"No free man shall ever be debarred the use of arms." - Thomas Jefferson, Virginia Constitution, Draft 1, 1776
Well ladies and gents, our shop is full. Like, totally full.
Below is a chart detailing the census for our healthcare network's regional (metro area) hospital systems. Includes 4 hospitals total - the flagship plus 3 satellites (Sat 1, 2, 3; note that Sat 2 does not have an ICU).
You'll note that in addition to basically all med/surg ('regular hospital') floor beds and ICU beds being full, fully >25% of all patients across all hospitals and bed types are COVID+. It's honestly not clear what we're going to do for new admissions, given that ICU rooms are already moving to double occupancy (and are still full).
The most ironic thing is that Merck is playing an ethics card, too fast may be not ethical. Ken Frazer's rise in the Merck started when he became a lead defender in one of the most unethical data manipulations cases by a pharma company in recent history that ended up costing Merck several billions in settlements. I believe the reason why he went up after that was because the projected losses were several fold higher so he was seen as a savior.
I don't think the doc who wrote it, or anyone else in the peer community has hands on actual studies. I want to see them with my own eyes. Some of his critique is open to critique too. For example, 164 cases could have a been a prespecified count based on projection stats so by itself it doesn't tell much.
Doesn't read posts longer than two paragraphs.
regarding the HVAC/filtration front, I've seen several points that may help:
Higher MERV filters for either HVAC or box-fan hack. Seems to be MERV 13 is what is generally recommended. Can calculate how much airflow you're pushing through each box fan and you could scale up and try to aim for 3-6 air changes per hour for whatever space you're trying to keep "clean"
Open windows if possible. Going outside is even better.
40-60% humidity
I know we discussed this before, but new information tends to change answers. And there are a lot of people contributing to this thread who work in the relevant fields or, at least, adjacent to the relative fields.
Once we have one or more vaccines being used, will the vaccination be one-time for life, once every decade like tetanus/diphtheria, or once per year like the flu vaccines? In other words, is the virus mutating or does the vaccine effectiveness decrease over time? Is there enough evidence to even formulate an answer?
Another question: Is there any evidence to suggest which one of the vaccines is the "best" one? And, if so, what makes it the "best"? With three (to my knowledge) candidates, which will go into mass production and mass adoption?
1. We do not know how long the immunity provided by the vaccine will last, as by definition that has yet to be tested. However, coronaviruses do not mutate nearly as fast as influenzaviruses. Influenza viruses have a genome that is segmented and can be shuffled (like a deck of cards) between 2 strains of flu infecting the same host. It will not require a whole new vaccine to be designed, manufactured and distributed every year like we do with influenza.
Beyond that I do not know for sure. Coronaviruses do accumulate mutations (like all organisms), but the vast majority of those mutations are not significant enough to change your immune system's ability to recognize it. I would imagine it is possible but a long-horizon concern. I would be more concerned about the emergence of a 2nd, totally different respiratory pathogen from a zoonotic source, myself.
2. Current evidence suggests all 3 vaccines (moderna pfizer astrozeneca) are pretty comparable. all 3 use very similar technological approaches and all 3 appear to have 90% or greater efficacy from the current results of ongoing phase III trials. I am not aware of any reason to think one is materially better than the other. I have no idea what will happen re: distribution, production ,etc.
I do actually know one small piece of information - select healthcare workers will be getting one of the vaccines by Dec 10. My thesis advisor, for example, who is a MICU doc at our local county hospital that is also apparently a DoD designated Ebola center, will be getting his first shot that week.
Working on plans here for vaccine distribution to front line clinical staff in December. (Not me personally, but my institution.)
Regarding durability of vaccine-mediated immunity, 1-3 years is probably a safe range for a bet. I'm reading up on this topic this afternoon, but since the virus emerged less than a year ago, it really still is a guess. I agree with Neph about mutations. I'd be very surprised if that becomes a problem anytime soon.
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