COVID-19

[zenith]

Is vaccinating someone with covid the worst thing in terms of putting most pressure on the virus to mutate?

Absolutely no. Vaccinations does NOT increase pressure to mutate.

Vaccinations only restricts mutation by restricting duplications.


The only thing exerting pressure to mutate is mutation rate. The more it mutates the more likely random chance changes a fragment of code. 

Code that is not exposed to adverse agents like vaccines (or antibiotics in the case of bacteria) might or might not develop a resistance, but unless it is tested it won’t be known, so most mutations just get lost in the noise.


This should be verifiable. Mutation rate should increase with number of new cases and decrease with number of vaccinations.

Read the discussion.
https://www.sciencedirect.com/science/article/pii/S0092867421002269

SARS-CoV-2 incidence and vaccine escape
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(21)00202-4/fulltext

These are tough times for concrete/binary thinkers.

[aperson]

Is vaccinating someone with covid the worst thing in terms of putting most pressure on the virus to mutate?

Absolutely no. Vaccinations does NOT increase pressure to mutate.

Vaccinations only restricts mutation by restricting duplications.


The only thing exerting pressure to mutate is mutation rate. The more it mutates the more likely random chance changes a fragment of code. 

Code that is not exposed to adverse agents like vaccines (or antibiotics in the case of bacteria) might or might not develop a resistance, but unless it is tested it won’t be known, so most mutations just get lost in the noise.


This should be verifiable. Mutation rate should increase with number of new cases and decrease with number of vaccinations.

Completely speculative and untrue nonsense. Mutation dynamics are more complex than "The larger the pile of virions the larger the pile of mutations". At a completely basic and obvious level, mutations that confer fitness against antibodies require those antibodies to exist in the population at a significant level in the first place for them to proliferate via relative fitness.

We watched the same patterns of selection occur repeatedly. D614G increased transmissibility in a naive population and immediately went global because early in the pandemic all that mattered was raw transmissibility. In October, recurring convergent mutations started showing up in areas that had high antibody seroprevalence because now antibody escape grants fitness:

https://virological.org/t/the-ongoing-evolution-of-variants-of-concern-and-interest-of-sars-cov-2-in-brazil-revealed-by-convergent-indels-in-the-amino-n-terminal-domain-of-the-spike-protein/659

Recent genomic findings are showing a sudden landscape change in SARS-CoV-2 evolution since October 2020, coinciding with the independent emergence of VOCs carrying multiple convergent amino acid replacements at the RBD of the S protein. One hypothesis is that such a major selection pressure shift on the virus genome is driven by the increasing human population immunity worldwide acquired from natural SARS-CoV-2 infection. Our findings suggest that SARS-CoV-2 is continuously adapting in Brazil and that RDRs 2/4 variants here detected might have evolved to escape from NAb against NTD supersite and could be even more resistant to neutralization than the parental P.1, P.2, and B.1.1.33(E484K) viruses. The sequential evolution steps observed in Brazil recapitulates the pattern observed in South Africa where the VOC B.1.351 first acquired key RBD mutations (E484K and N501Y) and some weeks later the NTD deletion 𝚫242-244.

In general, if you wanted to provide the best setup to select SARS-CoV-2 for vaccine escape, you would vaccinate half the population and then remove all non-pharmaceutical interventions to allows as much spread as possible. Then you would increase the rate at which vaccinated and non-vaccinated people interact as much as possible. Now any virion that manages to hop from an unvaccinated-infected person to a vaccinated person and break through is much more likely to have some sort of fitness against vaccine-induced antibodies.

[gerontocrat]

In general, if you wanted to provide the best setup to select SARS-CoV-2 for vaccine escape, you would vaccinate half the population and then remove all non-pharmaceutical interventions to allows as much spread as possible. Then you would increase the rate at which vaccinated and non-vaccinated people interact as much as possible. Now any virion that manages to hop from an unvaccinated-infected person to a vaccinated person and break through is much more likely to have some sort of fitness against vaccine-induced antibodies.

Is it not something like this of which the USA authorities are afraid, i.e. a very significant proportion (30%?) of population unvaccinated and no restrictions on movement of the population that are just about to have a big long party?

The USA graphs show an unwelcome slowness to reductions in daily new cases, reductions in active cases and especially reductions in daily deaths.

In contrast, Italy does seem at last to be having some success in dragging the data down.

click to enlarge images

[aperson]

Is it not something like this of which the USA authorities are afraid, i.e. a very significant proportion (30%?) of population unvaccinated and no restrictions on movement of the population that are just about to have a big long party?

I imagine some members of our public health apparatus are expressing concern. I also imagine there are members of our economic apparatus expressing concern about dire financial consequences if we don't open things up and have people consuming again right now.

In the United States of America, we know who wins between economists and subject matter experts.

[Archimid]

At a completely basic and obvious level, mutations that confer fitness against antibodies require those antibodies to exist in the population at a significant level in the first place .

The above is completely untrue and a key misunderstanding.

An antibody does not need to exist for a mutation to happen which confers escape ability against said antibody.

I WILL SAY AGAIN:

 There are many different mechanisms by which a mutation can confer escape ability and antibody does not need to be present for the mutation to occur.

Mutations simply occur. They are transcription errors. Most of them harm the virus. Some of them confer escape ability by random mechanisms. An antibody need not to be present for a mutation to occur that confers escape ability.

We watched the same patterns of selection occur repeatedly. D614G increased transmissibility in a naive population and immediately went global because early in the pandemic all that mattered was raw transmissibility. In October, recurring convergent mutations started showing up in areas that had high antibody seroprevalence because now antibody escape grants fitness:

Mutations started showing up in areas that had high antibody seroprevalence because the virus mutated a lot in those areas, having many chances of producing a fitness.

Please understand the logical fallacy here. You have a high seroprevalence and high mutation rate because you had many mutations happen which results in both high seroprevalence and high mutation.

Seroprevalence was not causal to the mutation rate. Both the high seroprevalence and the high mutation rate are a consequence of the high number of cases

In general, if you wanted to provide the best setup to select SARS-CoV-2 for vaccine escape, you would vaccinate half the population and then remove all non-pharmaceutical interventions to allows as much spread as possible. Then you would increase the rate at which vaccinated and non-vaccinated people interact as much as possible. Now any virion that manages to hop from an unvaccinated-infected person to a vaccinated person and breakthrough is much more likely to have some sort of fitness against vaccine-induced antibodies.

Absolute nonsense.  If you vaccinate half the population pockets of herd immunity will significantly lower the mutation rate due to the low duplication rate.

If you want to maximize vaccine escape you do nothing. You let it mutate wild in all populations as much as you possibly can. Then you can randomly select populations and find variants that will make you shiver, some with all kinds of exotic defenses to agents that haven't even been invented yet.

Completely speculative and untrue nonsense.

This should be verifiable. Mutation rate should increase with number of new cases and decrease with number of vaccinations.

[SteveMDFP]

At a completely basic and obvious level, mutations that confer fitness against antibodies require those antibodies to exist in the population at a significant level in the first place .

The above is completely untrue and a key misunderstanding.

An antibody does not need to exist for a mutation to happen which confers escape ability against said antibody.

I WILL SAY AGAIN:

 There are many different mechanisms by which a mutation can confer escape ability and antibody does not need to be present for the mutation to occur.

Mutations simply occur. They are transcription errors. Most of them harm the virus. Some of them confer escape ability by random mechanisms. An antibody need not to be present for a mutation to occur that confers escape ability.

I think you're drawing a distinction without a difference.  You're correct about the biology of mutations, but not the epidemiology.  For a given variant to become dominant among circulating variants, it must have a fitness advantage.  Generally, resistance to antibodies raised against older strains will only have a fitness advantage when the human population has many people with those antibodies.  For practical purposes, aperson is correct.

We watched the same patterns of selection occur repeatedly. D614G increased transmissibility in a naive population and immediately went global because early in the pandemic all that mattered was raw transmissibility. In October, recurring convergent mutations started showing up in areas that had high antibody seroprevalence because now antibody escape grants fitness:

In general, if you wanted to provide the best setup to select SARS-CoV-2 for vaccine escape, you would vaccinate half the population and then remove all non-pharmaceutical interventions to allows as much spread as possible. Then you would increase the rate at which vaccinated and non-vaccinated people interact as much as possible. Now any virion that manages to hop from an unvaccinated-infected person to a vaccinated person and breakthrough is much more likely to have some sort of fitness against vaccine-induced antibodies.

Absolute nonsense.  If you vaccinate half the population pockets of herd immunity will significantly lower the mutation rate due to the low duplication rate.

No, aperson is correct here.  If you want to maximize evolutionary pressure to develop resisistance to the antibodies raised by a particular vaccine, you promote contact between vaccinated and unvaccinated.  Yeah, the total number of mutations will be reduced by the lower number of people with active infections.  But the fitness advantage of virions with such mutations will be maximized when there are many bodies around in which they can thrive, while their unmutated brethren are relegated to a shrinking population of never-vaccinated and never-infected humans.   The resistant variant thus becomes dominant among circulating strains, and non-mutated variants decline.

[Archimid]

Let's return the original question:

Is vaccinating someone with covid the worst thing in terms of putting most pressure on the virus to mutate?

No. It most definitely is not.

If you want to exert maximum mutation pressure, you improve the growth media and let it rip. You Stop vaccinating, stop masking, stop distancing and let it replicate as much as possible. You will have variants that can't even be imagined yet, waiting to test their fitness in the population, if the chance ever presents itself.

To put the most pressure on the virus to mutate, you let it replicate.

If you want to maximize evolutionary pressure to develop resisistance to the antibodies raised by a particular vaccine, you promote contact between vaccinated and unvaccinated.

 
In aperson's exercise of 50% vaccinated vs 50% unvaccinated, the mutation pressure is bound mostly by viral prevalence on the unvaccinated population and its attack rate towards the vaccinated population.

If the prevalence of the virus in the unvaccinated is low, the probability of an escape mutation appearing is low.

Only when viral prevalence is high on the unvaccinated AND attacks on the vaccinated population are high the chances of mutations increased and specific pressure towards a specific escape variant is increased.
 
Contact between vaccinated and unvaccinated does very little if nothing if viral prevalence in the unvaccinated is low and attack rate from unvaccinated is low.


 Now if the mutation that escapes immunity already exists, then the escaping variant will increase in relation to the other variants, but there is no mutation pressure other than the increased pressure of being more prevalent than the others. By being more prevalent, the variant experiences more replications, but only because it is more prevalent. It will mutate accordingly.

We come back to my point, the defenses, whether they are vaccines or antibiotics, do not increase mutation pressure.

[kassy]

Soon, for  a small fee, Big Pharm will be glad to sell you a pill against effects of their vaccine ...

And a pill to mitigate effects of the first pill ...

sidd

Don't say that, sidd. They are the heroes in the war against nature, right there in the frontline with the GMO, AI and nuclear energy heroes. Technology will defeat disease and death. Please, wrap me in plastic and chemicals, put my brain in a computer, shoot me to Mars.

How many times have you used medications to recover from illness, or stop infections?
Medicines have stopped some of the worst kinds of infections that are entirely preventable.

snip

Covid isn't a terrible disease, but it is bad enough, and a simple vaccine that prevents the disease and the consequences of getting it is below you. Why are you like this?

Some people have a hard time parsing that Neven is talking about the bigger debate.

You have probably read some of his writings on concentrated wealth and this ties in to sidds comment about Big Pharma.

If you look along all the AGWIG threads there are many which still belief mostly in tech solutions but we cannot go on as we do. If all cars were EVs we still would be living beyond our means so we have to evolve beyond that. Our agriculture is not sustainable so we might want to solve that which means addressing the root causes of those things.

Why do we have an obese population now? If you think about it from a public perspective it makes no sense because it just costs money but that happened because it also makes some people a lot of money. Somehow we ended up with this rotten society were nothing is sustainable.

That is what the wrap me in plastic etc part is about but i guess it does not land well.

[aperson]

Only when viral prevalence is high on the unvaccinated AND attacks on the vaccinated population are high the chances of mutations increased and specific pressure towards a specific escape variant is increased.

Yes, this is the point of what I wrote, because this is the scenario that matches what the USA (and other places that are lifting restrictions with a partially vaccinated population) are currently implementing.

Now if the mutation that escapes immunity already exists, then the escaping variant will increase in relation to the other variants, but there is no mutation pressure other than the increased pressure of being more prevalent than the others. By being more prevalent, the variant experiences more replications, but only because it is more prevalent. It will mutate accordingly.

Selection for vaccine-induced antibody escape does not happen until a significant portion of the population is vaccinated. Before then, randomly generated escape mutations will show up and then pop out of existence because they do not gain any special fitness. Afterward, they will persist and replicate in vaccinated populations.

That is the entire point of my explanation. It is not just the amount of mutations that you allow to happen, it's also how you make different populations interact to select for which mutations survive and propagate over time. So your statement, "Vaccinations does NOT increase pressure to mutate." is not true. More accurately, your statement is vague and not well-defined. A more well-defined statement would be "Vaccinations do not increase selective pressure for certain mutations", which is untrue for the reasons outlined above.

The resulting policy message from this is that how you vaccinate absolutely matters. You want a vaccination campaign to be swift and complete, and you don't want to lift other interventions until the campaign is done.

[Archimid]

The resulting policy message from this is that how you vaccinate absolutely matters. You want a vaccination campaign to be swift and complete, and you don't want to lift other interventions until the campaign is done.

Perfect advice. Very similar to an antibiotic course.

Yes, this is the point of what I wrote, because this is the scenario that matches what the USA (and other places that are lifting restrictions with a partially vaccinated population) are currently implementing.

True. My hope is that the pressure vaccination exerts against mutations, combined with common sense travel safeguards, lowers the likelihood of an escape variant emerging, at least in the US.

India worries me the most as a candidate to produce an escape variant because of their replication rate.

Before then, randomly generated escape mutations will show up and then pop out of existence because they do not gain any special fitness

The one thing vaccines do is create specificity for already existing variants to become predominant.  Much in the same way antibiotics provide specificity for antibiotic-resistant strains. If the vaccine is never used, then the strain will likely not become predominant, because other more fit strains will.

But there will likely be many more mutations if the vaccine is not used, with the chance for some really nasty bugs to emerge.

[Richard Rathbone]

The USA graphs show an unwelcome slowness to reductions in daily new cases, reductions in active cases and especially reductions in daily deaths.

B.1.1.7 is the reason for this. There's enough interventions/vaccinations/prior infections to suppress the older variants, but not B.1.1.7. At the moment the falling epidemic of older variants is roughly balanced by the growing epidemic of B.1.1.7, but if they don't get a move on with vaccination cases will go up again as B.1.1.7 becomes dominant.

https://twitter.com/trvrb/status/1386694440023068677 thread.

https://twitter.com/trvrb/status/1386694460294144000/photo/1 summary graph

[aperson]

The one thing vaccines do is create specificity for already existing variants to become predominant.  Much in the same way antibiotics provide specificity for antibiotic-resistant strains. If the vaccine is never used, then the strain will likely not become predominant, because other more fit strains will.

Yeah, I think this is the behavior that ultimately leads to the rule of thumb that viruses with repeated antigenic escape attenuate over time. When you make a virus keep seeking out antibody escape potential, you are making it lose other parts of its fitness over time because most of those mutations do not come for free.

When we speed this process up by using vaccine-derived antibodies we may be helping this attenuation process along. Alas, I yearn for eradication rather than attenuation and our policymakers do not care.

[Rodius]

Soon, for  a small fee, Big Pharm will be glad to sell you a pill against effects of their vaccine ...

And a pill to mitigate effects of the first pill ...

sidd

Don't say that, sidd. They are the heroes in the war against nature, right there in the frontline with the GMO, AI and nuclear energy heroes. Technology will defeat disease and death. Please, wrap me in plastic and chemicals, put my brain in a computer, shoot me to Mars.

How many times have you used medications to recover from illness, or stop infections?
Medicines have stopped some of the worst kinds of infections that are entirely preventable.

snip

Covid isn't a terrible disease, but it is bad enough, and a simple vaccine that prevents the disease and the consequences of getting it is below you. Why are you like this?

Some people have a hard time parsing that Neven is talking about the bigger debate.

You have probably read some of his writings on concentrated wealth and this ties in to sidds comment about Big Pharma.

If you look along all the AGWIG threads there are many which still belief mostly in tech solutions but we cannot go on as we do. If all cars were EVs we still would be living beyond our means so we have to evolve beyond that. Our agriculture is not sustainable so we might want to solve that which means addressing the root causes of those things.

Why do we have an obese population now? If you think about it from a public perspective it makes no sense because it just costs money but that happened because it also makes some people a lot of money. Somehow we ended up with this rotten society were nothing is sustainable.

That is what the wrap me in plastic etc part is about but i guess it does not land well.

If Neven wants to talk big picture, then go for it.

But he is being flippant and is consistently underestimating Covid, plays it down, outright admits his anti-vax stance for the Covid vaccine, and more.... none of that is big picture, that is a personal opinion within his own world.

This virus can be combated with a combination of vaccine, social distancing when required, testing and tracing. That is hardly wrapping people up in plastic and chemicals or requires massive dislike for an industry (imprectect as it is) that can provide some of the solution.

You wont get any argument from me about how capitalism has created the obseity crisis, or unhealthy and inactive people and the vast array of bullshit that this economic system has created. But that is the world we created and the consequences are climate change and, now, Covid. And other pandemics will appear as well.

But none of that has anything to do with Covid and how it functions and spreads and how to deal with the issue.

We need a vaccine, we need to do the actions to prevent it spreading. And the backdrop is what it is..... part of the bigger problem. So why do we need to keep listening to the continuing snarkiness of a person who prefers to do nothing about a significant problem and who goes against what the experts in that field are saying.... why is he allowed to post information to support his thinking from people who arent even experts in the field?
If his content was posted in the artic section it would be removed or he would be challenged as a denier and probably blocked.

The simple fact is this.....
Covid is bad enough to take the actions to stop it spreading freely.
When it spreads freely it kills a lot more people than when controlled.
It does organ damage regardless of severity.
Neven lives in a rich country with great health care, so he is safe and his need to take a vaccine is optional in some ways.... which is as entitled as hell..... but the rest of the world doesn't have his significant advantages of shelter, health care, food and water, security and more. And it is those exact same entitled people who caught Covid  and jumped on planes and spread it around the world.... and it has the audacity to sit there and undermine the problem and refuse to take one vaccine to save other people's lives.

I may be over-sensitive to these things because I lived in a poor country without proper food, shelter, water or medications for two years. It sucks.

I am married to a woman brought up in poverty and it is a hard life in as many aspects as us entitled cant even imagine.

They don't get the same options or any option to refuse something as simple as a life saving vaccine. And when I am back in rich countries or listen to rich people refuse something as simple as a vaccine, or talk about how awful capitalism is while they reap the rewards of the system, it kind of pisses me off.

So yeah, his attitude doesn't go down well with me.
And more so when he is wrong about the severity of Covid and when he posts wrong information and posts about being anti vax....

If he wants yap on about capitalism etc, surely there is another thread to take his little rants rather than a thread dedicated to staying up to date with the progress of Covid as a disease?

[sidd]

Re: "So why do we need to keep listening to the continuing snarkiness of a person who prefers to do nothing about a significant problem and who goes against what the experts in that field are saying.... why is he allowed to post information to support his thinking from people who arent even experts in the field?"

Use the ignore button ?

sidd

[Rodius]

Re: "So why do we need to keep listening to the continuing snarkiness of a person who prefers to do nothing about a significant problem and who goes against what the experts in that field are saying.... why is he allowed to post information to support his thinking from people who arent even experts in the field?"

Use the ignore button ?

sidd

Or he could stop doing it.

Why should I ignore him... isn't that how deniers get away with their ongoing lies and how misinformation becomes the standard believed information?

Isnt that how these things perpetuate and become worse?

[sidd]

This has been discussed elsewhere, e.g.:

https://forum.arctic-sea-ice.net/index.php/topic,2273.msg210904.html#msg210904

Milton and Mill make the case better than most, and a long time ago; alas, they do not seem to be taught in schools anymore ...

Perhaps take this discussion to that thread, or to  the "Forum Decorum" topic ?

sidd

[Archimid]

SARS-CoV-2 incidence and vaccine escape
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(21)00202-4/fulltext

These are tough times for concrete/binary thinkers.

Assuming a fixed vaccine escape mutation probability per infection (p), the risk of a vaccine escape variant arising in a specified time period is 1 – (1 – p)N, where N represents the number of cases in that period.

Thanks for the link. N is the mutating pressure inducing agent.

[oren]

Well said Rodius.
Neven wants to discuss the big picture, this is the wrong thread for it, as has been said repeatedly. As the big picture discussion is not taken up by others, Neven is using snark and flippant language, I guess in the hope of generating some response.
In addition, Neven often spreads misinformation about Covid, gained from shady websites such as Swiss Policy Research, although this has become less so over time.

As a moderator, if Neven would be doing this in the Cryosphere section I am in charge of, he would have been edited and reprimanded. It's funny and sad because what I know of moderating I learned from Neven himself, whom I greatly respect in all other aspects except his Covid posting behavior and stance.

Free speech is fine but in a forum and specifically the ASIF there are still certain basic rules which need to be followed.

Putting Neven on ignore is a terrible solution as all other posts by Neven are very important, IMHO. Ignoring a poster in a specific thread could come in handy, not for the first time.

I will cross post to the Decorum thread, feel free to respond there as well.

[Neven]

I apologize for posting that last comment, as it isn't productive. I'm just frustrated with how easy it is to manipulate people's fear of death and disease.

[Rodius]

I apologize for posting that last comment, as it isn't productive. I'm just frustrated with how easy it is to manipulate people's fear of death and disease.

Your comment is yet another example of you downplaying the pandemic.

[SteveMDFP]

I apologize for posting that last comment, as it isn't productive. I'm just frustrated with how easy it is to manipulate people's fear of death and disease.

Manipulating them into doing what?  Putting on a mask, avoiding indoor crowds, getting a vaccine?  That isn't manipulation, that's a rational response to risk of death and disability.

Manipulating them into clicking on links?  Yes, but the media do this with all topics, and all sides of all controversies.  How many headlines have you read about some imminent asteroid strike?  It's just profit motive applied to the media. Fear-mongering isma ubiquitous aspect of media, not a component of some dastardly conspiracy. Knowing the actual facts is the best armor to this abuse of the public.

We have a global public health crisis.  It persists because many governments and individuals have undermined rational public health measures that could have nipped this in the bud early.  The problems this sabotage causes humanity have just worsened over time, in the absence of adopting sound public health measures.

[Jim Hunt]

Neven wants to discuss the big picture, this is the wrong thread for it

At the risk of repeating myself, please see Alice F's sadly unloved 21st Century Schizoid thread:

https://forum.arctic-sea-ice.net/index.php/topic,3486

[Jim Hunt]

Manipulating them into doing what?

Buying stuff? Both literally and metaphorically!

See Alice F. op. cit.

[Archimid]

Or he could stop doing it.

As much as it pains me to say this, and as much poison I've thrown his way, I think his attacks keeps us sharp. So do BBR and TB. Even The Walrus helps by making this place not an echo chamber.

They are poisonous and dangerous to the truth, yet they are a path to better truths.

It's tough and inefficient, but when done honestly, insight is gained by debating even the most twisted arguments.

People like you, Richard Rathbone and Gerontocrat keep the thread sane with their data-driven insight.  People like Neven and TB stir the pot, people like El Cid and Oren and try to make it clear.

Somehow it all works.

[The Walrus]

I apologize for posting that last comment, as it isn't productive. I'm just frustrated with how easy it is to manipulate people's fear of death and disease.

Without commenting on his previous posts, I will say that far is a big driver, and used often to promote certain viewpoints.  This was evident in previous potential disease outbreaks, bird flu, ebola, and some early covid hype (including the J&J vaccine).  This is not unique to disease, but occurs repeatedly in the media.  WMDs, religious extremists, rogue dictators, crime, and even climate change to name a few.  Sometimes this hype actually causes the fear itself.  In the 1990s, a USAToday reporter created a story about black church burnings that gained national recognition.  The story fell apart upon closer scrutiny, but it led to a series of copycat crimes that caused the number or burnings to rise in the months that followed.  This hype was revived two decades later by the SPLC, without any corroborating evidence. 

Hence, I share his frustrations about manipulating fear, although not necessarily his overall opinions.

[aperson]

Not the kind of paper I want to be reading when I'm looking at taking a booster shot full of spike proteins every year for the foreseeable future.

It turns out this fear is unnecessary.

https://blogs.sciencemag.org/pipeline/archives/2021/05/04/spike-protein-behavior
Title: Spike Protein Behavior

Now we get to a key difference: when a cell gets the effect of an mRNA nanoparticle or an adenovirus vector, it of course starts to express the Spike protein. But instead of that being assembled into more infectious viral particles, as would happen in a real coronavirus infection, this protein gets moved up to the surface of the cell, where it stays. That’s where it’s presented to the immune system, as an abnormal intruding protein on a cell surface. The Spike protein is not released to wander freely through the bloodstream by itself, because it has a transmembrane anchor region that (as the name implies) leaves it stuck.

...

Some of the vaccine dose is going to make it into the bloodstream, of course.... [These studies] were done two ways – by using an mRNA for luciferase (and thus looking at the resulting light emission from the various rodent regions!) and by using a radioactive label (which is a more sensitive technique). The great majority of the radioactivty stays in and around the injection site. In the first hours, there’s also some circulating in the plasma. But almost all of that ended up in the liver, and no other tissue was much over 1% of the total. That’s exactly what you’d expect, and what you see with drug dosing in general: your entire blood volume goes sluicing through the liver again and again, because that’s what the liver is for. But when things like this hit the hepatic tissue, they stay there and eventually get chewed up by various destructive enzymes (that’s also a big part of what the liver is for). It’s a one-way ticket.

...

Update: there’s another level of difference that I didn’t mention. In the Moderna, Pfizer/BioNTech, J&J, and Novavax vaccines, the Spike protein has some proline mutations introduced to try to hold it in its “prefusion” conformation, rather than the shape it adopts when it binds to ACE2. So that should cut down even more on the ability of the Spike protein produced by these vaccines to bind and produce the effects noted in the recent papers.

[kassy]

How India descended into Covid-19 chaos

...

But experts say that the shortage of oxygen is just one of the problems which shows both federal and state governments were not prepared, having failed to do enough to stop or minimise the damage of the second wave.

Warnings have in fact been repeatedly issued, including:

In November, a parliamentary standing committee on health said there was an inadequate supply of oxygen and "grossly inadequate" government hospital beds
In February, several experts told the BBC they feared an impending 'Covid tsunami'
In early March, an expert group of scientists, set up by the government, warned officials about a more contagious variant of coronavirus spreading in the country - only for no significant containment measures to be taken, one scientist from the group told the BBC. The government has not made any comment on the allegations
Despite this, on 8 March, the country's health minister announced that India was in the "endgame of the pandemic".

So, where did it go so wrong?

The basics
In January and February, the national number of daily cases fell to under 20,000 from peaks of around 90,000 in September last year. Prime Minister Narendra Modi declared Covid beaten, and all places of public gathering opened.

And soon, people were not adhering to Covid safety protocols, thanks in part to confused messaging from the top.

While Mr Modi asked people to wear masks and follow social distancing in his public messages, he addressed large unmasked crowds during his election campaigns in five states. A number of his ministers were also seen addressing large public gatherings without wearing masks. The Kumbh Mela, a Hindu festival - which attracts millions - was also allowed to go ahead.

"There was complete disconnect between what they practised and what they preached," says public policy and health systems expert Dr Chandrakant Lahariya.

Prominent virologist Dr Shahid Jameel says "the government just did not see the second wave coming and started celebrating too early".

But there is more to the story: the devastation has also exposed the underfunding and neglect of the public healthcare system in India.

The heart-breaking scenes that have been witnessed outside hospitals - people dying without getting treatment - shows the grim reality of India's healthcare infrastructure.

As one expert puts it, India's "public health infrastructure was always broken, the rich and the middle class are just finding out". Those who could afford it have always relied on private hospitals for treatment, while the poor struggle to get even a doctor's appointment.

Recent schemes, like health insurance and subsidised medicines for the poor, are not helping because very little has been done in decades to increase the number of medical staff or hospitals.

and more:
https://www.bbc.com/news/world-asia-india-56977653

[Shared Humanity]

Researchers have identified a new variant of the bug spreading in Chicago.

[The Walrus]

India comprising roughly 17.5% of the world's population.  Two months ago, less than 5% of covid cases were in India.  Today, India accounts for almost half of all new cases worldwide, and that number continues to rise. 

[vox_mundi]

Excess mortality since the beginning of 2020 in Peru has got to be running fairly close to 0.5% of the entire population. 334,680 deaths in the last 70 weeks, 151,833 deaths in the same period 2018-19.

Equivalent would be in the range of 1.8 million excess US deaths.

https://mobile.twitter.com/Birdyword/status/1389922249344385025

----------------------------------------------

India’s Neighbours Close Borders as Covid Wave Spreads Across Region
https://www.theguardian.com/world/2021/may/05/indias-neighbours-close-borders-as-covid-wave-spreads-across-region

Nepal has been hardest hit to date, while concerns are growing in Pakistan and Bangladesh

In April, along with millions of other people, Nepal’s former king Gyanendra Shah, 73, and his 70-year-old wife, Komal, travelled to India for the Kumbh Mela religious festival. There he took a holy dip in the Ganges at Hardiwar and interacted maskless with officials, sadhus and other pilgrims.

On their return to Kathmandu’s airport, hundreds gathered to welcome the couple, who within a handful of days would test positive for Covid-19.

Thousands of Nepali migrants who work in India have returned infected too, and cases have risen rapidly not only in the Himalayan kingdom but in India’s other neighbours including Pakistan and Bangladesh.

... Scenes in India in recent weeks are being replayed in Kathmandu, with hospitals reporting they are close to being overwhelmed and crematory workers at the Pashupatinath temple, the biggest Hindu shrine in the capital, dealing with a surge in fatalities.

Nepal’s decision to allow people to continue to climb its Himalayan peaks as a vicious Covid-19 wave sweeps the country was dealt a further blow after 19 more climbers tested positive for the virus.

https://www.theguardian.com/global-development/2021/may/05/nepal-report-19-positive-covid-test-dhaulagiri-base-camp

... Pakistan, too, has been confronting a mounting sense of crisis in recent days and there are fears that the Eid religious festival that marks the end of Ramadan may prompt a fresh surge in infections, as it did last year.

Only about 2 million people have been vaccinated so far in the country of 220 million, the lowest rate in south Asia. Hesitancy about vaccination, fuelled by propaganda, is proving an obstacle.

Pakistan’s largest public hospital, the Pakistan Institute for Medical Sciences in Islamabad, has run out of beds and its doctors have been barred from talking to the media.

“The situation is awful,” said one doctor, speaking anonymously. “We are exhausting our resources. Most of the non-Covid wards have been turned into Covid wards, yet we don’t have any space for [incoming] patients. We need more nurses, medicines, and above all we need space. We need experts and critical care doctors.

... The rapid spread of infections from India is also causing alarm in Bangladesh, where authorities have closed borders, recommending they should not reopen until its neighbour’s situation improves.

The surge in infections in Bangladesh began at the same time as India’s second wave, in mid- March. Bangladesh has ramped up testing but struggled with its supply of vaccines, originally counting on the Serum Institute of India, which has diverted doses for India’s use.

----------------------------------------------------


view from the trenches ~ at 0.5 min - ambulance line

----------------------------------------------------

WHO Experts Voice "Very Low Confidence" In Some Sinopharm Covid Vaccine Data
https://www.reuters.com/business/healthcare-pharmaceuticals/exclusive-who-experts-voice-very-low-confidence-some-sinopharm-covid-19-vaccine-2021-05-05/

World Health Organization experts have expressed “very low confidence” in data provided by Chinese state-owned drugmaker Sinopharm on its Covid vaccine regarding the risk of serious side-effects in some patients, a document seen by Reuters shows.

The “evidence assessment” document was prepared by the WHO’s Strategic Advisory Group of Experts (Sage) for its review scheduled this week of the Sinopharm shot, authorised by 45 countries and jurisdictions for use in adults, with 65m doses administered.

The experts review evidence and give recommendations on policy and dosages associated with a vaccine.

The document includes summaries of data from clinical trials in China, Bahrain, Egypt, Jordan and the United Arab Emirates.

Vaccine efficacy in multi-country Phase 3 clinical trials was 78.1% after two doses, the document said. This was a slight drop from 79.34% announced previously in China.

The document said:

... We are very confident that 2 doses of BBIBP-CorV are efficacious in preventing PCR confirmed Cov0d-19 in adults (18-59 years)... Analysis of safety amongst participants with comorbidities (was) limited by the low number of participants with comorbidities (other than obesity) in the Phase 3 trial.

Among “evidence gaps”, it cited data on protection against severe disease, duration of protection and safety for use in pregnant women and in older adults, Reuters notes.

------------------------------------------------

Staff at an Indonesian pharmaceutical company have been accused of washing and repackaging used Covid nasal swabs, which were then sold to thousands of unsuspecting travellers.

https://www.theguardian.com/world/2021/may/05/workers-at-indonesian-pharma-firm-arrested-over-re-used-covid-swabs

The five, who worked for state-owned company Kimia Farma, washed and repackaged antigen nasal swabs for antigen-based rapid testing and used them on travellers at Kualanamu airport in Medan, said provincial police spokesman Hadi Wahyudi. ... nothing too fine for the tourists

“We will question top officials at the company to get to the bottom of the case,” Hadi said, adding that the five suspects had been doing this since December.

... at least they washed them ... Oh, and they have a smoking deal on a 1000 rolls of toilet paper

-------------------------------------

India’s Goa, sun and sand tourist destination, has country’s highest COVID rate

India’s Goa state, a hugely popular tourist destination on the western coast, has the highest rate of COVID-19 infections in the country, with up to one in every two people testing positive in recent weeks.

Two government-appointed medical officials working at the state’s COVID-19 data collection centre in the capital Panjim said the positivity rates in tests since April were between 40 – 51% the highest in the country.

----------------------------------------

India’s G7 delegation in self-isolation after COVID infections

The entire delegation of India to the Group of Seven summit in London is in self-isolation after two members tested positive for COVID-19, the UK government has said.

-------------------------------------------------

India reported one in four COVID deaths globally last week: WHO

India accounted for nearly half of the COVID-19 cases reported worldwide last week and one in four of deaths, the World Health Organization (WHO) has said.

-------------------------------------------------------------

[nadir]

I apologize for posting that last comment, as it isn't productive. I'm just frustrated with how easy it is to manipulate people's fear of death and disease.

Manipulating them into doing what?  Putting on a mask, avoiding indoor crowds, getting a vaccine?  That isn't manipulation, that's a rational response to risk of death and disability.

Manipulating them into clicking on links?  Yes, but the media do this with all topics, and all sides of all controversies.  How many headlines have you read about some imminent asteroid strike?  It's just profit motive applied to the media. Fear-mongering isma ubiquitous aspect of media, not a component of some dastardly conspiracy. Knowing the actual facts is the best armor to this abuse of the public.

We have a global public health crisis.  It persists because many governments and individuals have undermined rational public health measures that could have nipped this in the bud early.  The problems this sabotage causes humanity have just worsened over time, in the absence of adopting sound public health measures.

The Chinese Authorities are #1 in that list of undermining entities, aren’t they? They could have alerted the world in September 2019, yet they didn’t.
The WHO is #2 in that list ain’t it? With their slow, weak, contradictory, and often unscientific communiques (it took them almost until Summer 2020 to admit aerosol transmission, just to pick an example).
What about the Western Health Authorities like Dr. Fauci in a comfy #3 of that list, when they lied about the importance of masks?

You seem very enlightening (thank you for illuminating us, sir!) but it seems you choose not to see the worst elements that, actually, did not want to nip this in the bud to start with.

[be cause]

SteveMDFP has been contributing to this thread since day 1 . Unlike late arrivals , he has no need to rerun the discussions of a year ago just to make others happy . b.c.

[aperson]

SteveMDFP has been contributing to this thread since day 1 . Unlike late arrivals , he has no need to rerun the discussions of a year ago just to make others happy . b.c.

They do have a point though, and I have seen it as a major cause of vaccine hesitancy when talking to people. The mixed messaging regarding aerosol transmission from the WHO and the mixed messaging regarding using masks from the CDC made a lot of people distrust everything about our health apparatus from that point on because they dropped the ball so early on.

Unfortunately, this mistrust now extends to the vaccines themselves, which is problematic because we basically stumbled into a miracle vaccine through a decade of preparation and a significant amount of luck. If we aren't willing to talk about these very real problems with our health messaging, we also won't be able to convince a significant amount of people to take the vaccine.

[crandles]

India reported one in four COVID deaths globally last week: WHO

India accounted for nearly half of the COVID-19 cases reported worldwide last week and one in four of deaths, the World Health Organization (WHO) has said.

Code: [Select]

#, Country, Cases in the last 7 days, Deaths in the last 7 days, Population
#      World 5,606,671       91,565
1 India 2,702,756        25,339 1,391,419,959
2 Brazil    412,657        16,302      213,831,876
So yes that comment is about what is reported and is good enough.

But do we believe the figures are anywhere near accurate?

India has life expectancy of nearly 70 but due to young population only around 7.3 deaths per 1000 population. So a normal level of deaths would be approaching 200,000 and 25k deaths would "only" be an excess death rate of around 12.5% and you would expect crematoriums to cope with that level of extra deaths without huge expansion to where funeral pyres are held.

Of course India is a big country - there could be a few cities facing big problems with 50%+ excess death rates and many more not having issues such that the average excess death rate isn't all that much higher than 12.5%. Media would report on places reporting acute effects.

But can't help feeling India numbers are under-reporting actual severity.

[gerontocrat]

https://www.worldometers.info/coronavirus/#countries

INDIA
On this day, 5th May, India recorded daily new cases of 413k.
On this day, 5th May, India recorded daily new DEATHS of 3,982.
Both the highest for India so far.

7 day trailing averages are also at records, daily new cases 386k, daily new deaths 3,620.

Total cases 21 million, total deaths 230k.

Some may take some small comfort from that the graphs of daily increases in cases and deaths  show a small sign of bending as if moving to a peak. However, having spent some time some years ago in, shall we say,  the least economically favoured places and institutions on the Indian Sub-Continent, I have the thought that perhaps that bending of the graph may be a sign that even the ability to record cases, let alone treat them, has reached breaking point. I hope I am wrong.

[vox_mundi]

New Study Estimates More Than 900,000 People Have Died Of COVID-19 In U.S.
https://www.npr.org/sections/coronavirus-live-updates/2021/05/06/994287048/new-study-estimates-more-than-900-000-people-have-died-of-covid-19-in-u-s

A new study estimates that the number of people who have died of COVID-19 in the U.S. is more than 900,000, a number 57% higher than official figures.

Worldwide, the study's authors say, the COVID-19 death count is nearing 7 million, more than double the reported number of 3.24 million.

The analysis comes from researchers at the University of Washington's Institute for Health Metrics and Evaluation, who looked at excess mortality from March 2020 through May 3, 2021, compared it with what would be expected in a typical nonpandemic year, then adjusted those figures to account for a handful of other pandemic-related factors.

The final count only estimates deaths "caused directly by the SARS-CoV-2 virus," according to the study's authors. SARS-CoV-2 is the virus that causes COVID-19.

Researchers estimated dramatic undercounts in countries such as India, Mexico and Russia, where they said the official death counts are some 400,000 too low in each country. In some countries — including Japan, Egypt and several Central Asian nations — the Institute for Health Metrics and Evaluation's death toll estimate is more than 10 times higher than reported totals.

... Experts are in agreement that official reports of COVID-19 deaths undercount the true death toll of the virus. Some countries only report deaths that take place in hospitals, or only when patients are confirmed to have been infected; others have poor health care access altogether.

"We see, for example, that when health systems get hit hard with individuals with COVID, understandably they devote their time to trying to take care of patients," Murray said.

... Researchers at UW also released an updated forecast for the COVID-19 death count worldwide, estimating that roughly 2.5 million more people will die of COVID-19 between now and Sept. 1, driven in part by the dramatic surge of cases in India.

In the United States, researchers estimated roughly 44,000 more people will die of COVID-19 by September.

Estimation of total mortality due to COVID-19
http://www.healthdata.org/special-analysis/estimation-excess-mortality-due-covid-19-and-scalars-reported-covid-19-deaths

https://jamanetwork.com/journals/jama/fullarticle/2778361

[Richard Rathbone]

Thats a really lowball figure for India. The FT (from pyre counts) estimated a factor of 10, which would be 2M not 400k.

On the other hand they are exaggerating the undercount in the UK, which apart from 10k in the first four weeks of the initial wave has been virtually nil.

Using the most up-to-date data we have available, the number of deaths from the week ending 13 March 2020 up to 23 April 2021 was 709,330 in England and Wales. Of the deaths registered by 23 April 2021, 139,203 (19.6%) mentioned COVID-19 on the death certificate. During this period, the number of excess deaths above the five-year average was 114,971 deaths.

https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsregisteredweeklyinenglandandwalesprovisional/latest#deaths-registered-in-the-uk

There's some pretty shifty data analysis going on if they have managed to turn -25k for England and Wales into +50k for the UK. There are reasons why its -25k and they've listed them, but if they've counted them right they should be 25-35k not 75k.

Possibly they have confused the death certificates with the headline figure (deaths within 28 days of a positive test) and double counted the undercount in the headline figure by adding it to the death certificates. Their table is labelled as if they are using headline figures, but its actually using the UK death certificate count for registrations to 16 April, not the UK headline figure for May 3rd.

[vox_mundi]

... Some may take some small comfort from that the graphs of daily increases in cases and deaths  show a small sign of bending as if moving to a peak. However, having spent some time some years ago in, shall we say,  the least economically favoured places and institutions on the Indian Sub-Continent, I have the thought that perhaps that bending of the graph may be a sign that even the ability to record cases, let alone treat them, has reached breaking point. I hope I am wrong.

You're not wrong ...

-----------------------------------------------

India Covid: Is the Second Wave Slowing Down?
https://www.bbc.com/news/56987209

414,433 new cases and 3,920 new deaths

... Accurate assessments of the extent of the virus are only possible with widespread testing.

India has been conducting nearly two million tests a day.

This dipped at the start of this month to 1.5 million.

But by Wednesday, 5 May, daily testing was back at almost two million again.

This temporary fall in testing may go some way to explaining the extent of the dip in recorded daily infections in the first few days of May.

Testing has also been highly variable across the country, with some regions showing significant declines.

"This happened during the previous peak, in September, too," World Health Organization (WHO) consultant and economist Dr Rijo John says.

"When India was about to touch 100,000 cases per day, the testing rates fell."



When the authorities say case levels have fallen in some states - Maharashtra, Gujarat, and Telangana and the capital, Delhi - these same states have also seen a fall in testing.

In mid-April, when Delhi was conducting nearly 100,000 tests a day, recorded daily case numbers were around 16,000.

But by the end of April, when the case numbers had risen by more than 55%, testing had fallen by 20%, suggesting a much higher underlying level of infections.

Similar trends were observed in Gujarat and Telangana.

[... Coincidentally, these states are run by Modi's BJP party. Sounds familiar ...

... coronavirus testing makes the U.S. look bad, "so I said to my people, ‘Slow the testing down.’" - D. Trump]

https://www.politifact.com/factchecks/2020/jun/24/priorities-usa-action/trump-positive-coronavirus-tests-slowdown-look-bad/

Dr. A. Velumani runs a nationwide chain of medical labs. He told local media his labs have come under pressure from local politicians to manipulate coronavirus tests and report fewer positive results.

A VELUMANI: We are told, you shouldn't be doing more than this much. In fact, in a good number of cases, the question asked - why are your laboratories reporting more positive than other local laboratories?

https://www.npr.org/2021/04/29/992122467/indias-real-death-toll-may-be-many-times-higher-than-the-official-count

Testing capacity is clearly under great strain, with people unable to access tests because facilities are overburdened, Dr John says.

And across the country, the rate of testing, about 1.3 per 1,000 people, compares with three in the US and 15 in the UK.

... Gautam Menon, a mathematical modeller and professor of physics and biology, at Ashoka University, near Delhi, says: "Test positivity rates are still quite high, over 20% countrywide.

"So I would certainly think there is no reason yet to believe that India is past its second wave."



... India mainly uses two types of tests.

Polymerase chain reaction (PCR) tests are considered the gold standard, although there have been reports of new variants going undetected even in symptomatic patients.

But some state health authorities have been moving over to rapid antigen tests, which are quicker and easier to administer but less reliable [false negative].

In Delhi, nearly 35% of tests in April were rapid antigen.

------------------------------------------------------

India's Modi Made All of Trump's Covid Mistakes But On a Much Bigger Scale
https://www.msnbc.com/msnbc/amp/ncna1266101

[vox_mundi]

Alberta Health Services to Brief Health-Care Workers On Triage Protocol In Case 'Dire Situation' Should Occur
https://www.cbc.ca/news/canada/calgary/triage-alberta-health-services-covid-pandemic-1.6005595

Alberta, Canada: Some Alberta health-care staff will be briefed this week on a protocol for deciding which patients get potentially life-saving care if hospitals become overwhelmed with COVID-19, CBC News has learned.

An Alberta Health Services memo sent to staff said the Alberta Critical Care Triage Framework is a protocol that would be used in the event of a "dire situation" where demand for life-sustaining critical care is greater than the resources available.

The memo — which was shared with CBC News — describes the framework as a provincewide guide for the "difficult determination" of allocating those resources to critically ill patients when there are not enough for everyone.

"That they're going to be briefing people on that protocol this week suggests that they think this could get a lot worse," said Dr. James Talbot, Alberta's former chief medical officer of health.

Alberta has the highest rate of active COVID-19 cases in Canada.

AHS has announced it will cut back scheduled surgeries in Calgary, Edmonton and the northern zone to make room for a possible influx of COVID-19 hospitalizations.

The province has also set up a 100-bed field hospital at the University of Alberta in Edmonton that has not yet been used. A field hospital in Calgary has been used as an extension of the Peter Lougheed Centre's emergency department.

"Unless something is done to change the rate at which the cases are increasing, it's just a matter of time before we end up exceeding capacity in Alberta," Talbot said

... “I don’t care how robust your systems are, I don’t care how great your training processes are. There is no system in the world that can out-expand the exponential growth of Covid,” said Vipond. “Are we in trouble? Absolutely.”

https://www.theguardian.com/world/2021/may/06/canada-alberta-pandemic-north-america-coronavirus-covid

[vox_mundi]

After Oxygen Shortage is Tackled, the Next Big Crisis Will Be Lack of Doctors, Nurses for Covid Patients: Dr Devi Shetty
https://indianexpress.com/article/india/lack-of-doctors-and-nurses-to-treat-covid-patients-will-be-the-next-big-crisis-dr-devi-shetty-7298066/

Dr. Shetty said that statistically, 5% of Covid patients need ICU beds irrespective of their age, which means there is a demand for 80,000 ICU beds daily. But India has 70,000-90,000 such beds and all of them are occupied already even though the second wave of the pandemic has not reached its peak yet. Moreover, a Covid patient spends a minimum of 10 days in the ICU. Therefore, there is a need to create at least 500,000 additional ICU beds in the next few weeks.

"Once the oxygen problem is solved, the next problem over the next few weeks will be the death of patients in ICUs because there are no nurses and doctors to take care of them," Shetty was reported as saying, arguing that students must be pressed into service to fill the backlog.

We also need to produce 200,000 nurses and 150,000 doctors who are dedicated in managing Covid for the next one year,”

----------------------------------------------------

https://mobile.twitter.com/official_aimsa/status/1389229613033742338



------------------------------------------------------

... Oxygen shortages are blamed for deaths at even the best-equipped urban hospitals. On Saturday, in the capital New Delhi, 12 patients died at Batra Hospital after the facility ran out of medical oxygen. A tanker delivery had arrived just 90 minutes late.

Meanwhile, at Ballia district hospital, a facility in a rural area of Uttar Pradesh in northern India, a local reporter saw more than 20 patients on the floor, struggling to breathe. "Helpless cries of pain filled the air. Not a single doctor was in attendance," she reported.

https://theprint.in/health/virus-attacking-on-all-sides-hospitals-in-rural-up-districts-are-buckling-under-covid-flood/650490/

---------------------------------------------

Doctor In COVID-Hit India Forced to Decide Who Lives and Who Dies
https://www.aljazeera.com/news/2021/5/6/doctor-in-covid-hit-india-forced-to-decide-who-lives-and-who-dies

Rohan Aggarwal is 26 years old. He doesn’t even complete his medical training until next year.

And yet, at one of the best hospitals in India, he is the doctor who must decide who will live and who will die when patients come to him gasping for breath, their family members begging for mercy.

... Everyone at Holy Family Hospital – patients, relatives and staff – knows there aren’t enough beds, not enough oxygen or ventilators to keep everyone who arrives at the hospital’s front gates alive.

“Who to be saved, who not to be saved should be decided by God,” Aggarwal says. “We are not made for that – we are just humans. But at this point in time, we are being made to do this.”

During his marathon shift, which Reuters news agency documented to provide one of the most comprehensive accounts of overwhelmed hospitals during India’s harrowing surge, Aggarwal says he fears what will happen if he gets infected too, knowing that his own hospital will be unlikely to find him a bed. ... He is unvaccinated.

“We were all under the misconception the virus had gone,” he says.

When Aggarwal begins his shift around 9 am, four bodies lie in one of the areas where staff are supposed to remove their protective equipment.

In the emergency room, conditions are even more cramped.

Patients and relatives crowd every available space, many wearing no protection except for a simple cloth mask. Doctors and nurses have stopped wearing full protective equipment too – it is simply too difficult to work in.

In normal circumstances, Holy Family is one of the best hospitals in the country, attracting patients from across the world – and it still is, considering the conditions in government hospitals, where patients lie two to a bed, or die outside on trolleys in the baking sun. But the facility is still in a desperate position.

The hospital, which normally has capacity for 275 adults, is currently caring for 385. A sign posted outside shows the number of available general and intensive-care COVID beds remains the same as it has for weeks: zero.

Heading the ER, with its broken bones and coughs and colds, is usually a relatively simple task, left to a more junior doctor while senior consultants and specialists work in the ICU, where serious cases are quickly escalated. That system has long broken down, and the on-duty doctor in the ER is now one of the most critical in the hospital.

Before he begins his turn in the ER, Aggarwal first makes his rounds of the general COVID wards. Along with a senior colleague, he is responsible for 65 patients. That gives him a maximum of three to four minutes to see each one before any emergencies, which frequently occur.

He is minutes into his rounds when he receives an urgent call – one of his patients is sick. He sprints down the stairs and along a dimly lit corridor to Room 323, where an elderly man is barely conscious.

“He is on the way down,” Aggarwal explains to the man’s son.

... A security guard, Mahendar Baisoyar, is posted outside the emergency room door to ensure relatives don’t try to secure a bed “by force”, he says.

Last month, relatives at another hospital in the capital attacked staff with knives after a patient died. The city state’s top court has warned that more law and order problems at hospitals are likely if shortages continue.

Slumped in the back of a car, 62-year-old Vijay Gupta is one patient turned away, his family and friends debating what to do next. ... “We have been roaming around since 6am looking for a bed,” says Gupta’s friend Rajkumar Khandelwal. ...Others in the ER are so sick they are in urgent need of a ventilator, and Aggarwal pleads with families to look elsewhere. But they already have.

The medical staff look at everyone, give first aid as best as they can, but there is simply no space for everyone. “The doctors and nurses are demoralized,” he says. “They know they can do better, but they just don’t have the time.”

A little before 3pm, Aggarwal returns for his shift in the emergency room. He sits behind a desk as relatives crowd around him, pleading for admission. He makes the decision-making process sound simple.

“If a patient has a fever, and I know he’s sick but he’s not requiring oxygen, I can’t admit him,” he says.

“That’s the criteria. People are dying on the streets without oxygen. So people who don’t require oxygen, even if they are sick, so we don’t admit them usually.”

That’s one choice.

“Another choice is I have an old male and I have a young guy. Both are requiring high-flow oxygen; I have only one bed in the ICU. And I can’t be emotional at that time, that he is a father to someone. The young have to be saved.”

[vox_mundi]

The Covid-19 Hospital in India So Bad Patients Want to Get Out
https://amp.cnn.com/cnn/2021/05/03/india/hospital-coronavirus-deaths-oxygen-delhi-intl-hnk-dst/index.html

New Delhi and Meerut, India(CNN)For three days, Goldi Patel, 25, went from hospital to hospital in New Delhi's oppressive summer heat, frantically trying to find one that would keep her husband breathing.

Four hospitals turned away Patel, who is seven months pregnant with the couple's first child, before she finally found one that would take him. But the level of care at Sardar Patel Covid Care Centre and Hospital, a makeshift pandemic facility on the outskirts of the capital, is so lacking that her husband is begging to leave.

Around Sadanand Patel, 30, people are dying. He has barely any contact with doctors, and limited medicine. With 80% of his lungs already infected, he's terrified of what happens if his condition gets worse.

Only some Covid-19 patients manage to get admitted into India's overburdened hospitals. But once inside, some face a different kind of terror: an absence of medical care or supplies as people die around them.

In the cavernous, warehouse-style facility, some patients lie on beds made of cardboard. There is limited medicine, and Sadanand said he had only interacted with a doctor once or twice in three days since he was admitted last Tuesday. He watched two men in beds nearby scream for medicine only to die within hours when their oxygen appeared to run out.

By Saturday, his fifth day in the center, at least five people around him had died, he said. One dead body lay on the bed next to his for hours before it was removed.

... "The government thinks that they have opened this hospital, the patients here are getting treated," he said. "But actually, nothing like that is happening."

The doctors check on patients infrequently, Sadanand said. He's worried that if he needed medical attention, he would be too ill to call for help. Sometimes he talks with a patient in a nearby bed who advised him to get out of the center if he feels even slightly better.

Others have had the same experience. Sarita Saxena told CNN Friday her brother-in-law was admitted to the center after being turned away by at least seven hospitals. She doesn't believe any doctors are treating the patients -- the only people caring for them are family and friends. Those people risk catching Covid as there are no walls within the center to stop the spread.

... Lala Lajpat Rai Memorial Medical College (LLRM), a hospital in the city of Meerut, in the neighboring state of Uttar Pradesh, is inundated.

People are everywhere -- on stretchers, on tables, on the floor -- moaning and desperate for oxygen. There are about 55 beds for 100 patients, according to hospital staff. There are just five doctors. Some patients lie on the floor.

One of those is 32-year-old mother-of-two Kavita, who has no last name. She's been on the floor of the hospital for four days, struggling to breathe. She says she hasn't received any oxygen, and has seen 20 people die.

"I'm getting anxious," she said. "I'm scared that I'll stop breathing," she said.

... Some hospitals have warned patients that if they want to be admitted for treatment, they will have to source their own oxygen.

"We have now told patients before admitting them that they may have to get their own oxygen supply in case of emergency if they are admitted here," Poonam Goyal, a senior doctor at Panchsheel Hospital in Delhi's north said Saturday.

... Dr. Harsh Vardhan, the Minister for Health and Family Welfare, said Thursday there was adequate oxygen in the country and no need to panic.

"Oxygen was available in adequate quantity earlier and now there is even more," he told reporters outside a hospital. "We have so many more sources of oxygen available in the country ... Whoever needs oxygen should get it."

--------------------------------------------

At least 10 people died after Indian hospital ran out of oxygen: 'Everyone was helpless'
https://www.nytimes.com/2021/05/03/world/asia/India-coronavirus-deaths-oxygen.html

At least 10 people died overnight at the Chamarajanagar District Hospital in Karnataka, India, after the facility ran out of oxygen

Officials said 14 more patients died before oxygen arrived on Monday morning, but it's unclear if the oxygen deprivation is what led to their deaths. Rani, a 28-year-old nurse, told The New York Times her 29-year-old husband, Sureendra, was one of the COVID-19 patients who died. Sureendra was in the intensive care unit, and Rani said when she spoke to him at dinnertime, he sounded okay. At about 11:30 p.m., he called and was gasping for breath, she said, and begged her to come see him before he died. "Everyone was helpless," Rani told the Times, adding, "What will I do without my husband now?"

At Jaipur Golden Hospital in New Delhi, oxygen supplies were coming in every day at the same time, administrator Dr. Deep Kumar Baluja told the Times, but on April 24, they didn't arrive as scheduled, and there was no oxygen left. Because of this, 20 COVID-19 patients died "one after another," he said. "I have no words to express what I felt when patients died."

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India is fighting a healthcare crisis of unimaginable proportions with woefully outdated science
https://qz.com/india/2003471/india-is-still-using-a-woefully-outdated-covid-19-treatment-plan/amp/

The guidelines have not kept pace with research perhaps because no one bothered with them during the months when the country’s first wave had died down. An investigation by The Caravan magazine found that India’s scientific task force on Covid-19 did not meet even once in February and March, even as new infections had begun to rise. After Jan. 11, it met on April 15 for the first time to assess Covid-19 surge, which had become unrelenting by then, The Caravan reported on April 22.

What is alarming is that the health ministry’s latest guidelines (pdf) on home isolation, continue to recommend HCQ as a “prophylaxis” or preventive measure. There is no proof that HCQ works in those circumstances.

Till the end of January, official central government data showed that it had distributed 100 million tablets of HCQ to Indian states.

The same holds true for ivermectin, an anti-parasitic that was initially believed to help reduce the viral load. Doctors believe there is not enough evidence to support the claim that the drug has any real benefit for Covid-19 patients.

[Jeju-islander]

... Accurate assessments of the extent of the virus are only possible with widespread testing.

This comment and  graphic are very misleading. Targeted testing should be mentioned as an equal if not more important factor.

Using yesterday's data from https://www.worldometers.info/coronavirus/

The UK had 2,613 daily new cases. South Korea had 574.
The UK looks good in the chart above only because it tests so many people 2,374,830 tests / million of pop.
South Korea has tested 175,630 / million of pop.

The majority of people in South Korea have never been tested because they have never been in close proximity to someone who has been confirmed to have the disease. Yes a downside to this approach is that it  misses some asymptomatic spread.
But are the 161,933,673 tests taken in the UK really a success story to boast about.

[Richard Rathbone]

B.1.617.2 is upgraded to a variant of concern in the UK.

https://www.gov.uk/government/news/confirmed-cases-of-covid-19-variants-identified-in-uk

This is based on evidence which suggests this variant, first detected in India, is at least as transmissible as B.1.1.7 (the Kent variant). The other characteristics of this variant are still being investigated.

The current evidence suggests that the other variants detected in India, VUI-21APR-01 and VUI-21APR-03 are not VOCs, but this will be kept under constant review and investigations are ongoing into the reasons behind the different behaviours of these variants.

Cases of VOC-21APR-02 have increased to 520 from 202 over the last week and almost half the cases are related to travel or contact with a traveller. The cases are spread across the country, however, the majority of the cases are in 2 areas – the North West (predominantly Bolton) and London – and this is where we are seeing the greatest transmission.

i.e. over half are community spread. This is the biggest community spread of a variant since B.1.1.7
Sequencing takes about 2 weeks, so last week actually means between 3 weeks ago and 2 weeks ago.

There's a new technical briefing out as well.
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/984274/Variants_of_Concern_VOC_Technical_Briefing_10_England.pdf

The SGTF proxy for B.1.1.7 in PCR testing has taken a dive in most regions too, which is a bit less accurate and rather less lagged than sequencing and suggests the amount of B.1.617.2 reported in the next couple of weeks is going to continue to rise.

B.1.617.2 is the version without E484Q so it seems to me its probably getting a transmissibility advantage rather than an immune escape advantage. It'll be a while before its advantage in direct competition with B.1.1.7 can be pinned down, because the prevalence of B.1.1.7 in the UK has dropped low enough that they can be circulating in different demographics and relative prevalence changes can be more about the demographic than the virus.

[aperson]

But are the 161,933,673 tests taken in the UK really a success story to boast about.

Yes, rapid mass testing is an extremely effective strategy for identifying and isolating cases early, and it's a strategy the UK has decided to take seriously.

[SteveMDFP]

Thanks for that, Richard.  Very informative.

I suspect everyone reading this thread is well aware of the massive catastrophe in India.  Possibly less-well appreciated is the spread of this disaster across the region, and now reaching as far as the Caribbean.  The well-vaccinated Seychelles is not being spared.

It’s Not Just India: New Virus Waves Hit Developing Countries
https://www.bloomberg.com/news/articles/2021-05-03/it-s-not-just-india-new-virus-waves-deluge-developing-countries

Nations ranging from Laos to Thailand in Southeast Asia, and those bordering India such as Bhutan and Nepal, have been reporting significant surges in infections in the past few weeks. The increase is mainly because of more contagious virus variants, though complacency and lack of resources to contain the spread have also been cited as reasons.

In Laos last week, the health minister sought medical equipment, supplies and treatment, as cases jumped more than 200-fold in a month. Nepal is seeing hospitals quickly filling up and running out of oxygen supplies. Health facilities are under pressure in Thailand, where 98% of new cases are from a more infectious strain of the pathogen, while some island nations in the Pacific Ocean are facing their first Covid waves.   See table, attached

How much of this explosive spread is due to which variants is not clear to me yet.  In India, reports seem to suggest that the "UK Variant" B.1.1.7 and the "double-mutant" B.1.617 are the culprits.
_______________________________________

The matter of which vaccines may be effective against which variants is becoming quite vexatious.  The Seychelles is cited as the most-vaccinated nation in the world (perhaps Bhutan recently snagged that title with a recent mass-vaccination push).  The Seychelles, however, has not been spared this very recent surge coming on the heels of India's surge.  I believe that Sinopharm was used there primarily (though not exclusively):

Seychelles brings back curbs despite vaccination success
https://www.bbc.com/news/world-africa-56992121


It would be extremely useful to have statistics from India about which victims may have been vaccinated, and by which vaccines.  Given the level of chaos there, I'm not holding my breath for analyzable statistics.  I'm only aware of anecdotes, which are in part concerning about the matter of vaccine efficacy generally, but are in part reassuring about mRNA vaccines in particular.  But only anecdotes.

Most readers here are probably aware that the AstraZenica vaccine (ChAdOx1 nCoV-19 vaccine, or AZD1222) has shown negligible efficacy against the South African variant, B.1.351, "efficacy of 21.9%":

Efficacy of the ChAdOx1 nCoV-19 Covid-19 Vaccine against the B.1.351 Variant
https://www.nejm.org/doi/full/10.1056/nejmoa2102214

But other vaccines do show efficacy against B.1.351.  The title of this next reference is a tad misleading; only severe disease is fully prevented;

Novavax Vaccine Trial Indicates 100% Protection Against Severe COVID-19 Due to South African Variant
https://scitechdaily.com/novavax-vaccine-trial-indicates-100-protection-against-severe-covid-19-due-to-south-african-variant/

An updated analysis of the study indicated 100% protection against severe Covid-19 due to the B.1.351 variant.... The Novavax Covid-19 vaccine, known as NVX-CoV2373, is made by Novavax, Inc., a US-based biotechnology company developing next-generation vaccines for serious infectious diseases....
Novavax vaccine demonstrated an overall efficacy of 49% in the initial analysis (published in NEJM), and 49% in the subsequent complete analysis...
The initial analysis, now being published in NEJM, suggested that prior infection with the original Covid-19 strain did not protect against subsequent infection by the variant predominantly circulating in South Africa...
_______________________________________________________

My interpretation:  the world is no longer fighting a single virus.  We're fighting a whole family of viruses, with the number of members (variants) increasing month by month.  Infection by one version of this virus may or may not give immunity to other family members, and duration of immunity is generally unknown.

Clearly, some variants are resistant to immunity generated by some vaccines, but not others.  I'm optimistic that mRNA vaccines/boosters can be quickly tweaked to address this challenge, but I'm not optimistic that production and distribution of these tweaked jabs can come anywhere near the scale needed in the coming few years.

As anti-viral medications get rolled out over the coming months, it's highly predictable that some variants will develop resistance to any given antiviral.  I expect Remdesivir to become close to useless before long.  Probably Ivermectin will lose efficacy before too long as well.

Taking a lesson from HIV, antivirals will need to be used in combination, to inhibit development of resistance.  This approach may be essential to tame this family of viruses globally.

Don't discard your masks or your stock of toilet paper anytime soon.

[Shared Humanity]

You guys keep posting this stuff and it will be increasingly difficult for me to maintain my sense of calm since being vaccinated.

[Neven]

Expect more of it, and expect to be vaccinated a couple more times. 

[The Walrus]

The CDC expects cases in the U.S. to fall precipitously by the end of July.

https://www.cdc.gov/mmwr/volumes/70/wr/mm7019e3.htm?s_cid=mm7019e3_w

[nadir]

You guys keep posting this stuff and it will be increasingly difficult for me to maintain my sense of calm since being vaccinated.

That’s what’s being propagandized now, that you stay self-confined even when the risk of dying of COVID *after* being vaccinated, *in* the UK, is possibly 100 times less than dying of a bad flu, or a stroke, or of being hit by a car, etc etc etc

[Shared Humanity]

You guys keep posting this stuff and it will be increasingly difficult for me to maintain my sense of calm since being vaccinated.

That’s what’s being propagandized now, that you stay self-confined even when the risk of dying of COVID *after* being vaccinated, *in* the UK, is possibly 100 times less than dying of a bad flu, or a stroke, or of being hit by a car, etc etc etc

Missed, of course, in your response is the very real sense of the deadly drama that is playing out in India and other nations which was the driving force behind my sarcastic comment.

Eight weeks since my second shot, I still wear a mask when indoors in public spaces, partly to model correct behaviors, much less so to prevent a mild infection by a variant.