Coronavirus Sars-CoV-2/Covid-19 Megathread

[Syt]

[Sheilbh]

Thus, until the trial is finished (for what I read  and the results evaluated, it is not possible to determine if the potential vaccine is successful or not and can be considered an effective treatment. Once the trial is over, results are examined and the vaccine is deemed to be effective and approved by regulators, then those that got it during the test can be considered to be officially vaccinated (and the ones that got the placebo will have to get vaccinated anyway).

Yeah - and in this case the trial has reportedly been successful (about 90% effectiveness) and approval is delayed because of manufacturing issues.

It has nothing at all to do with external restrictions or regulations, when you join a clinical trial you are aware of that. IMO those volunteers that are making a fuss out of this are behaving in a very selfish and irresponsible way. Zero simpathy for them.

But in December when you joined the clinical trial you were not aware that the ban on you travelling might be lifted if you decided not to participate in this clinical trial and just get an authorised vaccine (on the back of other people participating in other clinical trials) when it was very unclear how many would be authorised etc. That's nothing to do with the clinical trial or what they signed up for, it's the wider context.

They had the opposite of informed consent because no-one knew that so many vaccines would be approved and rolled out so quickly. If they knew that this would mean them not being able to travel or go to certain venues while the rest of society could then I'd have less of a problem - and I imagine a woman whose family are overseas and a guy who needs to travel as part of his job wouldn't have signed up. But they actually probably suspected the opposite, that taking part would get them a vaccine quicker.

It seems weird that the terms didn't mention this. Did the company think that it would be fine to take several vaccines in parallel?

I don't see how the company could really say much about what health authorities or governments might or might not do - especially at a point when no vaccines had been authorised. It's not in their control and it would have been, at best, an educated guess.

[The Brain]

Thus, until the trial is finished (for what I read  and the results evaluated, it is not possible to determine if the potential vaccine is successful or not and can be considered an effective treatment. Once the trial is over, results are examined and the vaccine is deemed to be effective and approved by regulators, then those that got it during the test can be considered to be officially vaccinated (and the ones that got the placebo will have to get vaccinated anyway).

Yeah - and in this case the trial has reportedly been successful (about 90% effectiveness) and approval is delayed because of manufacturing issues.

It has nothing at all to do with external restrictions or regulations, when you join a clinical trial you are aware of that. IMO those volunteers that are making a fuss out of this are behaving in a very selfish and irresponsible way. Zero simpathy for them.

But in December when you joined the clinical trial you were not aware that the ban on you travelling might be lifted if you decided not to participate in this clinical trial and just get an authorised vaccine (on the back of other people participating in other clinical trials) when it was very unclear how many would be authorised etc. That's nothing to do with the clinical trial or what they signed up for, it's the wider context.

They had the opposite of informed consent because no-one knew that so many vaccines would be approved and rolled out so quickly. If they knew that this would mean them not being able to travel or go to certain venues while the rest of society could then I'd have less of a problem - and I imagine a woman whose family are overseas and a guy who needs to travel as part of his job wouldn't have signed up. But they actually probably suspected the opposite, that taking part would get them a vaccine quicker.

If people don't have 100% knowledge of the future they cannot give informed consent? I think we'll have to agree to disagree.

It seems weird that the terms didn't mention this. Did the company think that it would be fine to take several vaccines in parallel?

I don't see how the company could really say much about what health authorities or governments might or might not do - especially at a point when no vaccines had been authorised. It's not in their control and it would have been, at best, an educated guess.

I was talking about fine in the medical sense to take several vaccines in parallel. Seems a weird thing for the company to not know or tell the participants. The terms don't have to include stuff about following the law of the land, that is always a given.

[Sheilbh]

If people don't have 100% knowledge of the future they cannot give informed consent? I think we'll have to agree to disagree.

I mean I think informed consent is about possible risks associated with the treatment. My point is more that the situation now is so profoundly different than in December (third wave, UK variant, new full lockdown etc).

I don't think we can say - well these people should've known or been able to predict that we'd be in the position where we are now and they wouldn't be able to take advantage of the re-opening. I don't think it's that they lacked 100% knowledge of the future, it's more that I don't even think an unreasonable optimist would expect us to be in as good a position as we are now with mass events possibly reopening for the vaccinated or international travel.

Edit: I get they'renot vaccinated so should be treated the same - but I think we should want to treat people who are not vaccinated because they medically shouldn't be or because they've volunteered for another vaccination clinical trial differently from people who are choosing not to get vaccinated but otherwise could. If the outcome for both is the same, I don't think that's right or positive socially.

And I don't think it's enough to say well they knew what they were signing up for because I don't think that really works in the context of a pandemic with lots of legal restrictions that are changing fairly regularly. That's a different scenario from signing up for a clinical trial in normal times (and, frankly, we should be encouraging people to sign up for clinical trials against covid because of the wider social benefit from those trials).

[crazy canuck]

I think the bigger issue is that these trials include placebos.  Imagine learning you are in that group and could have been vaccinated if you had not been in the trial.

[The Brain]

Things can always happen in the future. I buy a house - property prices crash. I get an education - the job I'm trained for becomes illegal. A person who cannot deal with the uncertainty of the future probably shouldn't sign any contracts at all.

If participants are hard to find, there are incentives to sign up for trials that don't involve sacrificing safety.

People are denied driver's licenses because of medical reasons, which sucks for them and limits them in life. Them's them breaks. You signed up for a trial and your neighbor gets to do stuff you can't. How about the trial people man up, pat themselves on the back for helping humanity fight Covid, and accept that safety measures restrict them a while longer than others.

[garbon]

I think the bigger issue is that these trials include placebos.  Imagine learning you are in that group and could have been vaccinated if you had not been in the trial.

But, of course, that's a pretty common clinical trial setup.

[Syt]

I think the bigger issue is that these trials include placebos.  Imagine learning you are in that group and could have been vaccinated if you had not been in the trial.

But, of course, that's a pretty common clinical trial setup.

You can always unblind if need be, though, e.g. in case of emergency. Though I don't think this is an emergency.

[crazy canuck]

I think the bigger issue is that these trials include placebos.  Imagine learning you are in that group and could have been vaccinated if you had not been in the trial.

But, of course, that's a pretty common clinical trial setup.

Yes, in normal circumstances.  But not great in a pandemic.  There are other models which could have been used.

[Zoupa]

It will be very difficult to evaluate comparative efficacy between the different vaccines as time goes on. When Pfizer and Moderna got approved, they reported 95%+ efficacy and folks were "wow!"

What this means is compared to the control group, the vaccine group only had 5 people get COVID compared to 100 people getting COVID.

As time goes on, more people getting vaccinated and the R generally falling, it's difficult to say how it will impact "efficacy". J&J came out just 3 months post Pfizer/Moderna and its efficacy is 65%. It's 100% effective in preventing death and hospitalizations, but only 65% in preventing actual COVID infection. Is that a reflection of the R at the time of study? Is it just worse at preventing infection? The number of people that tested positive was much lower in both control groups and vaccinated group compared to Pfizer/Moderna. Is the accuracy of the data impacted?

The same questions can and should be asked for Novavax etc.

[crazy canuck]

It will be very difficult to evaluate comparative efficacy between the different vaccines as time goes on. When Pfizer and Moderna got approved, they reported 95%+ efficacy and folks were "wow!"

What this means is compared to the control group, the vaccine group only had 5 people get COVID compared to 100 people getting COVID.

As time goes on, more people getting vaccinated and the R generally falling, it's difficult to say how it will impact "efficacy". J&J came out just 3 months post Pfizer/Moderna and its efficacy is 65%. It's 100% effective in preventing death and hospitalizations, but only 65% in preventing actual COVID infection. Is that a reflection of the R at the time of study? Is it just worse at preventing infection? The number of people that tested positive was much lower in both control groups and vaccinated group compared to Pfizer/Moderna. Is the accuracy of the data impacted?

The same questions can and should be asked for Novavax etc.

Yep, one of the things that makes the usual placebo control group less than optimal in these times.  Another is the large degree of variation in precautions to avoid becoming infected. 

[Sheilbh]

Yeah - also presumably variants have a huge impact on the studies. It must have been a lot easier to begin with when Pfizer etc were doing their trials last summer.

I think the UK authorities have been monitoring studies on the real-life stats for Pfizer and AZ (not enough Moderna used yet - but presumably they'll be added:
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/988193/Vaccine_surveillance_report_-_week_20.pdf

In terms of comparative effectiveness it looks like much of a muchness.

[Admiral Yi]

Edit: I get they'renot vaccinated so should be treated the same - but I think we should want to treat people who are not vaccinated because they medically shouldn't be or because they've volunteered for another vaccination clinical trial differently from people who are choosing not to get vaccinated but otherwise could. If the outcome for both is the same, I don't think that's right or positive socially.

OK.  So we all *want* to treat them differently but we treat them the same. End of discussion. 

[viper37]

The Texas Mask Mystery

When the governor lifted the state's mandate, liberals predicted disaster. But it never came. Why?

In early March, Texas became the first state to abolish its mask mandate and lift capacity constraints for all businesses. Conservatives hailed Governor Greg Abbott's decision, while liberals predicted doom and death and President Joe Biden disparaged it as "Neanderthal thinking."

Nine weeks later, the result seems to be less than catastrophic. In fact, in a new paper, economists at Bentley University and San Diego State University found that Abbott's order had practically no effect on COVID-19 cases. "The predictions of reopening advocates and opponents failed to materialize," the authors concluded.

How could a policy so consequential—or at least so publicly contested—do so little?

One possible interpretation is that lifting mandates did almost nothing because masks in particular do almost nothing. This viewpoint enjoys widespread popularity among conservative outlets such as Fox News, and is likely behind Abbott's more aggressive decision to ban mask mandates in Texas.

Dana Stevens: Excuse me if I'm not ready to unmask

This explanation has a few holes. Plenty of evidence suggests that masks almost certainly do something, even if they're not perfect. Research in the Journal of the American Medical Association, for instance, found that masks "limit both exhalation and inhalation of infectious virus" and that universal masking "can help reduce transmission." A meta-analysis in the Proceedings of the National Academy of Sciences concluded that "places and time periods where mask usage is required or widespread have shown substantially lower community transmission." And several analyses published in Nature reported that surgical masks and unvented KN95 respirators reduce particle emission by up to 90 percent.

[...]

[Valmy]

For reasons I explained minutes after he lifted the mask mandate. Liberals should listen to me more.

Only now, after the CDC said it was ok, are mask mandates actually being lifted. The statewide mandates didn't really do much, it was a completely symbolic gesture by the governor to give him political capital after the ice storm debacle.