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Coronavirus Vaccine Update, June 11

Since I did a monoclonal antibody update in the last post, here’s one on the vaccine front, where there is a lot of news – and where there are a lot of issues coming up similar to the ones with the antibodies as well. The last vaccine update post was here.

What we’re seeing now is the plan for entering large-scale human trials. The Wall Street Journal‘s Peter Loftus broke the news of the overall plan in the US: Moderna’s candidate was said to be going into Phase III in July, followed by the Oxford/AstraZeneca effort in September, with Johnson & Johnson’s vaccine to follow. But J&J now says that they’re moving up the timetable and negotiating with the NIAID for Phase III trials before then. Moderna has selected 100 micrograms as the Phase III dose, which is what was expected based on their earlier results. (Update: a preprint from Moderna and their collaborators has just appeared, detailing the early work and mouse studies on their vaccine candidate). Meanwhile, AZ says that they will be scaling up the manufacturing of the Oxford vaccine during the trials themselves, on a risk basis, and it would not surprise me at all to see other companies doing something similar. They’ll basically have to – if one or more of these vaccines reads out well in Phase III, you’d want to get to dosing people as quickly as possible.

Note that Pfizer (and their partner BioNTech) are not part of this government-funded initiative – they’re going it alone, and (as mentioned before) seem to be taking the largest number of potential vaccine candidates into human trials. It’s definitely an effort to be taken seriously. And then you have the Sanofi/GSK work, which has been less in the news, but involves two of the most experienced vaccine companies in the world. So don’t ignore them, either. Merck is in the same category. Another company to keep in mind is Novavax, last mentioned here. They have now announced (no formal report yet) what appear to be very high antibody titers in primate dosing with their vaccine candidate, which they attribute to their proprietary adjuvant. As noted in that article, it’s impossible to directly compare these numbers with those reported in the other primate studies, but these results are certainly of interest. They’re expanding their manufacturing capacity as well.

Things are also moving very quickly in China, although with less information overall. Bloomberg reported that two of the vaccine candidates are being offered to employees of state-run companies who are traveling outside China for work, with data to be collected on that cohort, naturally. The Chinese Phase III trials are something of a mystery, at least to me, because it doesn’t appear (at least from the official figures) that there are any particularly good opportunities for testing them inside China at this point. So it will be interesting to see how those are going to be run, and where.

Unfortunately, that doesn’t look like a problem we’re going to have here in the US. In several states, cases are rising again, and in some others they certainly don’t seem to be falling. As many had predicted, we seem to be in for months of patchy brush-fire types outbreaks in various regions of the country. What will be tricky is coordinating the locations of all those clinical trials – ideally, you’d want them in the areas where the coronavirus is spreading most vigorously, but can those be identified in time to get a trial off the ground? Throw in the “second wave” possibility in the fall for even more uncertainty. In the end, the data will be collected from centers all over the country, and some of them will just have a better signal/noise than the others. I do not envy the folks coordinating all this, nor the ones who will be working up the data under time pressure.

There are other factors – former FDA head Scott Gottlieb noted on his Twitter account today that it doesn’t seem like the NIH/NIAID coordinated trials will be sharing control groups (which in theory is something that could speed things up). In practice, that savings might have been difficult to realize, but it’s interesting that it seems to have been ruled out from the start. It’s also unclear how data on the the US-company vaccine candidates will be collected outside the US, or where, or when. I’ve mentioned manufacturing above, and that’s a huge issue that’s going to be coming more into focus. The various vaccines mentioned have (in many cases) quite different processes for production and purification, adding to the complexity. And don’t forget distribution – the next few months will see (had damn well better see) a lot of preparation for what will be a gigantic worldwide rollout, done on a time scale that’s never been tried before.

Finally, there are political considerations. Aren’t there always. The various companies involved all have an incentive to be the first to announce an effective vaccine, of course – that will be a huge publicity event. On top of that, there is surely a desire on the part of the current administration to be able to announce this before the election in November – and let me be clear, this would be true no matter who was in office, or from which party. I will say, though, that the President’s willingness to promote hydroxychloroquine so far during the pandemic does not bode well for his restraint when it comes to potential treatments. The election season will just make that more fraught. And internationally, one can already see some elbow-throwing between the US and China (and potentially between the US and Europe?) on the origin of the first effective vaccine as well. Russia is part of this as well. National pride is at stake, which also can lead to some otherwise-irrational behavior.

The next few months, then, are not going to be dull. Politics aside, the organization and execution of all these trials will be a huge and complex effort, as mentioned, and when the numbers start coming out of them we’re going to surely be taken by surprise. That’s what clinical trials do; this won’t be different. I’m expecting sudden reversals, and sudden bursts of hope, despair, and confusion. None of us have ever seen anything like what’s coming, and I hope we never have another opportunity to see anything like it again!

 

70 comments on “Coronavirus Vaccine Update, June 11”

  1. myst_05 says:

    China will hopefully conduct human challenge trials to test their vaccine and inspire Western vaccine manufacturers to do so as well. The fact that we have tens of thousands of challenge trials volunteers (myself included) but zero takers on the vaccine manufacturers side is quite perplexing at this point.

    1. David Young MD says:

      Count me in

    2. John Duka says:

      Does one really need human challenge if you are able to generate neutralizing antibody levels seen in pooled convalescent serum? Especially if those levels are seen as protective in serum transfusions?

      1. Patrick says:

        Yes, of course. That’s the lesson over and over of medical history: Biology is more complicated then we understand, so you have to TRY IT IN PEOPLE. There is no substitute.

        Results like you describe should inspire a lot of confidence and might be reason to consider dosing certain high risk groups once safety is proven… but as Derek periodically reminds us, the history of drug development (and vaccines too) is littered with great ideas, backed up by strong data… which failed completely in humans.

        There’s just no substitute.

      2. Barry says:

        Neutralizing IgG seen in serum may be a poor marker for the IgA on the mucosal surface that actually protects one from an infection of the respiratory tract

    3. Walter Sobchak says:

      I understand that lots of Uyghurs have “volunteered” for those trials. /sarc

      1. Hap says:

        Using “volunteered” as an intransitive verb ought to make the sarcasm clear.

        1. Nico says:

          Volun”told”

    4. Harvey 6'3" says:

      I submitted an application to volunteer for a covid-19 vaccine, but was rejected because I am a routine teleworker (even before the virus). They wouldn’t tell me which company was looking for the subjects, but based on my experience, I think they are going to try and select people at higher risk to get data faster, if possible.

  2. Bill B. says:

    Many thanks, Derek. Always wonderfully readable, useful, & informative.

  3. Adrian says:

    Not “potentially between the US and Europe”, the US is already in full bully mode since March:
    https://www.nytimes.com/2020/03/15/world/europe/cornonavirus-vaccine-us-germany.html

    1. sort_of_knowledgeable says:

      Curevac was discussed here earlier.
      https://blogs.sciencemag.org/pipeline/archives/2020/03/16/curious-case-of-curevac

      The company denied that it was approached for exclusive US access even if the German health ministry is claiming otherwise.

      1. Adrian says:

        The majority owner of the company has said otherwise.

        There was a lot more about that in German media at that time, the US government was definitely interested in getting the CureVac R&D moved from Germany to the US (vaccine made in the USA) and giving the US exclusive access to any potential vaccine.

        The majority owner (a German billionaire well-known in Germany) has stated explicitly that he was not interested in selling the company for giving the US exclusive access to a potential vaccine.

        The US-citizen CEO of CureVac was replaced a few days after he met the US president.

        There was never a formal offer, but approached they were by the President of the United States.

        1. sort_of_knowledgeable says:

          There are over 100 other companies working on covid-19 vaccines, and curevac wasn’t considered a more notable candidate than the other companies, yet it is the only known company where it was claimed that it was approached for rights to US exclusive sales.

          There is certainly precedent for the US president to become fixated on one particular medical treatment which would be one explanation why an offer was only made to Curevac. Maybe offers to other companies were made but not known. Maybe the company just produced rumors of US interest as negotiating leverage in obtaining a loan.

          1. Adrian says:

            Your speculations are diverging quite far from the facts.

            The CEO of German company CureVac was invited to talk with the President of the United States. That’s not just “rumors of US interest”, did any other CEOs of foreign vaccine companies have invitations to the White House in March?

  4. Chris says:

    Oxford are already well underway in their Phase II/III trials in the UK and Brazil. Sir John Bell has recently said that they still have a hope that if all goes well, they can get approval in mid-September. So are the Phase III trials in the US just in case they do not get enough data in the UK and Brazil?

    1. Bridget says:

      Oxford/AZ are also ramping up production to have hundreds of millions of doses by October. It’s surprising that the US timetable is so slow for this, considering that Oxford is intending to have their own results by September. Would the US give an emergency directive? And if that is not the case, why not speed up the timeline here in the US? We are seeing infection rates beginning to rise again, and I think there will be a sense of urgency by August.

    2. Jeff C says:

      I’ll be a cynic and say that’s it’s easy to put in place ridiculous timelines when there is a very high chance that the Oxford vaccine will fail long before you get to that point. I’m amazed by the gushing towards them. They’ve had a long history in vaccines, none of it successful in terms of something product-like. The initial data was….meh.

      1. Charles H. says:

        “Meh” is too strong a condemnation where there isn’t currently a better alternative. Yes, it wasn’t a cure, but it appeared as if it guaranteed a mild case of COVID if you caught it. One can certainly hope that something better shows up, but that’s so much better than the current state that it’s hard to see the downside…which is that silent spreaders would become much more numerous. It would, however, (if it lives up to the promise) clear out the ICUs.

        Lots of problems here, of course, and I may be over-interpreting what I remember of the original report. But definitely better than “meh”.

        1. Bridget says:

          I agree. While “meh” isn’t ideal for a long term solution, it could make a significant impact over the short term and allow us to regain our economic footing without putting hundreds of thousands of people at risk.

        2. Mark Maidens says:

          If the oxford vaccine enabled a non lethal version of covid 19 we could probably safely reach herd immunity catching something akin to the common cold, that said If the vaccine produces an immune response that prevents lung infection how is it even possible that said immune response decides to leave people infected, It could be that Its the best the human immune system can achieve, vaccines by their very nature are not going to clear viral particles from the nose and throat,, especially when larger than natural viral doses are delivered to that area, there are no antibodies or T cells up your nose.

      2. Darby says:

        The results of partial protection in preliminary testing might connect to the subject of an earlier post here, the effect of alpha-interferon produced. This coronavirus quickly interferes with this response, but if there already are increased levels, from a recent viral challenge (real or vaccine), THAT may be all that’s needed to reduce symptoms. The partial protection may be very non-specific…

  5. Calvin says:

    I’ve been pretty impressed with the Kinsa dataset showing elevated temperatures ahead of increased cases of COVID-19 (2-3 lag between datasets). Obviously, there are holes and biases in the data, but if I was running a trial I’d be inclined to use that as a way to pick areas where something was more likely to happen rather than trying to spin up new sites once an outbreak was clear. It’s not perfect, but might give you a decent chance of running trials in those places where you can actually recruit patients.

  6. Matt Gruner says:

    This blog is essential daily reading for me. I’m concerned with any kind of corner cutting with so many unknowns in the new types of vaccines. It’s starting to sound like Dengvaxia but with the added atomic fuel of GOPs political future depending on injecting as many people as possible by November. Also, I’m more pessimistic than you on the current circulating virus being limited to small brushfires. We are pulling out of social distancing way too fast! There is still no cheap effective test that can be used by employer’s to prevent. unexpected mass closures. Based on what news I’ve read we won’t see infrastructure for regular mass testing until the fall (and we might never see contact tracing). From my standpoint a better policy than vaccine as quickly as possible is test, isolate as quickly as possible and take time to develop an old school vaccine. I sure won’t be getting injected myself with whatever questionable stuff Moderna sweeps through under the most forgiving lax supervision in the history of vaccine development.

    1. fajensen says:

      Based on what news I’ve read we won’t see infrastructure for regular mass testing until the fall (and we might never see contact tracing).
      I think that this is happening because, under the fell curse of modern neo-lib / NPM leadership, nobody wants to be proven to know anything that can lessen their dead-hand grip on “the narrative” or (worse) require them to do their actual damn job rather than just faff around as they please and skirt all that responsibility they are paid to have!

      We also see that especially the authoritarians will not be limited or diminished by trivial reality and will respond with fits of outrage whenever their actions are questioned! Even in Sweden this happens!!

      Thus, no measuring. Because then they can alway pull the old excuse about “that they couldn’t possibly have known / done anything differently” and then add those old tropes about “looking forward” and “lessons being learned”, aand they are off the hook!

      In Denmark, we can get tested “on-demand” now and there is a pretty robust antibody test for 299 DKK (35 USD) just recently available in selected pharmacies, starting with Copenhagen. If “we” can do it, so can anyone with the will.

      1. Some idiot says:

        “Pretty robust”: Sounds interesting! And a lot more promising than some other that have cropped up… How does that translate into rates of false positives and false negatives?

        1. fajensen says:

          I think they said these tests had something like 97% antibody detection rate. What that means Exactly, when used in practice on people, I don’t know.

  7. RossK says:

    DL said:

    “…it’s interesting that it (sharing control groups) seems to have been ruled out from the start…”

    Why interesting?

  8. steve says:

    I don’t think Trump’s taking credit for the vaccine will be much of a problem. He is starting his rallies again and moved his convention from NC to FL to avoid having to take any precautions. Coronavirus, of course, is now spiking in OK where he decided to have his first rally as well as in FL due to their governors ignoring warnings about early opening. As a result, they all are about to come face to face with Darwin so I doubt there will be much left come elections for them to cheer about.

    1. Steve Scott says:

      Convention attendees should all be recruited for vaccine trials

      1. LG Roberts says:

        His followers are all antivaxxers, so probably unlikely

    2. Ken says:

      Don’t worry, they’re doing everything they can to mitigate the risks – of lawsuits. https://www.nytimes.com/2020/06/11/world/coronavirus-live-updates.html#link-1c4ceab9

      “By clicking register below, you are acknowledging that an inherent risk of exposure to Covid-19 exists in any public place where people are present,” a statement on Mr. Trump’s campaign website informed those wishing to attend his June 19 rally in Tulsa, Okla. “By attending the rally, you and any guests voluntarily assume all risks related to exposure to Covid-19 and agree not to hold Donald J. Trump for President, Inc.; BOK Center; ASM Global; or any of their affiliates, directors, officers, employees, agents, contractors or volunteers liable for any illness or injury.”

  9. Alan Goldhammer says:

    I’ve seen a number of good papers in the past several weeks about more precise identification of antibody/virus interaction for the purposes of generation of mAbs and examining high titer sera from recovered patients. I think some of these labs will be in a position to identify Abs from vaccinated individuals and determine how potent the vaccine is. This would obviate the need for human challenge trials.

    I haven’t heard anything new on the Walter Reed vaccine approach but there are other groups that continue to work on alternates to those that are drawing the most press.

  10. Steve Scott says:

    This is what the Wall Street Journal reported on the Phase III Timelines:
    J&J said separately, mid to late September.
    _____________________________________________________________
    “According to the Wall Street Journal, which cited John Mascola, the head of vaccine research at the National Institute of Allergy and Infectious Diseases, a vaccine being manufactured by Moderna Therapeutics would come first, starting from July, followed by the Oxford vaccine in August and another vaccine candidate from Johnson&Johnson in September.”
    _____________________________________________________________
    Also, The Los Angeles Times reported today (June 11) that Sanofi is one of the five vaccine candidates being supported by the U.S. Government, not Pfizer as reported by the NY Times. And of course, Derek also reported that Pfizer is going it alone.
    https://www.latimes.com/california/story/2020-06-11/coronavirus-covid-vaccine-development-speed-fauci

  11. Mark says:

    What are the criteria for a good vaccine? The ideal vaccine will provide 100% protection, no toxicity, easy administration, and low cost. However, real life vaccines are likely to fall short. What percent effectiveness is acceptable? The same for toxicity, administration ease, and cost. It is probably useful to think about this before someone proclaims themself savior of the world with a product that has limited benefit and charges a thousand bucks per dose.
    I always fear that the first company out of the starting blocks will capture the market shoving aside worthier competitors.

    1. Bob Marlee says:

      Safer and cheaper than remaining unvaccinated.

    2. Steve Scott says:

      The major companies have pledged to make their vaccines at cost.
      There probably won’t ever be a 100 percent perfect vaccine. The first ones out of the starting gate may not be ideal, perhaps with limited length of immunity or imperfect immunity- but if they reduce the virus down to the level of a common cold or non-pneumonia flu, and can be turned out in large quantities, then it’s worth it to get us all back to normal and buy time until a better vaccine is fully tested and produced. So many unknowns, but the massive global efforts are encouraging, if not awesome.

  12. Erik Dienemann says:

    Derek – maybe I missed it, but what is your thinking of human challenge trials? There seem to be more than enough healthy young volunteers out there and, scientifically, it seems obvious that we’d get better exposure vs. response data in controlled studies (at least for that cohort of patients), so I’m struggling to see why we wouldn’t take advantage of it.

    1. Derek Lowe says:

      Haven’t written about it yet – but one problem is that you want to test a vaccine candidate for its performance (and risks) across a range of ages, and not just extrapolate from (as you say) healthy young volunteers.

      1. Phil says:

        Derek,
        What do you think of the idea that TB or polio vaccines could help protect against Covid-19 (as presented today in Science Mag)?

    2. johnnyboy says:

      That would be one hell of an informed consent form. “You have 50% chance of being given a placebo instead of a vaccine. Then we’ll inoculate you with a virus that we think results in hospitalisation in 30% (maybe ? – not sure, sorry !) of infected patients (oh, and that’s the natural disease, not the situation where we’re stuffing some random number of viral FFUs down your nose, that we think might approximate natural infection (maybe ? – not sure, sorry again !). Maybe you’ll need to go on a ventilator. Maybe you’ll die. Maybe not – who knows ? Thanks for your help in this matter. Sign of the dotted line.

      1. confused says:

        There would certainly be risks, but the hospitalization rate of COVID isn’t anywhere near 30% in a young healthy population (say 18-35 with no hypertension, diabetes, obesity, etc.)

        It was like 1% or 2% on the USS Theodore Roosevelt, and that population included people over 35 (the one death was 41) and probably some people with hypertension etc. Also, a Navy crew probably skews male, and men seem to have somewhat higher risk, so a 50/50 male/female sample might see lower rates.

        1. johnnyboy says:

          Missing the point I was trying to make – I don’t know what the hospitalisation rate would be in a test population, and you don’t either, and nobody does. Thinking about doing a challenge study when we’re completely in the dark about so many factos that might affect the volunteer’s outcome is deeply unethical. I’m sure you’d get plenty of wannabe heroes who’ll give their consent to be in study, but it sure as hell won’t be an -informed- consent.

          1. wubbles says:

            How informed was my great uncle in the Navy during WWII or the men who landed at Sword beach? This is an emergency and we’ve asked people to die for far worse causes.

    3. FoodScientist says:

      Aren’t the unhealthy volunteers more important? With respect to reducing mortality.

      1. Barry says:

        You might want a separate Clinical Study with a clinical population with co-morbidities. But if you want FDA approval for a vaccine to be given to the general public, you start your Clinical study with Phase I (safety) in healthies

  13. Thiago says:

    Sinovac, from China, will also conduct Phase III in Brazil. 9,000 shots. That starts nex month, so let’s see.

  14. matt says:

    Really remarkable to go from first description of a new condition to characterization of an infectious disease to vaccine and/or treatments in one year. Has this ever been done in all of human history? Even if it takes two years or three, it is an awe-inspiring thing.

    1. Ken says:

      I doubt it could have been done before in human history. Tools and techniques are being used that didn’t exist even ten years ago, or were prohibitively expensive in dollars and time.

      1. intercostal says:

        I think we will learn from this that modern bio-tech can do far more than we expected, far faster, when there is a real push to provide funding *and reduce systemic delays*.

  15. Sergio Martins says:

    Regarding the testing of Chinese vaccines, the governor of São Paulo announced today that the state-owned Instituto Butantan has partnered with SinoVac and will conduct tests with nine thousand volunteers in Brazil in July. There’s a good deal of publicity stunt in the announcement (he’s also a populist, though not as extreme as Bolsonaro, and has been clashing with the president over COVID in recent months), so I’d be cautious, but let’s see.

  16. Jeffrey Khoo says:

    Couldn’t plasma be collected from vaccinated volunteers and checked for sufficient antibody titres, then this plasma be used to treat volunteer patients to verify that antibodies generated by the vaccine are effective?

    1. Marko says:

      Not a bad idea , but you’d probably need to have a control arm where you treat with plasma from unvaccinated volunteers. The reason being that recent small studies have shown that non-Covid-specific IVIG shows some positive effect in infected patients.

  17. Lambchops says:

    Quite right on national pride leading to irrational statements being made. The UK government seemed desperate to insist that their track and trace system would be “world-beating” (which was a ridiculous assertion to begin with given that several countries had finished that race before we’d even got out of the changing room) rather than just settle for delivering something that works, which is all the public really wants.

  18. fajensen says:

    A consortium managed by Copenhagen University have managed to vaccinate mice. They will be moving into trials with people at the end of the year, here’s a snippet:
    “””
    The researchers have developed the vaccine technology they use in their work. The technology is called cVLP, which stands for ‘capsid Virus-Like Particle’.

    So-called coronavirus antigens are attached to the cVLP. Subsequently, the body’s immune system will respond to the antigens, produce antibodies and thus hopefully become immune to the disease. This has now been achieved in mice.
    “””
    https://news.ku.dk/all_news/2020/06/vaccine-against-coronavirus-passes-tests-in-mice

    If anyone are up for extreme white-knuckle stock rides, then Bavarian Nordic will produce it under license.

  19. Ben Bar-Haim says:

    CanSino plans to test at least one of their vaccine candidates in Canada as well. However, with the rapidly falling infection rate in Canada, phase III testing in that country may also become impossible or painfully slow.

    1. Hap says:

      Why can’t they come here? We don’t seem to have that problem.

  20. Mark says:

    Other than my own family, I don’t know of anyone who will be lining up for a Coronavirus vaccine. I keep reading both business and medical stories that seem to suggest the vaccine will be a boon for both the economy and the health of us humans. The seasonal flu vaccine is not taken by perhaps 55% of Americans despite annual deaths routinely exceeding 50,000. And this vaccine is “free” and is offered at virtually every pharmacy and grocery store with a little clinic on-premises. It seems to me that we can’t afford another shutdown of our economy. It also seems that a vaccine could prevent such a catastrophe. But what is the prediction regarding the percentage of the population that will actually get vaccinated if it is “voluntary?”

    1. An Old Chemist says:

      @Mark: The actual number of flu- related deaths in USA per year are somewhere between 3,500 and 15,000, and are not 50,000 as you have said (See the ‘Scientific American’ article at the following URL):

      https://blogs.scientificamerican.com/observations/comparing-covid-19-deaths-to-flu-deaths-is-like-comparing-apples-to-oranges/?fbclid=IwAR3i5163d1o0w9Xz6hDYnGlGc8K714DkqkHuXiOiSRy1q0_SSv5Mibsx0eI

      1. Mark says:

        I took my data in part from: https://www.cdc.gov/flu/about/burden/index.html

        “Flu season in the US, which runs from October through May, claims tens of thousands of lives every year. This season CDC estimates that, as of mid-March, 2019 between 29,000 and 59,000 have died due to influenza illnesses. Add to that the misery of hundreds of thousands of flu-related hospitalizations and millions of medical visits for flu symptoms this season.”

        Also: https://www.statnews.com/2018/09/26/cdc-us-flu-deaths-winter/

        “80,000 people died of flu last winter in U.S., highest death toll in 40 years” – Data 9/26/2018

        Finally from JAMA: “As of early May 2020, approximately 65 000 people in the US had died of coronavirus disease 2019 (COVID-19), the disease caused by the severe acute respiratory syndrome coronavirus (SARS-CoV-2). This number appears to be similar to the estimated number of seasonal influenza deaths reported annually by the Centers for Disease Control and Prevention (CDC) (https://www.cdc.gov/flu/about/burden/preliminary-in-season-estimates.htm).”

        But, even so, the number of people in the US who do not or WILL not vaccinate for the seasonal flu is said to be “around 55%” — I am simply wondering why the experts and the pols keep touting that a vaccination or several vaccinations coming to market will be such a great thing (perhaps for the economy and the stock market, among other things) if an essentially free and widely available “normal” vaccine is not taken by the majority of the population? Won’t it be “necessary” to mandate innoculation rather than “hope we all will get it voluntarily?”

      2. confused says:

        I don’t know. CDC says the range is like 12,000-60,000, with 61,000 (confidence interval ~45k-90k) for the exceptionally bad 2017-18 season.

        I read that article, but I’m not sure I’d trust it over the CDC numbers. Comparing flu to COVID numbers is certainly very fraught, since they’re determined very different ways; and the flu numbers are highly dependent on estimates and thus poorly constrained, and there certainly may be a significant upward bias.

        But total deaths rose quite a bit in the 2017-18 winter, so flu death certificate deaths probably *are* very undercounted.

    2. intercostal says:

      I don’t think another shutdown like the March/April one will happen even if there is a bad second wave, at least in most of the US and many other countries. Economies probably can’t stand it (e.g. US states running out of unemployment money) and the public willingness to comply would probably be too low to make the shutdown useful – a lot of states have seen infection/hospitalization/death rates that aren’t particularly high, so it’s seen by many as an overreaction. Something like 60% of US deaths have occurred in the top six hardest-hit states, which are all Northeast or Upper Midwest (NY, NJ, MA, IL, PA, MI).

      West of the Mississippi, except for a few localized areas (such as the Navajo Nation), the picture is very different.

      Especially since the hard-hit states tend to be very different politically and culturally from the less populous and/or lower-density states (TX is 2nd in US by population but relatively low-density).

  21. Mark says:

    I got my data from the DCD and JAMA:

    As of early May 2020, approximately 65 000 people in the US had died of coronavirus disease 2019 (COVID-19),1 the disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This number appears to be similar to the estimated number of seasonal influenza deaths reported annually by the Centers for Disease Control and Prevention (CDC) (https://www.cdc.gov/flu/about/burden/preliminary-in-season-estimates.htm).

    But my point or my question is are we thinking “if we make a vaccine it WILL be voluntarily taken by sufficient numbers of the population to build the immunity we need to prevent another shutdown of the nation’s — and the world’s — economy?

  22. A Nonny Mouse says:

    My son just received a letter this morning asking him to volunteer in the Imperial trial (similar to the Oxford approach). He is a 5th year medical student there, so no surprise really.

  23. Dan says:

    Does Oxford vaccine tested on animals? Does Oxford vaccine tested on humans? I am sure Oxford did! How is showing in neutralized antibodies in animal, human? Effective? safe? Any idea or any little detail info from Oxford would help tracking their progress on testing. Vaccine work or not is VERY CRUCIAL. Manufacturing the vaccine is not that difficult since multiple pharma companies can do and committed. Please advice. Thx

  24. Steve Scott says:

    I wonder if the Moderna mouse study sheds new light on the preliminary phase I human trial news release, that was criticized for its lack of detail. In the May 18 announcement, Moderna referred to “similar levels of neutralising antibodies” between the human study and the mouse study. Sure, mice are not people. But maybe some of you real experts can glean something useful. Just a hunch.

  25. Vance says:

    There is no vaccine until it’s mass-distributed. Plain and simple. No cure helps when the numbers of infected people keep growing.
    https://corontine.live/
    I guess people are going to keep suffering.

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