Developing Herd immunity

[ZNP]

I think we should examine this concept of Herd immunity. The main issue I have with vaccinations is that they take 12 to 18 months to get one. There should be (and is) a better alternative, not a replacement for an inoculation, but a way to greatly increase herd immunity immediately. Herd immunity is another way to reduce the spread of an epidemic. I am not suggesting that social distancing is not effective (it is) nor am I suggesting that we need 100% people immune, we only need 90%.

First you have to understand that this disease is most dangerous to those with preexisting conditions that would be of a concern and for the elderly. So this suggestion on increasing herd immunity would not apply to these, except of course they would benefit from herd immunity.

Second, viral lode is an important concept here. If we consider the analogy of my body being the castle and this virus is the mongol hoard trying to storm the castle and then viral lode is how many soldiers are in the mongol hoard. Imagine you had a choice, you could be invaded by a million, a thousand or one. You can't choose to not be invaded, but you can control how big their army is going to be. I think we would all choose to be invaded by 1.

Third, there are ways to weaken this virus. For example, at 104 degrees F it does not have the ability to invade a cell and replicate.

With those three points understood I would suggest an old fashioned form of inoculation which is to give you an active virus. Obviously this would be optional and you would have to be in good health. I doubt we have the capability to make sure that each inoculation only has a single virus in it, but the principle is still true, we can make sure that it is an extremely small dose. We can also preheat the inoculation to 104 degrees F to give your body a head start on dealing with the virus. Finally, it could be injected into the blood stream heading away from the lungs to make sure if you do get an infection it is not in the lungs.

The advantage is that we could have had millions of these types of shots available in December of last year. By administering them in hot spots like Wuhan, Italy, Spain and NYC we could have greatly reduced the spread and death toll of this disease. We could have eliminated the need to shut down the world's economy.

Also, one thing NYC is doing is taking plasma from people with immunity and using it to treat those who are sick. Another old fashioned approach. By doing this we would have a list of millions of people who are immune. Obviously we would have focused on front line workers like EMT and hospital workers. This means it would have been very easy for us to get plasma as those who do show up sick in the hospital need treatment.

 

[sesquiterpene]

The advantage is that we could have had millions of these types of shots available in December of last year. By administering them in hot spots like Wuhan, Italy, Spain and NYC we could have greatly reduced the spread and death toll of this disease. We could have eliminated the need to shut down the world's economy.

I'm sorry, but that's insane. You don't take a brand new emerging pathogen, whose mortality rate is unknown, and just turn around and inject it into the population at large.

What you are suggesting is very similar to a live attenuated vaccine, which requires very extensive testing to see how to do it safely. There are many different approaches to developing vaccines - subunit antigens, mRNA - which might be done more quickly, and more safely, than this.

 

[ZNP]

I'm sorry, but that's insane. You don't take a brand new emerging pathogen, whose mortality rate is unknown, and just turn around and inject it into the population at large.

I thought I made it clear that this is not what I was suggesting. First, they believe this virus was first detected in September, I was suggesting doing this in December. By then you do have an idea of the mortality rate, the symptoms, who is most at risk, and how contagious it is. Second, I made it clear you aren't injecting it into the population at large. You are screening people based on health and need. So if I am a front line health care worker in a hot spot (Wuhan, Italy, Spain, NYC) I would have a great need, if I live in Montana which has yet to have a single case I don't have a need. Second if I don't have any of the high risk factors then they would consider me, if I do have them then they don't. Third it is voluntary, we don't "inject the population at large" they request this knowing they are at great risk of contracting it anyway.

What you are suggesting is very similar to a live attenuated vaccine, which requires very extensive testing to see how to do it safely. There are many different approaches to developing vaccines - subunit antigens, mRNA - which might be done more quickly, and more safely, than this.

Fine, do that. My point is if you are on the front lines of a hot spot you are going to be infected. I would rather have some control. By December you knew enough about this disease to see who was most at risk, and get some idea of how deadly and how contagious.

My concern is that the best approach has become the enemy of a better approach.

I hear experts like Bill Gates say that we won't get past this till we have a vaccine. It can take 12-18 months to get one of those. One of the big holdups is making enough for everyone and then injecting everyone. Since this is worldwide are we really going to make billions of these or is this just the plan for the developed world and this virus will continually spring up around the developing nations wiping out the ghettos.

The second problem with that whole "vaccine" approach is that no one knows if this is mutating into different strains and if the vaccine we have in 18 months will even be all that effective by then.

It seems to me that if you are asking people to be cashiers at grocery stores, EMT's, Health care workers, etc then you can do something better than a mask. Because this issue will return again and again. We have had SARS, MERS, Swine flu, and Covid 19 all within a relatively short time. We need a better procedure than just shutting down the world's economy every time there is a new viral strain.

 

[RDKirk]

"Herd immunity" is a chimera. It doesn't exist as any "solution" to a deadly disease, it's only the result of a catastrophe successfully held below the level of an actual "extinction event."

We had diseases that ravaged communities long before we had vaccines for them...that was "herd immunity."

You may be too young to have experienced the terror that polio or small pox caused--but I remember it. That was after hundreds of years of suffering those diseases without vaccines...so-called "herd immunity."

If "herd immunity" worked as people suddenly think it does--as a solution to the problem--we would not have needed or desired a vaccine for polio or small pox or measles or shingles.

Herd immunity is not a solution. It's merely a example of survival of the species.

 

[Yttrium]

One basic problem with herd immunity is that we don't know how long the "immunity" lasts. If it lasted permanently, then it might be worth it for some to get the disease early. But if it only lasts for, say, a month, then there is no herd immunity. And permanent immunity doesn't seem likely in this case.

Covid 19 coronavirus: Dr Gary Payinda - Let's put Covid 'herd immunity' out to pasture

 

[ZNP]

"Herd immunity" is a chimera. It doesn't exist as any "solution" to a deadly disease, it's only the result of a catastrophe successfully held below the level of an actual "extinction event."

Tell that to the WHO which has declared certain diseases essentially extinct. I for one hope Polio does not come back and that the Measles continue to be held at bay.

We had diseases that ravaged communities long before we had vaccines for them...that was "herd immunity."

One form. But we have eradicated certain diseases as well thru immunization, that also is herd immunity and what we are talking about here, not mythical beasts.

You may be too young to have experienced the terror that polio or small pox caused--but I remember it. That was after hundreds of years of suffering those diseases without vaccines...so-called "herd immunity."

Thank you for that I will treasure this comment. It has been a long time since anyone said "you may have been too young for something", so thanks for making my day. You are right, Polio was a historical fact for me, though not for my aunt.

If "herd immunity" worked as people suddenly think it does--as a solution to the problem--we would not have needed or desired a vaccine for polio or small pox or measles or shingles.

Herd immunity is not a solution. It's merely a example of survival of the species.

I think we need to have a lot of tools in the toolbox, not just one hammer. Social distancing is great at flattening the curve but does nothing for speeding up the recovery from the disease. Social distancing might help assist with this and future diseases to evolve to not be as virulent, another plus. But it would be horrible if this is our only response until we have a vaccine. Masks, gloves and plastic screens are also good at reducing the spread, all for it, but again, we need more tools in the toolbox because front line workers will contract it and there has to be a better solution than to just tell people it is one of the risks that come with the low pay.

 

[ZNP]

One basic problem with herd immunity is that we don't know how long the "immunity" lasts. If it lasted permanently, then it might be worth it for some to get the disease early. But if it only lasts for, say, a month, then there is no herd immunity. And permanent immunity doesn't seem likely in this case.

Covid 19 coronavirus: Dr Gary Payinda - Let's put Covid 'herd immunity' out to pasture

If that is the case then developing a vaccine which will be readily available in 18 months is also a waste of time.

So the best tool in the toolbox in my opinion are the strategies that Taiwan used to keep the epidemic from hitting their island. I think we will have to all employ these tools at our ports of entry and we will have to do this from now on.

 

[pitabread]

Tell that to the WHO which has declared certain diseases essentially extinct. I for one hope Polio does not come back and that the Measles continue to be held at bay.

That's a result of vaccines though.

In the absence of vaccination, those diseases can still be problematic. Recent outbreaks of measles in under-vaccinated populations is a prime example.

 

[Yttrium]

If that is the case then developing a vaccine which will be readily available in 18 months is also a waste of time.

Well, we don't know yet. A vaccine might last a good while, long enough that regular doses are practical. Or we might not manage to come up with a vaccine at all.

In the worst case scenario, we may have only isolation to eradicate the virus, in which case we should certainly look into any ways we can to test and reasonably isolate the disease. The Taiwan method would be awfully difficult to put in place here, but it's worth looking at.

 

[RDKirk]

Tell that to the WHO which has declared certain diseases essentially extinct. I for one hope Polio does not come back and that the Measles continue to be held at bay.

Because of vaccines, not because of herd immunity. A vaccination program is not the result of herd immunity. I see that you are trying to conflate the two, but you are wrong.

 

[ZNP]

The Taiwan method would be awfully difficult to put in place here, but it's worth looking at.

I think the world has to change. Not talking about rural America, but cities like NYC have to put thermal cameras into the stations for all forms of mass transit. People with temperature cannot be allowed to use mass transit. When you institute this people will stop going to work with a fever because everyone will know you can't.

 

[ZNP]

Because of vaccines, not because of herd immunity. A vaccination program is not the result of herd immunity. I see that you are trying to conflate the two, but you are wrong.

I am not defining herd immunity in this thread as being from people who contracted the disease. On the contrary I am strongly pushing the idea of using all of our understanding of epidemiology to facilitate herd immunity. I know that when people see this term they think of Sweden. That is not what I am talking about with the term "Developing Herd immunity".

 

[sesquiterpene]

Because of vaccines, not because of herd immunity. A vaccination program is not the result of herd immunity. I see that you are trying to conflate the two, but you are wrong.

Well, I don't think anyone thinks vaccination program is the result of herd immunity, you've got it backward: Herd immunity is the (hopeful) result of a successful vaccination program.

An example of a natural herd immunity without vaccination would be measles. Before mass vaccination measles would come in cycles as pretty much everyone susceptible got the disease, then it would die down until a new group of children were born. Pretty much everyone past their teens was immune, and almost noone in that cohort was ever stricken.

 

[ZNP]

What you are suggesting is very similar to a live attenuated vaccine, which requires very extensive testing to see how to do it safely.

In an attenuated vaccine, live virus particles with very low virulence are administered. They will reproduce, but very slowly. Since they do reproduce and continue to present antigen beyond the initial vaccination, boosters are required less often. These vaccines are produced by growing the virus in tissue cultures that will select for less virulent strains, or by mutagenesis or targeted deletions in genes required for virulence. There is a small risk of reversion to virulence; this risk is smaller in vaccines with deletions. Attenuated vaccines also cannot be used by immunocompromised individuals.

Advantages[edit]

• Activates all phases of the immune system (for instance IgA local antibodies are produced)[4]
• Provides more durable immunity; boosters are required less frequently[5][citation needed]
• Low cost [6]
• Quick immunity[citation needed]
• Some are easy to transport and administer (for instance OPV for polio can be taken orally, rather than requiring a sterile injection by a trained healthworker, as the inactivated form IPV does)[7]
• Vaccines have strong beneficial non-specific effects. That is effects which go beyond the specific protective effects against the targeted diseases.[8]

Disadvantages[edit]

• Secondary mutation can cause a reversion to virulence.[9] In this case, the virus can mutate back to the wild type virus or mutate further.
• Can cause severe complications in immunocompromised patients.[10]
• Some can be difficult to transport due to requirement to maintain conditions (e.g. temperature)

 

[sesquiterpene]

I thought I made it clear that this is not what I was suggesting. First, they believe this virus was first detected in September, I was suggesting doing this in December. By then you do have an idea of the mortality rate, the symptoms, who is most at risk, and how contagious it is.

I think you have an exaggerated idea as to how fast you can obtain these numbers. The infection can increase exponentially, but that means it starts off with a slow boil, especially considering the long incubation and recovery time. To get a true mortality rate you need a test available to measure asymptomatic/mild cases - and of course the mortality rate is not a fixed number, as it changes depending on how prepared your health system is versus how many cases you have. To find out how contagious it is you need extensive contact tracing. We still can't be confident of all these numbers.

Fine, do that. My point is if you are on the front lines of a hot spot you are going to be infected. I would rather have some control. By December you knew enough about this disease to see who was most at risk, and get some idea of how deadly and how contagious..

But even in Wuhan only a small fraction of the population caught the virus, so you aren't assured of being infected no matter where you are. Adding to the number of infected at this point would simply not be indicated. The people most on the front lines would be health care workers, but they should be the ones who have the best access to PPE, and the training to use it.

 

[sesquiterpene]

In an attenuated vaccine, live virus particles with very low virulence are administered. They will reproduce, but very slowly. Since they do reproduce and continue to present antigen beyond the initial vaccination, boosters are required less often. These vaccines are produced by growing the virus in tissue cultures that will select for less virulent strains, or by mutagenesis or targeted deletions in genes required for virulence. There is a small risk of reversion to virulence; this risk is smaller in vaccines with deletions. Attenuated vaccines also cannot be used by immunocompromised individuals.

Advantages[edit]

• Activates all phases of the immune system (for instance IgA local antibodies are produced)[4]
• Provides more durable immunity; boosters are required less frequently[5][citation needed]
• Low cost [6]
• Quick immunity[citation needed]
• Some are easy to transport and administer (for instance OPV for polio can be taken orally, rather than requiring a sterile injection by a trained healthworker, as the inactivated form IPV does)[7]
• Vaccines have strong beneficial non-specific effects. That is effects which go beyond the specific protective effects against the targeted diseases.[8]

Disadvantages[edit]

• Secondary mutation can cause a reversion to virulence.[9] In this case, the virus can mutate back to the wild type virus or mutate further.
• Can cause severe complications in immunocompromised patients.[10]
• Some can be difficult to transport due to requirement to maintain conditions (e.g. temperature)

And developing these vaccines takes time. We are still looking for good animal models, so how do you test how attenuated your virus is? You still walk a sometimes fine line between injecting enough live virus to stimulate a strong reaction, and not too much to cause injury.

Some of the other types of vaccine are inherently safer because they are not causing an actual infection. The mRNA vaccine I mentioned in the Human Challenge thread contains only a single type of molecule, encased in a suspension, and was apparently safe enough to start immediate Phase 1 safety and dosing trials.

 

[ZNP]

And developing these vaccines takes time. We are still looking for good animal models, so how do you test how attenuated your virus is? You still walk a sometimes fine line between injecting enough live virus to stimulate a strong reaction, and not too much to cause injury.

Some of the other types of vaccine are inherently safer because they are not causing an actual infection. The mRNA vaccine I mentioned in the Human Challenge thread contains only a single type of molecule, encased in a suspension, and was apparently safe enough to start immediate Phase 1 safety and dosing trials.

I get it that there are safer and better methods. Generally speaking the best methods are the most expensive and take the longest. But the question for people on the front lines is not to choose from among the best possible inoculations. Right now they have no option at all. Even if you had an identical mortality rate from the vaccine as from getting infected, say 1% for simplicity sake, it would still be much better. Why? First of all you would have a list of 90 people who are immune for everyone who is seriously ill. Like I said, NY is using the plasma from people with immunity as a treatment. 2nd you would be fully aware what is going on, paying careful attention if you got symptoms and would respond as quick if not quicker to symptoms than you would have otherwise. 3rd if we are giving this in December, it is long before hospitals became overwhelmed so you would get top care. One of the selection criteria would be people who are fully covered with medical insurance. 4th we would know much more about this virus, particularly the incubation period and all the possible symptoms. 5th you would have all of these medical workers, their blood, their antibodies, their experience to help you understand the disease. 6th the chances are very good that the mortality rate would be lower, much, much lower since you are doing everything in your power to insure that it is much lower. So in December you take a risk, in January you know that the risk is 1/10th or 1/100th of that for someone who contracts it without the inoculation. Now for the next million people who choose they have much better information to base their decision on.

In my opinion the first 10 to try this would have to be those who are trained epidemiologists since they would fully understand the risks they are taking and because their observations would be most informative for us. The next 100 would have to be health care workers who were highest risk of contracting it and who also could fully comprehend the risks. But if you did this in December you would be able in January to expand this based on the data. That would have been soon enough to make a very big difference in Italy, Spain and NYC. It was March 15 when NYC began to shut down.

 

[Richard T]

They used to have chicken pox parties where parents would bring their kids so they could be infected. As was basically stated, this or some similar scheme is not worth the risk, since it the features of immunity are not fully known. Some people are getting it twice already and when looking at antibodies, some have quite a bit and others who have had COVID have very little. I would want to wait too for some of the drug trials to be completed. Several anti-virals and anti-immune drugs are good candidates. If you were one of the unlucky to have a reaction, you would surely want to know what might be helpful.

 

[Subduction Zone]

They used to have chicken pox parties where parents would bring their kids so they could be infected. As was basically stated, this or some similar scheme is not worth the risk, since it the features of immunity are not fully known. Some people are getting it twice already and when looking at antibodies, some have quite a bit and others who have had COVID have very little. I would want to wait too for some of the drug trials to be completed. Several anti-virals and anti-immune drugs are good candidates. If you were one of the unlucky to have a reaction, you would surely want to know what might be helpful.

Whether a person can get it twice so soon appears to be in doubt. It is still too soon to tell. For more on people that appear to have gotten it a second time you can read more here:

Can You Develop COVID-19 Twice? Here's What We Know

 

[Richard T]

Preliminary research suggests it may be possible for some people to get the virus twice. (low antibodies from some recovered patients) or alternative theories exist where the virus may re-emerge, as the patient never really cleared it in their first encounter. Other possibilities included testing issues. In light of these findings, it would be wrong at this point to assume herd immunity Can You Get Sick With Coronavirus Twice? The Jury Is Still Out Recovered coronavirus patients are testing positive again. Can you get reinfected? - CNN