is recovered and not spreading it) the better. Will we get most people tested this way before a vaccine is available? Who knows. But once it’s established how widespread infection really is, we’ll know which communities have been largely exposed and where there is still risk of initial infection. This could help manage relaxing of shelter in place orders, maybe by zip code.

14

That solution will be “let some people die”, phrased differently, not hard quarantines. IMHO.

15

I think there will eventually be a vaccine and antiviral treatments, but as with flu, it won’t be 100% effective. In fact, “success” could initially be a vaccine and/or antiviral treatment regimen that has inconsistent success. Over the next 12-24 months, the volume of cases will hopefully drop and as a result, this will probably fade from front page news. But people will still die, probably in higher numbers than with seasonal flu. It’s just something we’re going to have to live with for a while, I’m afraid.

16

Are you volunteering? If not, I’d thank you not to make that decision for the rest of us. Some of us believe a human life has value, even if it isnt being used to produce widgets.

17

I didn’t make a decision, I’m predicting one. Eventually we’ll be either past any surges or perhaps accepting that we’ll get some sort of annual surge. We aren’t going to keep social distancing and shutting down the economy forever. You can cling to the sacredness of human life but the fact is, the world will march on with possibly one more disease in the background.

18

I don’t think anyone here is saying “Eh, fuck the vulnerable, we need to get the economy working.”

What they’re saying is that in the longer haul, restrictions on movement, congregation, etc… are going to have to be loosened, because at some point (soon, I’m thinking) there will be a large number of people who won’t be able to make ends meet otherwise. And we’re already seeing a lot of people struggle who were economically precarious before all this.

So what I think we’ll see is what others have said- a loosening of restrictions concomitant with a ramped up testing, quarantine and contact tracing infrastructure that’ll have legal teeth. In other words, if you are exposed to someone who is tested positive, they’ll have the authority to coop you up and/or test you without your consent so that the virus does not spread.

This will mean that some people will die who might not, if the lockdowns and social distancing was continued indefinitely. But it also means that fewer will die than if we just pulled the cork out of the bottle and let everything go.

19

Also, I’m not sure how super scared of this disease we have to be after this initial onslaught. Once we figure out better protocols for treatments we have available now and likely develop new treatments, I don’t see why this is necessarily going to be worse than the flu if it hangs around.

20

Interesting that the plague also likely originated in Asia.