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The President’s Coronavirus Treatment

I’ve had emails asking me what I think about President Trump’s illness and the course of treatment that he’s under. To be honest, this wasn’t a subject that I really felt like writing about – every time I write anything about Trump here, I regret it – but the reports have been so increasingly odd that I think that a discussion is in order.

I have to start off by admitting that the timeline of the president’s coronavirus infection is hopelessly confused. It’s very hard to say how long he’s been infected. But I also have to say that even if we had that figured out, it still might not be much help. Different people can have radically different courses of disease in this pandemic – a fact that’s been made abundantly clear over the last several months. But since the president has several risk factors working against him (age, gender, and BMI), one has to be ready for anything.

So what can we infer from his course of treatment so far? He got Regeneron’s monocolonal antibody cocktail very early, it seems, and at the highest clinical dose (8 grams). There has been no formal publication of Regeneron’s results, not even an unreviewed preprint, and I haven’t blogged about their recent press release (which is all we have). Like all press releases, it tells us some things and leaves some out. The company states that the antibody treatment reduced viral load and alleviates some coronavirus symptoms, particularly in patients that had not mounted a good antibody response of their own at the time of treatment. That all makes sense. But we don’t know if it actually helps with mortality, chances of being hospitalized (or going to an ICU once there), total time hospitalized, and so on. We also have only the earliest safety readouts (which so far don’t look problematic).

I would assume that Regeneron knows more than this, in unpublished form, and that this knowledge was part of their interaction with the president’s physicians when they provided the monoclonals. If I had to bet, I would bet that this would be an appropriate therapy. But betting the president’s health is another thing entirely, and I’m glad that I didn’t have to make that call. And this leaves Regeneron’s executives with even more reason than others to hope that the president recovers well, obviously.

Overall, though, it would seem that if you’re going to give monoclonal antibodies, that they would be best given early in the course of the disease, when therapy is still in antiviral mode. The addition of a five-day course of remdesivir to the treatment regimen fits that as well: both of these are designed to lower the amount of virus present and (in theory) keep the disease from progressing to a more severe stage.

That severe stage shows up as an overactive immune response leading to the well-known “cytokine storm”, and potentially big trouble. It really looks like the best therapy we have for that at the moment is dexamethasone. So I found it interesting – and not in a good way – that the president’s medical team had actually put him on dexamethasone, because its mode of action is to damp down the inflammation response. And if a person is still in the early stages of infection, that’s the opposite of what you want to do. There’s a real gear-shift in the treatment of coronavirus patients, when you have to switch from treating the viral infection to treating the immune consequences of the viral infection, and what’s appropriate for one phase of treatment is definitely not appropriate for the other.

Update: as pointed out in the comments, the RECOVERY trial is the RCT that showed that dexamethasone can be effective here – but it was only significant in patients under 70 years old. In the 70 to 80 year old cohort, there was no effect at all (!) See Figure S1 here.

So since the Walter Reed physicians are, in fact, very competent, the only conclusion I can draw from this is that the president’s infection is further along than we had thought. They may well be seeing signs of inappropriate over-response to the coronavirus and are trying to knock that down before it gets more serious. Another possibility, I suppose, is a similar over-reaction to pneumonia (which is the only reason I have ever had a short course of dexamethasone myself). OK, then. . .but how on Earth do we square any of that with the physician’s comment yesterday that Trump was doing so well that he might be discharged today? Discharging a 74-year-old man with coronavirus in the middle of remdesivir and dexamethasone therapy makes no sense at all.

But neither did Trump’s motorcade trip around Walter Reed yesterday. The news is full of people talking about what a bad idea that was, and I would especially single out Dr. James Phillips, whose views I agree with completely. The New York Times reports that the president wanted to be discharged yesterday, in fact, and that the limo ride was some sort of compromise. You have to imagine that his doctors are being put in some nearly impossible situations, but there are a lot of things about the president’s illness that simply are not adding up. It’s obvious from the oh-yeah-in-retrospect statements about his oxygen levels dropping on Friday and Saturday that we are not hearing anywhere close to the whole story about his illness. And what we are hearing makes very little sense.

I do not expect things to get any more sensible today, if you’re wondering.

Update: they most certainly didn’t.

206 comments on “The President’s Coronavirus Treatment”

  1. Unimportant says:

    Some small typos:
    [2nd para, line 1] “hopeless” –> “hopelessly”
    [2nd para, line 4] “over the months” –> “over the past (several?) months”

  2. Dr. Manhattan says:

    I think a lot of us in the microbiology field are also bewildered by the reports and treatment regimens. The sequence of antiviral treatments seems reasonable, if not a bit unusual in employing the as yet unapproved monoclonals. But using dexamethasone is indeed a troubling sign.

    And speaking of virology, some excellent choices for the Nobel Prize.

  3. Eddie says:

    “I am inclined to believe that he has the coronavirus… and that everything he will say about that truth will be a lie.”

    -Dr. Tressie McMillan Cottom

    On the subject of Trump and his propensity to lie.

    1. chemist says:

      The media and so-called “experts” have been lying to us about coronavirus the entire time. End the quarantine rules, end the face diapers, let people make their own decisions about their health.

      1. also a chemist says:

        The problem here is that the decisions you make about your health also affect others. We cannot leave the fate of society in your hands. Face the fact that you live together with other people and that that means that you have to think about their wellbeing too. If you have cancer or any other non-contractible disease, then you can do whatever you want.

  4. idiotraptor says:

    I too was puzzled be the acknowledgement that DJT was administered “steroids” (dexamethasone). The documented medical experience on use of this agent in COVID19 as well as, its pharmacologic action screams that it not be administered early in disease course.

    All of which compels me to conclude the DJT was infected an earlier time point than is being represented. And that the White House, at the behest of the President or having been repeatedly and persistently conditioned to do so, is lying about it.

    1. delbor raymondo says:

      We don’t know when he got infected, we only know when he tested positive.

      1. Blaise Frederick says:

        We know he says he tested positive on Thursday. We have no idea when he first tested positive, because they refuse to answer that question. Not that the answer would necessarily be meaningful, since they feel no compulsion to tell the truth, but if his first positive test was Thursday you’d think they’d say that.

    2. eub says:

      Yeah. The use of a corticosteroid is telling us a lot about *something*. I am not an MD much less a COVID specialist but I have not seen anyone say they would prescribe dex for a patient symptomatic for a few days, and presumably still in active viral replication. (Anyone?) It seems likely that if this prescription was directed by medical logic, that the prescriber knows something we haven’t been told.

      Or it was directed by illogic, that’s always an option.

  5. Calvin says:

    So this is all a little more straightforward than I think we might be making it. Trump is directing his treatment, not the physicians. So he’s asking questions and saying, “Give it to me”. And Trump is perfectly entitled to that, even if we think it’s not a good idea. After all he demanded HCQ and got it. So he got the Regeneron cocktail because he’s a friend of the CEO. He then asked for everything else hew could get. And the physician is making the judgement that these treatments will cause less harm than good and can justify it to themselves, even if we might not. I think it really that simple. And it’s nuts, but fundamentally I think he’s directing his own treatment…….

    1. Sok Puppette says:

      … and the same applies to the “discharge”, except more so. People in hospitals keep having to be reminded that patients aren’t prisoners and can leave any time they damned well please.

      1. J N says:

        Some people have responsibility that extends beyond individual — for example, a family breadwinner, or the chief executive of a nation. So there ought to be more than “I’ll do what I want” involved in the decision about personal health, when that health is important to others.

        1. Sok Puppette says:

          Well, yeah, but I didn’t say Trump *should* “discharge” himself. Just that he *can*, so there’s not a lot of point in a physician trying to stop him.

    2. johnnyboy says:

      I would tend to agree with your assessment of the situation. And to think that physicians who are part of the army staff would tend to be a lot more obedient to the commander in chief than someone at a civilian hospital. That said, I think there’s probably nothing stopping a physician from telling Trump “you want dexa ? Sure, I’ll give you dexa”, then giving him a shot of saline to shut him up, if he thinks dexa is contraindicated.

      1. James Millar says:

        That would have to be one confident physician. A third of the country would think he was a Democrat hitman who murdered their savior if the President died and the deception came out.

    3. Whatever says:

      The simplest explanation is the doctors are saying Trump had all the latest treatments for covid whether or not Trump actually had them. Think about it – if you or a loved one needed covid treatment would you want the treatment Trump received or one he didn’t receive? Everyone of all political strips assumes the President gets the best treatment available so any treatment he doesn’t get is being labelled as “not the best”.

    4. MattF says:

      Agree. We’re seeing the medical knowledge of Dr. Trump in action.

  6. Giannis says:

    “. So I found it interesting – and not in a good way – that the president’s medical team had actually put him on dexamethasone, because its mode of action is to damp down the inflammation response. ”

    Well with 8g of an antibody cocktail (with picomolar IC50) + remdesivir I highly doubt that you will have much replication in the lungs and other organs. Now the upper respiratory tract is strange in that IgG and some drugs (remdesivir including, or at least this is what I remember) do not reach high concentrations.

    So stopping the viral replication + a strong anti-inflammatory treatment might be better than antivrals alones. Inflammation can only do harm if you have taken care of the virus with drugs…

  7. Barry says:

    The window in which Remdesivir has shown (modest) benefit is early in the course of infection, when the viral burden is not yet high The window in which dexamethasone has shown (more impressive) benefit is later in the course of infection, when the immune over-response is a greater threat than the virus itself. That Trump is reportedly getting both simultaneously says that–rather than the best care–he’s getting the VIP care. “VIP syndrome” is a known risk when doctors subordinate expert judgement to the whims of a diva.

    1. Sok Puppette says:

      Regardless of who’s controlling it, the right treatment kind of depends on what your goals are, doesn’t it? If your goal is to maximize the probability of keep the person *alive*, you don’t want to use the dexamethasone untile later. But if your goal is to maximize the person’s immediate ability to appear to be in good health, then you might be willing to use it earlier, especially if the damage to the competing “keep them alive” goal wasn’t likely to be really large.

  8. Sok Puppette says:

    You’d bet that was appropriate therapy?

    I’ve always gotten the impression you’d consider it inappropriate for anybody ELSE to get an unapproved therapy, regardless of what the manufacturer knew “off the books”.

    1. LtObvious says:

      Then how can a clinical trial exist?

      1. J N says:

        Because a clinical trial is constructed to have a valuable scientific outcome. Individual uncontrolled experimental use is unlikely to produce any reliable information on safety and efficacy unless the treatment turns out to be magically effective, or uniformly deadly/debilitating.

    2. Derek Lowe says:

      “Appropriate” as in “medically useful”. I think it’s inappropriate in the way you describe, though.

  9. Philip says:

    Derek, thanks for writing this post.

    Friday morning I was telling friends that he would get remdesivir and convalescent plasma. After a bit more thought, I changed convalescent plasma to monocolonal antibodies. I thought this because I made the assumption that Trump was tested daily. The daily testing would allow Trump to get the antiviral therapies soon after his infection.

    All of that seemed true until his doctor’s lied about his O2 requirements. Then when he went on dexamethasone I was sure something was up with what we were being told. Looking for the simplest answer lead me to believe that Trump had not been tested on Tuesday or Wednesday. Which is odd being he should have had a test before the debate. It also means the antiviral therapies were not started as early in his infection as I had thought. This could lead to a worse outcome than if Trump had been tested daily.

    As for waiting for the RT-PCR test Thursday night-Friday morning, I was sure he had had the Abbott ID Now test. I was not sure it was positive, but that was the way I was leaning.

    1. Rock says:

      It has been determined that Trump did not get tested before the debate because he arrived late (purposefully?).

    2. J N says:

      IIRC the ID Now test has a very low rate of false positives — false negatives are more common but the rate is in dispute.

      My understanding is that a positive rapid test is a near guarantee of infection with a relatively high viral load.

      Anyway with an ID Now positive, Trump should have isolated immediately, as, absent error, he certainly had COVID.

      It’s frustrating to see the First Patient set this kind of example, with the administration supporting the message in every way.

      1. Philip says:

        J N, IIRC the ID Now test has a relatively high threshold compaird to RT-PCR with CT of 40. Still way below the threshold to be infectious.

  10. bookdabook says:

    T is a well known control freak. It is obvious he has somehow subsumed the loyalty of the Walter Reed doctors. Like others who have accepted that burden, e.g. the mask deniers in his circle now suffering the virus, they are rolling the dice on their reputations by prescribing him, most likely at his demand, the kitchen sink. We’ll see in 4 weeks if enough voters have seen through this nonsense, nonscience approach to life and running govt to get us back on track.

  11. cancer_man says:

    “But since the president has several risk factors working against him (age, gender, and BMI), one has to be ready for anything.”

    Gender isn’t a real risk factor nor is his BMI since those just over 30 don’t seem to be at risk based on French and British reports. The obese who die of Covid-19 are seriously obese.

    1. Adrian says:

      “Gender isn’t a real risk factor nor is his BMI since those just over 30 don’t seem to be at risk based on French and British reports. The obese who die of Covid-19 are seriously obese.”

      What you write is contrary to everything that is known about COVID-19.

      To make a random example, the male populist from New York who controls nuclear weapons and who is easily recognizable by his distinctive blonde hair was in an ICU at age 55 despite being only slightly obese.

      No doctor in the UK considered it a surprise when an over-50 male slightly obese man with COVID-19 was in hospital like many other that fit the same description.

      1. rtah100 says:

        No, it does not contradict the data. Go read the UK ICNARC report (national intensive care data). 12,000 covid cases and the BMI distribution of cases in icu-admitted covid patients is +/- 1% of the age adjusted general population BMI distribution for every BMI bracket except . except the very highest (40+). What is more, the relative patient mortality rate is lowest for the fattest! This is either an artefact of small numbers (more probable) or, just possibly, because fat bears have the resources to survive hibernating on a ventilator (delicious but unlikely).

        1. DataWatcher says:

          In Trump’s case, rather than be concerned about how “morbid” his obesity is, I’d probbly be more worried about his overall health and the strength of his immune system based on the QUALITY of his diet. If he’s as much of a junk-food junkie as he likes to say he is, there’s a good chance he’s actually “undernourished” in terms of how much nouishment he gets from what he eats. A person can load up the empty calories, get fat, and still lack actual nourishment and be at higher risk for disease.

        2. Adrian says:

          It is easy to draw incorrect conclusions from statistics.

          Old people tend to have lower weight.
          People critically ill with COVID-19 tend to be either very old and slim (obesity is less prevalent among old people – obese people die earlier and old people tend to eat less), or fat and middle-age.
          If you look only at BMI or age, the BMI or age distribution might look even because these groups cancel each other out in these individual metrics.
          But the fact that most very old people who are critically ill with COVID-19 are not obese does not change the fact that moderate obesity is a risk factor.

          Men die earlier.
          High-risk age groups are mostly female.
          People critically ill with COVID-19 in the age group 80+ are 3:1 men.
          The general population in this age group is 2:1 women.
          For people 100+ the age distribution is 5:1 women.
          Many people miss that in the high-risk age groups equal risk would mean that people critically ill or dying of COVID-19 would have to be 2:1 or 5:1 female.

          1. Petros says:

            Well British Prime Minister Boris Johnson was seriously ill with Covid and in intensive care for some time, still appearing listless months later. He was 55 when in hospital with a BMI around 36

    2. confused says:

      From the CDC numbers it seems pretty clear that in the US significantly more men than women die of COVID at young adult to middle-aged age groups: https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm

      Eg 25-34 years: 510 women, 1003 men; 35-44 years; 1258 women, 2698 men; 45-54 years: 3325 women; 7063 men.

      Now the overall numbers are not that dramatic (104896 male vs 89191 female) but there are fewer very old men than very old women, as female life expectancy is quite a bit longer, and the oldest age groups are the largest driver of overall mortality.

      I think it has to be a factor…

      1. Concerned says:

        The ACE2 receptor that SARS-CoV2 binds to is on the X-chromosome, therefore females potentially have two alleles for it while males only can express one allelic option. This could explain the several correlations between biological sex and COVID outcomes.

    3. There was in fact a Pipeline post just the other day about sex (as opposed to gender) being a factor in covid mortality.

      https://blogs.sciencemag.org/pipeline/archives/2020/09/28/interferon-and-the-coronavirus

      “But in 987 severely ill patients, at least 101 of them had such antibodies against at least one of the Type I interferons (!) […]

      37% of the 101 patients in this group ended up dying of the disease, which is also an extreme statistical red flag. […]

      Interestingly, 95 of those auto-antibody patients were male, so this could also be one of the reasons why men add up to being a risk group of their own.”

  12. Dark Day says:

    Meanwhile, as Trump receives the absolute Cadillac of care, the Affordable Care Act is again on the potential chopping block as the Supreme Court resumes.

    1. Driving Uphill Both Ways says:

      Really?

      Before ACA most people has a group plan, either through their employer or an professional association. The typical employer offered a choice of several plans, including PPO.
      Drawing on the admittedly small sample size of people I know whom I’ve discussed insurance with, all have had higher costs and diminished coverage since ACA, because the massive ACA bill had many provisions that negatively impacted existing group (non-ACA) plans.
      There is a group of people who do benefit from ACA, those with no previous coverage who receive a substantial subsidy and do not pay the actual cost of their ACA plan. For them it can be of great benefit, but this is due to a Peter-pay-Paul condition and not due to smarter or more efficient care. But for most, ACA != their health insurance.

      1. Seebs says:

        Yes, really. The number of people completely uninsured has dropped dramatically, because lots of people did not have access to health plans through their employers — mostly people doing hourly/part-time work, or unemployed, or disabled. (And not everyone too disabled to work gets the legal recognition and benefits that you might assume they do.)

        The costs of my health coverage have increased for as long as I’ve had health coverage, and I don’t think it’s noticably worse under the ACA. The difference is that I know at least five people who didn’t have health care before the ACA, and do now.

        1. TNJ says:

          Count me among them. I am wondering if this comments section is being astroturfed. There is some weirdly anti-logic, anti-science, anti-fact nonsense being strewn about.

          Furthermore, considering that in the old days not so long ago, pregnancy was a preexisting condition for which you could be denied coverage, AND considering that this crisis is not yet over and many people will not be capable of getting insurance through their job, methinks there is an agenda being pushed to try to make the worse, less popular option (axing the ACA) more palatable somehow. Not going to work.

          1. Charles H. says:

            Of course it’s being astroturfed…or the political equivalent. That’s why Derek didn’t want to write about this….but I’m glad he did.

  13. delbor says:

    The design of the ACA was an abomination from the beginning. The Democrats had the power to do it right and didn’t, for whatever reason. Most likely it was to placate the economic interests of the medical establishment. So instead we got an unconstitutional kluge.

    1. Fraud Guy says:

      The reasons were manifold.

      Because of Republicans invoking the filibuster in the Senate, they needed all 60 Democrats there on board, which meant those pulled by special interests in the Pharmaceutical and Insurance industries got outsized influence.

      In addition, even though none of them voted for the ACA, Republicans in the House pushed something over 100 amendments to it. Democrats accepted many of them, despite what harms they did to their initial plans, in a fruitless effort to try to get a bipartisan bill.

      Between those two malign influences (bought and paid for and kneecapping), the ACA was not nearly as good as it could have been.

      Finally, it was upheld as constitutional.

      1. J N says:

        As you mention, the mandate was repeatedly upheld as constitutional versus numerous theories in multiple jurisdictions.

        The Republican *legislative* repeal of the mandate is what has screwed up the ACA, as it removes logic (and fairness) from the economics.

        Without a mandate, “insurance” works like gambling, where you only pay for your winning bets. No wonder the cost of your bets keeps going up.

  14. luysii says:

    There is a very bright side to Trump’s illness even if you are not a Trump hater. Docs must deal with people as they are, not as docs wish them to be.

    The bright side is that the number of new cases of COVID-19 is likely to significantly drop in the the coming months and we have President Trump to thank for that

    Why? Because people don’t respond to abstract facts and exhortations given by people they don’t know. They do respond to particular examples.

    The fact that Trump and Co. disparaged masks, and then came down with the virus will be far more convincing, than any pronouncements from Dr. Fauci or various mayors, governors, congressmen or senators.

    I saw this many times in practice.

    An example.

    Neurologists treat migraine headaches. It is well known that migraines are triggered by stress. When someone was having a bout of several migraines under the stress of divorce, illness, finances you name it, I’d tell them this, but I could see they didn’t believe me.

    So I’d say let me tell you about my wife’s migraines. She’s had them even before I met her when she was 19. And as is typical of migraine, they became less frequent and less severe as she got older.

    So she had gone 18 months without one, until the afternoon that she found out that our 12 year old son, had a bone tumor in his ankle which would need surgery. Immediately, I could see the patient had bought in the particular what I’d just told them in the abstract.

    I think the populace is presently saying to themselves. Maybe we ought to wear masks and only be around people wearing them. Look what happened to Trump and the Senators.

    A cynical friend wrote the following back after reading the blog extolling Trump’s public service

    ” thanks for helping me appreciate President Trump’s public service.

    The potential benefits of this style of leadership seem almost without limit.

    Think, for example, of how the President could affect automotive safety if he were to demonstrate the perils of driving a car over a cliff.”

    1. MagickChicken says:

      I think you’re giving Trump and his followers too much credit. If he lives through this, they’re all just going to point and say, “See? It couldn’t even kill an overweight 74-year-old man! #DemHoax!”

    2. Phil says:

      There are already plenty of reports that the MAGA crowd does not intend to change their behavior. Nor do the people in charge of the campaign and rallies.
      In fact, they are already trying to spin things by saying that Trump took all recommended precautions (which every knows is BS) and STILL got sick, therefore all those precautions are pointless.

      1. Dr. Manhattan says:

        Apropos there unto, from this morning’s Boston Globe. The front page story starts out thus:

        “ As he loaded two of the largest Trump signs he could find into the bed of his pickup truck this weekend, George Post, 69, was sure of three things.

        The president, who is hospitalized with COVID-19, will be fine, he said. The explosion of virus cases in Wisconsin, which claimed its first victim here in Dunn County just last week, is nothing to worry about. And wearing a mask is certainly not a solution to either of those nonproblems.

        “It’s proven that masks don’t do nothing,’’ Post, a Republican, said, looking pointedly at a reporter. “Your mask isn’t doing nothing.’’

        1. anon says:

          Gives a whole new meaning to “dumb as a Post”!

          1. JasonP says:

            Oh come on.

            Early on in this pandemic, when pictures were out of people in China wearing masks, the scientists here raced in to state that wearing a mask would not prevent you from getting COVID-19. Seems like I recall a few government officials stating the same thing.

            Now I get that, masks do not meet the 95% CI that they are preventative. But the message was heard by many. What scientist and health officials failed to realize that even if a mask reduced one’s chances of contracting the virus OR reduced the number of viral particles one received and thus a less severe case, wear one was a good thing.

            Dining at the table of scientific evidence is fine and right, but at the expense of practicality and overall benefit to society?

            So you dirtied the water when y’all told the public not to wear a mask, that it wouldn’t prevent COVID-19 and now you want to rant when guys like this emerge? Perhaps one would be better suited to put their intelligence to use to find a way (like the doc above) to put this whole thing in perspective that that gentleman, and others, can relate to.

          2. J N says:

            JasonP: There were literally no masks of the wrong type (x95) available nationally during the NE/CA wave. The messaging was “don’t wear a mask,” and practically speaking, if you were a civilian without a mask and no friends with a construction/medical/clean room/crafts/??? job, you weren’t going to get one, and trying to do so would make you a PITA for everyone else.

            In re cloth masks and surgical masks, surgical masks have lately been considered (seriously, by some) a vanity measure in the operating theater, as the patient’s flora is responsible for the vast majority of surgical site infections, and airborne SSIs seem to be extremely rare. Maybe if surgical staff was a lot less healthy, surgical masks would be great things, but they are apparently more “surgical theater.”

            Before 2020, and perhaps relevant only to COVID-19, surgical masks were often not thought helpful in preventing flu transmission (Asians notwithstanding?):

            https://www.cdc.gov/flu/professionals/infectioncontrol/maskguidance.htm

            But research has apparently considerably advanced the case for masks with COVID-19. Are they absolutely causal in reducing transmission? I don’t know. They seem to be very relevant though.

            Regardless, it’s not even remotely as simple as “Fauci said this. Fauci said exact opposite. Fauci is a lizard shape shifter.”

          3. theasdgamer says:

            Do cloth masks do any good? Do lay people maintain masks properly?

            Give me a break about masks.

        2. Philip says:

          He was correct. Masks don’t do nothing. They do something. Something being protecting people around you to a great extent and protecting you to some extent.

    3. Dark Day says:

      “, , ,people don’t respond to abstract facts and exhortations given by people they don’t know. They do respond to particular examples. The fact that Trump and Co. disparaged masks, and then came down with the virus will be far more convincing, than any pronouncements from Dr. Fauci or various mayors, governors, congressmen or senators.”

      Hope that’s the case, but it doesn’t look that way so far . . .

      https://www.youtube.com/watch?v=BsbzZZIKa6s

      1. luysii says:

        It’s all great fun to snark away at the Trumpenprolitariat, but look at what it did for Hillary

  15. MagickChicken says:

    So the press release from Regeneron only talks about efficacy in patients that aren’t mounting their own immune response. Isn’t that basically the definition of immune deficiency? I know older people mount *weaker* responses, but is this implying that Trump has more major issues than we know about?

    You know, like HIV or syphilis?

    1. Fraud Guy says:

      Probably the latter, as he often exhibits signs of tertiary impact from that disease, especially the mental incapacity.

  16. Calvin’s and Barry’s assessments of the social situation surrounding T’s care strike me as very reasonable, and both square with and neutralize the assessment that Walter Reed’s physicians are eminently competent.

  17. blogreader09 says:

    So, PDT is both getting the “absolute Cadillac” of care and, simultaneously, being prescribed inappropriate/dodgy meds at inappropriate/dodgy points in time. Interesting.

    ^^^^^^^^^^^^^^^^^^^^
    “I am inclined to believe that he has the coronavirus… and that everything he will say about that truth will be a lie.”

    -Dr. Tressie McMillan Cottom

    Am inclined to believe that Dr TMcMC is a charter member of the “Ultimate Poor Losers Club” who can neither forget nor forgive the defeat handed to HRC by DJT in the 2016 election.

    1. Hap says:

      Because DJT is not knowledgeable about what his care should be and yet insists on having control over it? (The motorcade around the hospital sounds an awful lot like something a seven-year-old would do if he had his own drivers, for example.) He can get whatever care he wants whether or not it’s a good idea. As an analogy, you can go offroad with a Cadillac but (at least as normally sold) it probably won’t go well. The fact that he has the best car he can get doesn’t mean that it can do everything, and it does not function to its potential when driven by someone who can’t drive but thinks they can.

      His honesty is at this point legendary…just not in a good way. Trump is like the lawyer in the lawyer joke: “How do you tell a lawyer is lying? His lips are moving.”

  18. Steve Scott says:

    Some experts are also pointing out that Trump may be the only person on the planet to get all three of these powerful medications at the same time. There’s no data on whether there would be a harmful interaction between them, apart from their possible separate side effects. So he is a test case of sorts.

  19. passionlessDrone says:

    > “But since the president has several risk factors working against him (age, gender, and BMI), one has to be ready for anything.”

    You forgot about being low income.

    Heeeeyooooooou!

  20. David E. Young, MD says:

    I have to give Regeneron credit for starting several studies at once and aiming for large number of participants. If I recall, they have a study for hospitalized patients a study for ambulatory patients and a study for household contacts of covid19 patients. Underwriting several studies like this is good and is something that Gilead did not do. I gather that the infusion of the combo antibodies is rather well tolerated and that Regeneron has been diligent in producing enough to go around. I wish them the best. I am pleased with their approach.

  21. b says:

    Trump says he will be leaving Walter Reed tonight, 10/05/20, at 6:30PM ET. In his announcement he says “Feeling really good! Don’t be afraid of Covid. Don’t let it dominate your life”. If only the other 200,000 people that had died had not let it dominate their lives.

    1. Fraud Guy says:

      He also said he had “really great drugs”. I bet they were.

      1. eyesoars says:

        A narcissist/egomaniac in a ‘roid rage. Just what the world needs in a leader. /s

    2. chemist says:

      “Muh 200,000 people died!” Yeah and only 6% of them died from the virus alone, the rest had on average 2 other serious comorbidities. Fools like you approved of shutting down the country and wrecking people’s businesses and careers over a flu. You are human scum.

      1. confused says:

        *Most* people over a certain age have some form of comorbidity, and lots of these things (obesity, hypertension, etc.) are both very common in the US population and things people live with for decades. The presence of comorbidities doesn’t mean COVID wasn’t the true cause of death.

        I do think some measures were and are overreactions, especially for younger populations/education/etc., but downplaying the actual results of COVID doesn’t really help your case.

        1. Dark Day says:

          Honestly, this argument is a red herring. If we looked at a random sample of coroners’ reports on people who have died, we’ll virutally ALWAYS find multiple causes of death (e.g., “myocardial infarction due to hypertension due to arterial disease . . .” etc.etc.etc.

          Meanwhile, how can even the most avid Trump apologist deny that this latest Trumpian gambit is horribly irrersponsible? I’m thinking both in terms of its potential danger to public health and — at least as crucial — the way it will almost definitely further erode public confidence in a vaccine, and hence uptake. Any hope at all of containing this virus depends on public trust in scientific medicine — without significant uptake, even a “miracle” vaccine of 90+ percent efficacy (let alone the 65 – 75% we’ll probably be getting in the first generation of vaccines) wouldn’t be effective.

          Did I say “irresponsible”? In alll honesty, “deadly” would be a more appropriate adjective.

          https://www.nytimes.com/2020/10/05/us/politics/coronavirus-vaccine-guidelines.html

          1. confused says:

            Yeah, exactly, multiple causes of death don’t really mean that much.

            I generally agree with the rest, except that “containing” is I think not exactly the right term. It’s already worldwide. I think that at this point COVID is widespread enough that it is going to end up endemic no matter what; the benefit of greater vaccine uptake in the near-term is fewer (hopefully *dramatically* fewer) deaths on the way to that.

            Now maybe decades down the road it could be eradicated completely, but I rather doubt that – with far better treatments by then, and this year’s fear largely forgotten, endemic COVID probably won’t be frightening enough to drive major eradication efforts.

      2. Al Chemist says:

        ““Muh 200,000 people died!” Yeah and only 6% of them died from the virus alone,” – so you don’t think that vast majority these people would live if they did not catch the sars-cov-v2 virus ?
        People live with chronic diseases, which is actually a definition of it.

        And how about a following hoax:
        https://ourworldindata.org/grapher/excess-mortality-raw-death-count?tab=chart&stackMode=absolute&region=World

  22. If you check out the table on p. 35 of the supplementary appendix of the initial RECOVERY paper, there was no benefit in Trump’s age group for dexamethasone over standard of care.

    https://www.nejm.org/doi/full/10.1056/NEJMoa2021436?query=featured_coronavirus

    1. Derek Lowe says:

      Now, that I did not realize! Thanks very much – updating the post!

    2. To add to my comment, Twitter user Lu Chen @houndcl pointed out: “While it’s definitive that dex works on late stage & severe/critical covid, the elderly participants are mainly in the non-ventilation group.” (based on table S3)

      Which is absolutely correct. So the 70-80 age group participants mostly didn’t happen to be in the group that saw the largest benefit. However…the president is also apparently not in that group either.

  23. blogreader09 says:

    Hap says:

    “Because DJT is not knowledgeable about what his care should be and yet insists on having control over it?”

    Too bad there’s not a shred of evidence to support such a statement. Oh, but wait. You heard it from Mika Brzezinski on CNN, right?

    1. Hap says:

      It would be an awfully parsimonious theory to explain what his treatments are (and their lack of consistency with known medicine around COVID). Either that or his doctors don’t know what they’re doing, either.

      It sort of amazing that everyone other than Trump doesn’t know what they’re doing. If Trump knows what he’s doing, I’ll take “not knowing what you’re doing” for $1000, Alex, because what he’s been doing is not working out well.

  24. Sunyilo says:

    Let me say: nothing is easy to do around DJT – chief of staff, national security advisor, secretary of HHS, primary care physician, epidemiologist in chief, etc… All I can conclude with certainty: most Americans would be better off were he the Sultan of Brunei…

  25. phb says:

    some of the side effects of dexamethasone (the site basically repackages the FDA info)
    https://www.rxlist.com/dexamethasone-side-effects-drug-center.htm

    Convulsions, depression, emotional instability, euphoria, headache, increased intracranial pressure with papilledema (pseudotumor cerebri) usually following discontinuation of treatment, insomnia, mood swings, neuritis, neuropathy, paresthesia, personality changes, psychic disorders, vertigo.

    1. Derek Lowe says:

      It’s quite a list – dexamethasone is a very potent steroid indeed. But those side effects, FWIW, aren’t universal. I didn’t notice any of those when I had a short course of it during an episode of double pneumonia, fortunately.

      1. theasdgamer says:

        The side effect list is usually mandated by lawyers and docs who use them know which patients have risk.

    2. UserFriendly says:

      So basically you’re saying there will be no way to tell if Trump is suffering from any side effects.

      1. I think his all-caps 15-tweet series twenty hours ago is evidence enough of ‘roid rage, wouldn’t you suppose?

        1. Stewart says:

          Only if he was the person who made those tweets, rather than a staffer. I’ve seen various people expressing skepticism that he was responsible for them.

  26. DrivingRoundAbout says:

    May I ask a layman question? Or two.

    What is the antibody’s method of action? Does react with and disrupt each virus particle so that it cannot function
    or
    Does it attach to enough of the many spike proteins to block the virus’ docking with a cell
    or
    Does it bind or attach to the virus and present a flag to naturally present cells so that both are whacked by something else?
    Or
    Have I completely missed how it works?

    As I said, not advanced questions

    1. Derek Lowe says:

      Both number 2 and number 3 on your list. Perfectly reasonable question!

      1. DrivingRoundAbout says:

        Thanks!

  27. Thomas Olsen says:

    I find it interesting how meth users never get the common flu. They did a study back in 2012 that in my opinion should of been continued. Meth was actually keeping the flu from replicating. So why can’t it not be possible to isolate whatever is in the meth to stop it? Till this day, I still don’t know any tweakers that got sick even now with the coronavirus at large.

    1. MP says:

      Sudafed basically tries to do this. Maximize the decongestant properties, minimize the stimulant properties. I’m skeptical meth users don’t get sick though (rather they may just mask respiratory symptoms with massive doses). That said I haven’t looked into it in depth.

    2. Phil says:

      Here’s your Poe’s Law of the day, folks!

    3. David says:

      The 2012 study you reference is probably Chen PLoS One 2012;7(11):e48335 which was a study of the effects of influenza A virus replication in cell culture. The study did not evaluate human immune response or human clinical infection. I am unaware of any published study showing a lower infection rate in humans. In fact, methamphetamine is a potent immunosuppressant, and meth users are prone to increased incidence of a number of types of viral infections.

  28. Scott Ulrich says:

    Sorry if this was asked in an earlier comment that I didn’t see, but ****8 GRAMS**** is the clinical dose of the antibody cocktail? That amount of protein is lunch-quantity!

    1. Dr. Manhattan says:

      Not that out of line for antibodies. Remember, most therapeutic small molecules are in the 400-1000 MW range. Monoclonal antibodies are around 150 Kd for each molecule.

    2. Barry says:

      Yes, the molecular weight of a gamma globulin/mAb is >300x the molecular weight of a typical “small-molecule” drug. So for the same molar concentration (if the tissue distribution is the same) 30mg of a small-molecule drug corresponds to about 8gms of mAb

    3. Mammalian scale-up person says:

      That is a lot even for antibodies. In comparison, ZMapp doses are a maximum of 3.5 g and anti-rabies is 2-3 g. Palivizumab (anti-RSV) is dosed at 15 mg/kg.

  29. Heteromeles says:

    From a paywalled article on Talking Points Memo (which has a strong, left-leaning bias): it may turn out that the President hasn’t been tested regularly, and that they were relying on testing others around him to keep him safe. He only got tested after he became symptomatic and others close to him got sick.

    If this entirely political speculation is true, they don’t know when he was infected, not that this matters particularly (as pointed out above). It is also definitely possible that he’s dictating the course of his treatment, on a “give me everything” approach and checking himself out of the hospital when he feels better. He may also not be familiar with how dexamethasone affects him personally. But because of who he is, rather than have him detained and subjected to an involuntary psych test before allowing him to walk out against medical advice, they’re letting him go back to the White House.

    My general prediction is that this is not going to be a pleasant week for the US, or any part of the world who has to deal with our issues really.

    1. Marko says:

      Well , if you wanted to cover up the process and timeline of Trump’s infection , you would certainly want to squelch any efforts to contact-trace those who were in Trump’s ( and the dozens of others infected ) orbit around that time . That is exactly what they’ve done – squelched the contact-tracing.

      The Anti-Science Force is strong in The Orange Man. The CDC has now , sequentially , warned about the dangers of airborne routes of infection , then retracted it , then warned again , then retracted again. Round three , coming up , I’m sure.

  30. former scientist says:

    As for the Dexa – could it not be that the docs wanted to shut the patient’s immune system down so it does not interfere with the monoclonals? So Dexa was not given to to avoid a Cytokine storm in this case but to avoid that the patient’s immune system would go after the antibodies, which it might perceive as intruders since they were injected and not produced by the patient’s body. I am not an expert, so take that thought with a grain of salt. And they are not concerned because he got a ton of antibodies now plus Remdesivir, the virus has no chance despite the Dexa given in an early stage.

    Another thought is about the time line. I have seen reports that virus loads matter too. If the president was exposed (no mask) to a large load the infection could have progressed faster and vehement than with a lower virus load (masked). Again, I am no expert, just throwing some more thoughts into the reaction vessel.

  31. Conrad Santini says:

    What makes sense is that Trump has corrupted the medical decision process at Walter Reed just like he has done at FDA, CDC and all other parts of the Government that he touches. He’s back at the White House, sick, gasping, unmasked and transmitting virus all over the building. He doesn’t care.

    He will reap what he has sown.

  32. JimM says:

    From what I read in this thread and other sources, it appears at least possible that Trump knew he was infected with the virus heading into the debate.

    And if that’s true, I believe we would have to conclude that the explanation for his bizarre antics is that he wasn’t trying to win the debate by any usual standard. Instead, his primary goal was to give the virus to Biden in order to prevent voters from having a choice of voting for a President who is not deathly ill.

    1. DrivingThrough says:

      The President’s antics offend many and entertain more than a few. Antics or not, the speculation/accusation that DJT was attempting to infect Biden runs into Qanon territory. That’s a degrading neighborhood regardless of whether it’s run by the Sharks or the Jets.
      It would also be entirely ineffective in a well ventilated room with what appears to be a dozen feet of separation.

    2. theasdgamer says:

      You probably believe in Russia Collusion, too.

  33. Steve says:

    First you have to realize that he lies with every breath he takes so we have no idea when he caught the disease OR when he tested positive; tellingly, the WH has refused to let CDC do contact tracing since then they’d have to tell the truth. Second, the utter gall of this imbecile to tell people not to worry about COVID after 210,000 Americans died on his watch, while people can’t access hospitals or reimbursement unless they’re extremely ill, all the while he is trying to take away healthcare for millions with NOTHING to replace it is just obscene. The sooner this SOB is out of office and in jail the better for the US as well as the rest of the world.

    1. chemist says:

      I hope you die of a stroke when Trump wins again next month, by an even bigger margin

      1. c says:

        And if he doesn’t?

        That’s what we’re all more interested in. I expect people like you to be very cool-headed, indeed.

  34. steve says:

    One scientific question. Dexamethasone can cause erratic behavior even in normal people. Are there any studies of what it does to someone who is already a psychopath?

    1. cynical1 says:

      This is what the package insert states: “Psychic derangements may appear when corticosteroids are used, ranging from euphoria, insomnia, mood swings, personality changes, and severe depression, to frank psychotic manifestations. Also, existing emotional instability or psychotic tendencies may be aggravated by corticosteroids.”

  35. theasdgamer says:

    Relying on the hoax media (CNN, New York Times, Washington Post) for facts will only get you into trouble.

    They were saying that Trump could have been discharged a day earlier per the Walter Reed protocols for discharging covid patients.

    Phillips contradicted Walter Reed protocols. Oops.

    1. Derek Lowe says:

      The phrase “hoax media” when applied to the organizations you mention does not give you any credibility. As you are well aware, there is a long list of stories that have appeared in those outlets that this administration (and previous ones!) have denied that have eventually proven to be true.

      1. chemist says:

        And many of them demonstrably false, like the years of fake hoax investigations like the Mueller report that concluded Trump and his associates did not solicit any help from Russia. Derek, you’re an idiot for believing the mainstream media and your political opinions are worth less than dog shit.

        1. bob says:

          You must be confused, the Mueller report did not clear Trump admin of anything, very far from it… It’s conclusion was that you cannot charge a sitting president, but things might be interested after he loses… Also, bipartisan Senate Intel report went further and found 100s of (known) contacts between Trump admin and Russian govt, all of which very much validating what you keep calling “fake news”.

          1. theasdgamer says:

            The release of the House Intel Committee documents put the Russia Collusion nonsense to rest. People who lied on CNN that they had absolute proof that there was collusion testified to the opposite before the HIC.

          2. theasdgamer says:

            Lefty journalists like Matt Taibbi and Glenn Greenwald tried to expose the Russiagate Hoax, but without a lot of success in persuading lefties who had sunk their entire intellectual savings into it.

            https://www.rollingstone.com/politics/politics-features/russiagate-fiasco-taibbi-news-media-826246/

      2. theasdgamer says:

        Derek, you haven’t been paying attention to the multiple hoaxes pushed by the New York Times, CNN, WaPo, etc.

        Trump-Russia Collusion has been thoroughly debunked.

        ditto Pee Dossier, Covington Kids, Jussie Smollett, Bubba Wallace, Kavanaugh Accusers, Ukraine Collusion, “Trump Said Covid was a Hoax” Hoax, Hydroxychloroquine is dangerous Hoax, Hydroxychloroquine Doesn’t Work Hoax, etc., etc., etc. More than seventeen hoaxes pushed by the hoax media in three years.

        I don’t think you realize how silly you sound so so many of us when you say that criticizing the Hoax Media makes someone seem ridiculous.

        In my view, anyone who gives much credence to any of the hoax media about political questions is delusional. It’s possible to find some baby, but it requires throwing out a lot of bathwater. And I find lefties spewing bathwater like a fish breathes water.

        Maybe you don’t get out much. There is a wide divide in this country. Those on the left are far more likely to have serious mental issues and be taking medications–especially antidepressants.

        Phillips is known for making Never Trumper rants. Any of his ideas should be taken with a bucketload of salt.

        1. bob says:

          Sure, I’ll bite:
          “Trump-Russia Collusion has been thoroughly debunked.” – if by debunked you mean mostly checks out, despite best efforts of your AG to suppress it, then yes.

          “ditto Pee Dossier” – not sure I agree – recommend you read this https://www.spectator.co.uk/article/was-the-pee-tape-a-lie-all-along-

          “Covington Kids, Jussie Smollett, Bubba Wallace” – you must be selectively reading stuff as I am pretty sure I’ve seen all news outlets on both sides on political spectrum report developments on all these subjects. In fact it does look like respected media outlets are much more likely to post news that debunk their previous articles, because that’s how journalism works – stories come out with the facts that have been given at the time and narratives get corrected if found wrong.

          “Kavanaugh Accusers” – What about them? I must have missed something there.

          “Ukraine Collusion” – lol, you mean what is widely accepted to be a Russian intelligence misinformation campaign by all major US intelligence agencies? Just to add its sole purpose looks to be helping Trump to deflect some of the negative press he’s been getting over Russian help he received during 2016 campaign.

          “Trump Said Covid was a Hoax” Hoax – what hoax is this then? Your man just today heavily implied that Covid is very much like flu again.

          “Hydroxychloroquine is dangerous Hoax” – I wonder why Trump didnt want to take it if its so amazing? He seems to have demanded and got every other Covid med.

          “Hydroxychloroquine Doesn’t Work Hoax” – It doesn’t seem to work though does it? So far all major studies found it ineffective.

          1. theasdgamer says:

            In terms of infection fatality rate, covid is indeed much like the flu. Both have about a 0.13% ifr worldwide.

          2. theasdgamer says:

            Too bad for you that you lack critical thinking skills.

          3. c/o vid says:

            “theasdgamer says:
            7 October, 2020 at 10:33 am
            In terms of infection fatality rate, covid is indeed much like the flu. Both have about a 0.13% ifr worldwide.”

            Total mortality from covid worldwide is today round 1,050,000 and we have few heavy months to go .d. By the end of the year we will know that it’s lethality was 3-5 worse then the seasonal flu’s.
            Keep it coming, Russia Today is proud of you.

            one study says :
            “We estimated an average of 389 000 (uncertainty range 294 000-518 000) respiratory deaths were associated with influenza globally each year during the study period, corresponding to ~ 2% of all annual respiratory deaths.”

          4. theasdgamer says:

            Vid,

            Per the WHO, there have been 1.04 million covid deaths worldwide. Per the WHO’s Mike Ryan, he estimates that there have been 750 million covid cases worldwide. Per the CDC, the 2017-8 ifr for flu was around 1.3.

            QED (I assume that you have access to a calculator.)

          5. coco vid says:

            1,3 or 0,13 ?

            who cares, right, it’s a hoax anyway

          6. theasdgamer says:

            coco,

            So, do you think that the flu is _more_ dangerous than covid?

            And will you make a mountain out of a decimal point _mistake_?

            So covid has about the same ifr as flu? Yes or no?

          7. chiz says:

            The IFR for covid19 is around 1% according to a number of recent studies and there are good reasons for thinking that it cannot possibly be lower than 0.3%. Its not clear to me exactly where Ryan is getting his numbers from. Supposedly it comes from average of antibody surveys but I haven’t seen a link to a paper and i would take such a result with a large amount of salt since it might result from slightly false assumptions about the false positive rate in such surveys.

          8. Marko says:

            Former CDC Director Dr. Tom Frieden on the COVID vs flu comparison :

            https://twitter.com/DrTomFrieden/status/1313539632735412233

        2. Al Chemist says:

          “Trump-Russia Collusion has been thoroughly debunked.”

          Tell it the guys that have been indicted in this case

          “So far, Mueller’s team has charged eight Americans once affiliated with Trump’s campaign or administration, 13 Russian nationals, 12 Russian intelligence officers, three Russian companies, and two other people with federal crimes.”

          1. theasdgamer says:

            All process crimes except the Russians. The charging of Russians was a smokescreen and the DOJ’s deep state lawyers dropped the charges against the Russians because it was a hoax.

            There was never any evidence for the collusion narrative and now documents are coming out showing that the whole thing was fabricated by the Clinton campaign and Brennan’s documents show that the White House was knee deep in the whole thing.

        3. Ol' Bone Spurs says:

          Nothing like being juiced with ‘roids. Almost as good as not paying taxes. Now bring me my bucket!

      3. cancer_man says:

        All three were horrible when reporting on the nuclear accident at Fukushima as they completely ignored what health physicists around the world were saying about risks and have been quite bad with this virus.

    2. bob says:

      You must also think that majority of world’s media orgs are “fake news” or “hoax media”, as they all reported pretty much the same things as outlets you mention. At what point do you consider the possibility that the overwhelming majority of media orgs are not in some great conspiracy against a foreign leader, and that maybe what they accurately report information that is passed to them?

      1. theasdgamer says:

        The news media generally runs with the same narrative whether it is in the US or Europe. Asia is a little different.

  36. theasdgamer says:

    Wow, someone call 911. Another outbreak of Trump Derangement Syndrome.

    1. steve says:

      It’s not another outbreak – Trump has been deranged for a long, long time.

      1. theasdgamer says:

        Steve,

        Get back on your meds. Seriously.

  37. steve says:

    It’s not another outbreak; Trump has been deranged for a long, long time.

  38. Dr. Faustus says:

    This is your President…

    “We have developed, under the Trump Administration, some really great drugs & knowledge. I feel better than I did 20 years ago!”

    …this is your President on dex.

  39. blogreader09 says:

    Adolescent name calling, extreme exaggeration, blatant falsehoods and transparent virtue posturing are all too rampant among the anti-Trump postings on this thread.

    Will landslide pro-Trump election results in November be enough to stop the madness? Probably not but here’s hoping/praying they happen anyway.

    1. bob says:

      Not completely up to speed with things from this side of the pond but last I read the news it seemed that Biden has nearly doubled his lead in the polls, so the landslide may not be the one you’re expected.

      1. steve says:

        Bob – You’re absolutely right but what’s missing in your analysis is the massive amount of voter suppression by Trump and the repugnicans – shutting down post office sorting machines, removing mailboxes, limiting mail-in drop-offs (TX governor removed all but one per county leaving the 7.1 million people in Houston with one drop-off), voter ID, etc, etc all to suppress the minority vote that is primarily Democratic. He claims mail-in votes are fraudulent but has lost EVERY court case he’s ever tried on it because there is absolutely NO evidence whatsoever to back up his ridiculous claims. They are obviously scared to death to let people actually vote because they already know the result.

        1. theasdgamer says:

          Republicans want to suppress voting. It’s true.

          Here’s some of the voting suppression Republicans favor:

          Dead people voting

          Non-citizens voting

          Underage people voting

          People voting multiple times.

          You are quite correct that republicans favor vote suppression.

          1. bob says:

            …yet despite several investigations Trump admin found no evidence to back up any of those claims. Sounds very much like that claim Trump made about not losing the popular vote.

          2. steve says:

            All of which are bullshit as proven in multiple court cases. In fact, Trump couldn’t come up with a single one to prove his case. “PRESIDENT DONALD TRUMP’S campaign, ordered by a federal court judge in Pennsylvania to back up its claims of fraud in the state’s vote-by-mail system, has documented only a handful of cases of election fraud in recent years — none of which involved mail-in ballots. The revelation, which came in the form of a partially redacted 524-page document produced by the Trump campaign last week, undermines the claim by Trump team operatives that mail-in ballot fraud is a grave risk to Pennsylvania voters.

            The campaign is suing Pennsylvania Secretary of the Commonwealth Kathy Boockvar and each of the state’s county election boards to prevent election administrators from providing secure drop boxes for mail-in ballot returns. These drop boxes allow voters to return their mail-in ballots by hand, without sending them through the postal system and risking delays. The Trump campaign alleges that the practice “provides fraudsters an easy opportunity to engage in ballot harvesting, manipulate or destroy ballots, manufacture duplicitous votes, and sow chaos.”

            In a motion last week, Citizens for Pennsylvania’s Future and the Sierra Club called on the Trump campaign to provide evidence of the existence of voter fraud, arguing that the campaign’s lawsuit was “replete with salacious allegations and dire warnings” about Pennsylvania’s elections and that they “must either be compelled to provide discovery concerning their fraud-based allegations or be precluded from pursuing these claims going forward.” Judge J. Nicholas Ranjan granted the motion, ordering the campaign to “produce such evidence in their possession, and if they have none, state as much.”

          3. theasdgamer says:

            Gaslighting is your strong point, Bob. Judicial Watch got state documents showing that there are lots of inactive voters in three Pennsylvania counties and that those counties gave inaccurate info in federal court.

          4. theasdgamer says:

            Multiple democrats have been convicted of voter fraud in both New Jersey and Texas.

            Your gaslighting shtick isn’t working so well.

          5. theasdgamer says:

            Here’s some more voter suppression by republicans…

            https://twitter.com/SVNewsAlerts/status/1313956190855012353

            Oh, wait, that was some democrat USPS employee dumping them, never mind.

          6. bob says:

            @theasdgamer
            re: voter suppression: honestly, when a single anecdote of a mailman dumping his post, which included “several mail ballots amongst them” is the proof Trump uses to support voting fraud – and you can bet your house that he’ll be pushing Barr to give him something to support his claims, then you know your argument is bunk.
            Seriously if this was an actual widespread issue you would see examples coming out of it left right and centre, but we dont.

      2. theasdgamer says:

        Bob, when the pollsters increase the percent democrats polled by 5% from a previous poll, it will SEEM that democrats are gaining momentum. You say you’re not American, so I don’t fault you for missing this.

  40. NatureMagIsRightAboutTrump says:

    There must be a lot of trolls on this website now as no scientist worth his/her salt could ever support this guy. “The US president’s actions have exacerbated the pandemic that has killed more than 200,000 people in the United States, rolled back environmental and public-health regulations and undermined science and scientific institutions. Some of the harm could be permanent.” https://www.nature.com/articles/d41586-020-02800-9

    1. theasdgamer says:

      Thanks for that, you flat earther troll.

  41. Sulphonamide says:

    You must have pondered long and hard before starting this topic Derek. Gives a new meaning to things I won’t work with. I’m sure all your regulars desperately look forward to times when there is nothing particularly newsworthy to talk about and you find that someone has discovered that you can make a mercury-based azide and it only explodes when you vigorously shake more than 100 g with equally vigorous heating. While we rely on you for keeping us informed…right now some of your delightful turns of phrase and a good laugh might be just as valuable an act of public service.

    1. Derek Lowe says:

      Oh, believe me. I am very much looking forward to that day.

  42. SteveM says:

    Trump is intrinsically erratic. So his Covid dog and pony show is bound to be erratic. All information about and from Trump is distorted and even warped. It has no objective meaning.

    Strip out the histrionics and the hyperbole and Trump appears to be back at the White House recovering uneventfully apart from the medical/political circus.

    BTW, given that Russia Hate is tightly coupled to Trump Hate I’m surprised that angle hasn’t been tossed into the mix here. Although some Nut-Job Harvard prof claims Russian agents infiltrated Walter Reed while Trump was there.

    I and some friends of mine have independently decided that we don’t care who wins the election. Because the U.S. Ponzi Scheme economy will collapse and the other systemic pathologies will continue no matter which aging Nitwit sits in the Oval Office in 2021.

    I.e., When there are no (legitimate) alternatives, there is no problem. Cheers…

  43. Dark Day says:

    Well, looks as if the White House blinked. Difficult to believe, but someone did the right thing.

    https://www.washingtonpost.com/nation/2020/10/06/coronavirus-covid-live-updates-us/

  44. drsnowboard says:

    And to think Nobel season used to be the contentious subject…..

    1. sgcox says:

      well, chemistry prize list is interesting

      1. Marko says:

        Derek is writing a post about the winner(s). Or , if you prefer , you can watch the movie :

        https://www.netflix.com/title/81220944?source=35

      2. TJ says:

        I see the chemistry prize is now a biochemistry / genetics prize.

  45. Marko says:

    As of Mon , Oct 5 , Trump became positive for anti-CoV2 IgG (i.e. his own , not the MAb ):

    https://twitter.com/PressSec/status/1313884629791911937/photo/1

    I haven’t seen much about concerns that MAb treatment might inhibit a normal adaptive immune response , so I guess this was to be expected. The Dex might be expected to put a damper on the continuing response, however , which could be a good thing or a bad thing , depending on whether viable virus is still around when he comes off the Dex.

    1. Marko says:

      I take that back. It was probably the MAb that caused the positive test :

      https://twitter.com/maggiemfox/status/1313906240519634946

      What a mess. Why don’t they check the titer for both spike and nucleocapsid antibodies and then we’d have an idea what’s going on with the adaptive response ?

  46. Hopeful Layman says:

    Wondering what this episode will do in terms of the Regeneron monoclonal antibody treatment. Assuming his condition continues to improve, will it be more likely to garner at least EUA approval soon? And if it continues to be as effective as it apparentely was for Trump, will this end up being good news in terms of the overall effort to treat (and, we hope, ultimately contain) COVID? If we had a decently effective vaccine along with a therapeutic that worked as well as this seems to, that combination could truly be a game-changer.

  47. Bill says:

    Was reading discussions a day or so back above on deaths due solely to Covid vs deaths due to other issues but with covid. Which I think is a discussion of Excess Mortality. Found an interesting chart that seems to reinforce the latter side.

    https://ourworldindata.org/grapher/excess-mortality-raw-death-count?tab=chart&stackMode=absolute&region=World

    If I read that right, Covid took a big bite, but now our weekly death rate is lower than the previous four year average? They weasel word about recent data completeness, but even the trend for the last many weeks agrees with the current data point,.

    1. Marko says:

      Check the same chart in a month and the the current recent trend will very look different. We may not be at the 10-12,000 excess deaths per week that we were in late July/ early Aug. , but we’re still in the 6-8,000 per week range.

      The average deaths baseline hasn’t changed much since mid-summer. Reported COVID-19 deaths per week are only down about 30% from the summer peak. There’s no way we’ve fallen all the way to the average line in excess deaths at this time.

    2. Daren Austin says:

      If you want to look at excess mortality data then mortality.org have a Shiny app for your pleasure here https://mpidr.shinyapps.io/stmortality/
      The last few weeks are unreliable due to reporting delays.

  48. Bill says:

    Maybe so. But I’ve been following it about 3-4 weeks now expecting the corrections you expect. And so far it hasn’t happened. The negative slope has remained constant for the period I’ve been watching and so the trajectory took it where it is.

    At what point do you just say…okay, that’s the data?

    1. Marko says:

      “At what point do you just say…okay, that’s the data?”

      Like I said , for today’s data , about a month from now. When the FT was regularly posting excess death updates , for the US the latest data was always about a month old. The NYT here shows a lag of 18 days ( 9/23 update ):

      https://www.nytimes.com/interactive/2020/05/05/us/coronavirus-death-toll-us.html

      “…..Epidemiologists refer to fatalities in the gap between the observed and normal numbers of deaths as “excess deaths.”

      From March 15 through Sept. 5, the most recent date with reliable death statistics, estimated excess deaths were about 42 percent higher than the official coronavirus fatality count. If this pattern holds, it would put the current death toll at about 285,000 people…..”

      And , let’s not be naive , there’s an election approaching. Trump will be squeezing down the flow on any data streams that reflect ( the awful ) reality between now and then , whether from the CDC or red states.

      Patience. Wait a month or so.

    2. theasdgamer says:

      Never, because he’s bought into the intellectual vapidity with all his intellectual savings. You can look at “Our World in Data” and see the long term trend.

      https://ourworldindata.org/grapher/daily-covid-deaths-7-day?tab=chart&time=2020-05-16..latest&country=~USA

      1. theasdgamer says:

        Looks like you’ll have to cut and paste the link yourself.

    3. John Stamos says:

      When it benefits your preferred political candidate.

    1. theasdgamer says:

      What a bunch of silliness from NEJM editors. Bunch of leftist quacks!

      They already retracted one article this year.

    2. JasonP says:

      The sad thing about this is that this move just strengthens the argument that science IS political. Kind of hard to stand behind “data” when it is viewed as politics. Those guys should be know that their endorsement isn’t going to sway many minds, but should have weighed the fall out to science that will result from such an action.

      Is their candidate really in that much trouble that they need to wipe out any good will to make a political statement?

    3. John Stamos says:

      Glad to see NEJM finally take a stand against political meddling in science, by……politically meddling in science.

      Could you imagine, just for one second, how the media/scientific establishment would have reacted if, in Jan/Feb when the virus was spreading, Trump called for even a single one of the measures undertaken today, while he was being impeached? Unilaterally closed schools, widespread travel bans, economic lockdowns, mandatory hospitalizations and enforced quarantine.

      Seriously, imagine it. Just picture it, picture the reaction, the howls of authoritarianism and dictatorship, the moral outrage from the left, the protests, the lack of compliance. There would be myriad articles claiming “it’s just the flu” and “poor people suffer from lockdowns” out of NYT and WaPo, there would be articles in NEJM decrying the health effects of lack of cancer screening etc etc.

      This is yet more needless firing of political arrows at a ghost of a target. The arrows carry with them credibility, and they’ll soon be totally gone.

  49. Dark Day says:

    “Is their candidate really in that much trouble that they need to wipe out any good will to make a political statement?”

    Unfortunately, that horse has already left the barn — and Trump was riding it.

  50. confused says:

    Politics aside, what does this say about the status of the treatment itself? I mean, presumably Regeneron must have some confidence in it to use it on the President – “our experimental treatment killed the President” would presumably be really bad news for a company.

    What’s the status of clinical trials?

    Frankly, if they’re confident enough in the harm/benefit balance to give it to POTUS, why can’t FDA make it available to regular citizens?

    1. Bill says:

      I agree with that completely. Long term randomized controlled trials are not appropriate for pandemics where daily deathrate is in the thousands worldwide.

      At some point you have to employ assumption of risk and informed consent. Find a balance between drug risk and disease risk. Having safe and tested Covid treatments available sometime in 2022 is useless. I hope.

      1. Drive, Stop At RR Crossing says:

        I’m just a dumb caveman, but a panicky pandemic is exactly when long term trials ought to be done. Perhaps a VLST (very large scale trial) on a high risk group can be done, or a phased, monitored rollout. When emotions, financial and political stakes are high is exactly the time when caution is required.

        It’s widely repeated that people live an average of less than 6 months after entering a nursing home. I can’t vouch for that stat, but we do know that about about 40% of deaths from this virus occurred in nursing homes, and another chunk were those who went for care home to hospital and then died. Those are not people who were at the end of life. You can’t cancel death, attempts to do so lead to people being kept going in considerable misery, often without the ability to ask for their ‘help’ to be halted.

        Net: The IFR is about 1/2 of 1 percent overall. Among people in some semblance of health and not nearing their last day, it’s closer to 1/25th of 1 percent, or one in 2500. Fatalities are dropping every month, possibly because treatments are improving, possibly because of shifts in the virus.

        Rush out a vaccine and find it causes some strange, lifelong ill effect in one person out of a thousand and you’ve arguable done more harm than good with the “quit this testing nonsense” policy.

        But the harm doesn’t stop there: People today are jittery and risk-averse. Roll out one high-profile vaccine which has even a 1/1000 rate of severe complications and you’re made every day Christmas for the anti-vaccine, supplement and quackery crowd.

        Before we were comprehensively educated, we knew that haste generally makes waste. it seems this has been unlearned over recent decades.

        1. Dark Day says:

          Remember though, it’s not just about deaths — we’re learning more and more that COVID is physically devastating to a lot of people who suffer from serious symptoms, and “recovery” can be an extremely arduous process. I don’t exactly know the percentage of “recovered” COVID patients who are being classified as “long haulers” (suffering from debilitating symptoms for months already, and possibly for years to come), but it’s not an insignificant amount.

          I also question the statistic about the percentage of “elderly” (i.e., 65 and over) who die from COVID being nursing home patients. Nursing homes were early “hot spots,” but I don’t think they still are. Although I agree with you 100% about the folly (and cruelty) of using heroic measures to extend life and “keeping people going in considerable misery,” I’m equally leery of slipping down the slope in the opposite direction — “Oh, it’s ‘only’ old people dying, and most of them are going to die pretty soon anyway, so . . .”

          Then, of course, there are the racial disparities in mortality, apparently across all age groups — more significant in the long run, perhaps, than merely focusing on “just” the elderly.

          So for these reasons (among others), I do think our currentg sense of urgency is well-founded. (Then, of course, there’s the economc, social, psychological, and emotional toll that this thing has extracted already, and seems likely to continue to do for the forseeable future. Not all toxins are physical.)

          1. confused says:

            I agree that the urgency in developing treatments/vaccines is absolutely warranted, not only for deaths but (as you say) to end the social/emotional/mental health/etc harms of all this*.

            But I think the 40% of US deaths from long-term-care facilities is indeed about right (a couple of weeks ago covidtracking.com claimed 43%; exact numbers will be hard because of differences in state reporting).

            I think we’ve “lost” a lot of the advantages of modern supportive care in reducing mortality (compared to previous pandemics like 1957 and 1968) because we have lots more highly-vulnerable people in highly concentrated settings.

            *Which I would argue are probably worse than the actual deaths, in a sense; the US population losing say 25% of our quality of life for one year is arguably “equivalent” in “quality of life” terms to about 1 million deaths [330 million x 0.25 = 82 million life-years / life expectancy of about 78 years = ~1 million].

    2. Barry says:

      Assessing safety (as is done in Phase I clinicals) and assessing efficacy (as is done in Phase II/Phase III clinicals) are two different matters. When the FDA was first established in 1906, safety was its only mission. But in the 21st c., we expect it to evaluate and certify both safety and efficacy before granting approval. And without FDA approval, no insurer will pay for treatment.

      1. @Barry’s point can be made a lot stronger. All one can learn about safety from Phase I clinical trials is whether or not a drug is outrageously, ridiculously unsafe. There’s no hope of learning more, from the few dozen healthy subjects exposed. Some drugs (e.g., chloramphenicol) are used only warily, and in selected patients, because of serious adverse events that occur at the 10^-4 or 10^-5 level.

        @Barry’s account of the history is correct. In hindsight, though, the 1906 idea that safety could be reasonably assessed without assessing efficacy was a fantasy. Nothing is perfectly safe, so in the absence of efficacy, nothing is safe enough. This insight was behind the requirement of demonstrated efficacy that came with the 1962 FD&C Act.

        When drugs are developed for people who are asymptomatic and nearly healthy (say, people who are mildly hypertensive or minimally hyperlipidemic), adequate safety is very safe indeed. In the case of vaccines developed for people who are perfectly healthy and at low risk of serious infection , nothing less than proven efficacy and squeaky-clean safety will pass.

        1. Dark Day says:

          Maybe a related question: I’m sure we’ve all read those stories about the side effects apparently suffered by some of the individuals in the Moderna and Pfizer Phase III trials. All of those individuals — relatively young, physically robust — said it was “worth it” to grind it out through 12 hours or so of pretty extreme discomfort, high fevers, chills (one person actually cracked a tooth from shivering), etc. But these vaccines will also be administered to frail elderly people, people with pre-existing conditions, and others. I’m guessing that side effects such as these could easily be fatal for some of this population.

          So the question is — for whom is “safety” determined? Will some vaccines be approved, but then be contraindicated for certain people (ironically, the people at highest risk, who most need it)? If this is the case, then the original plan of administering the vaccines first to the highest-risk poulations might not be feasible. In that case, what’s Plan B?

          1. Bill says:

            Even if a vaccine turned out inappropriate for high risk people, they still benefit.

            People don’t just get infected…it’s passed to them by others. Most commonly family members. If a vaccine works on those people, the high risk will be less frequently infected.

          2. confused says:

            Yeah. Even if herd immunity really is at 60% for the US population, if 20% of the US has had it by the time a vaccine rolls out to the “general public”, 40% of people getting vaccinated ought to be enough to pretty much stop it (well a bit more, since lots of asymptomatic people won’t know they had it, so the 20% infected and the 40% vaccinated would have some overlap).

          3. Barry says:

            The flu-like symptoms some vaccines evoke are because they activate the host’s immune system. It’s expected that they would be milder in older subjects exactly because their immune response is not as strong as in younger individuals.
            Any vaccine maker will want to run the first clinical in a population that is going to show dramatic efficacy (i.e. 18-28yr olds) rather than in the geriatrics who are at greatest risk from the disease. Clinical subjects will be grouped by age. It’s possible that the FDA will grant approval for some age brackets but not for others.

          4. Dark Day says:

            Jury seems to be out on when (or whether) herd immunity can happen — I’ ve seen estimates ranging from 60 – 80%. That assumes, of course, that the “immunity” resulting from either having COVID or being vaccinated is relatively full and lasting (for at least year, one would hope). Cases of reinfection appear to be rare, so that’s a good sign — but we really won’t know unti the months pass by and more people who have been infected either do or do not get reinfected.

            I am concerned, though, that we could have a situation where the vast majority of the population have been vaccinated, have a good amount of immunity, and — given the segregated nature of our society — “most” people who interact with one another on a regular basis will probably have something close to herd immunity in their everyday lives, since that “herd” pretty much consists of a relatively homogeneous group of people interacting with one another. At the same time, though, low-income communities, communities of color, etc. could become isolated, segregated “COVID ghettos,” just as right now they are often hotbeds of things street violence, malnutrition, and other pathologies related to social inequality. The U.S. doesn’t consist of a single “herd” — we’re many “herds” who, in many cases, are isolated from one another in our everyday lives.

          5. confused says:

            There will surely be efforts to vaccinate poorer communities, as these tend to have higher risk from COVID/less ability to work from home, etc. TX already has this in its vaccine distribution/prioritization plan.

            So I think this problem has already been thought of and so probably won’t happen.

        2. confused says:

          What I was suggesting was not “we don’t need data” but rather “it seems like Regeneron likely already has data that’s convincing at least to *them*, for them to risk giving it to the President, since an ‘our experimental drug killed the President’ headline would be extremely damaging”.

  51. Dexamethasone – danger (= kainic acid – like glutamate…brain “accelerator”, but excess is toxic)

    and

    REGN-COV2 antibodies from Regeneron will NOT impact a KNOWN toxin within the spike protein.

    “However, COVID-19 patients in intensive care units (ICUs) have SARS-CoV-2-specific antibodies, raising the question of

    why patients with these antibody responses are NOT controlling disease.”

    http://science.sciencemag.org/content/369/6508/eabc8511.full

    The *toxin* looks to impact esp. a7nAChR and along with it NMDA receptors.

    The toxin (from a SPIDER) is a viral sequence linked to ssRNA positive strand viruses.

    If you want a Rx, look at ebselen to impact (i.e. inhibit) COVID 19’s main cysteine protease = M pro or CL pro. which is Nsp#5. If you want to try an OTC solution, look very closely at TUDCA and also take glycine.

    1. chiz says:

      So, there’s a toxin is the spike protein is there? This sounds like one of those silly conspiracy theories – like the virus being made in a Chinese lab – that circulates on fb.

  52. Barry says:

    Trump on dexamethasone is now retaining so much water that he can’t button his collar. If he is to wear a tie, he’ll have to buy a bigger shirt. And that tie won’t reach even to his belt buckle

  53. Dark Day says:

    RE: The ongoing discussion/debate about mask wearing (now and after a vaccine is rolled out) —

    Dr. Fauci and others continue to maintain that for most of 2021, masks and “distancing” will continue to be essential, although I think it’s probably safe to say that some of these restrictions might loosen up a bit (e.g., maybe removing the mask mandate for some outdoor activities?) as the vaccine rollout progresses. In terms of compliance, places of business will simply continue to enforce their “No mask, no entry” rules until the official mandate is lifted.

    At least for the time being, though, in some parts of the state it looks as if the mandate will be given some additional teeth . . .

    https://www.lakemchenryscanner.com/2020/09/04/deerfield-approves-plan-allowing-police-to-issue-tickets-to-those-who-dont-wear-face-coverings/

    1. confused says:

      Hmm, how long are they expecting the vaccine rollout to take?

      I really can’t see masks being required, except maybe in a few hard-hit cities that might retain fear of it longer, after everyone who wants a vaccine has gotten one.

      1. Dark Day says:

        . . . also, I don’t think public health officials will loosen (or not loosen) masking and/or social distancing requirements as a “favor” to anyone. They’re scientists, and they’ll go with the data. I’m not sure at what point the case positivity rate has to be so dimniishingly small that we can feel assured the crisis is over, but until that point, public health practices will continue to be enforced.

        1. confused says:

          This assumes it will be the public health officials making the decisions, which I am not sure is the case. Public health is mostly state-level in the US, at least in terms of mandates; once emergency declarations are removed by governors etc. the public health officials won’t (as I understand it) have the power to mandate much.

          There is already a lot of political resistance to emergency powers (several states with Republican legislatures and Democratic governors have had lawsuits about this, and some orders have been struck down, at least in MI and WI). I think few states will keep orders in place once most people have been vaccinated.

          And I think public fear (and therefore political support for measures) will evaporate much more quickly than you’re thinking. (If the fall wave is really bad, that would be different; but the numbers I’m seeing from e.g. Spain suggest it won’t be. I don’t believe one word of the IHME model.)

  54. Dark Day says:

    Fauci is saying until “toward the end” of 2021. Remember, it’s not just the rollout, which is simply a matter of logistics; it’s the uptake. It will take a lot of effective, culturaly astute advocacy to build public confidence in a vaccine up from the 50% area where it is now.

    1. Dark Day says:

      . . . and if you want some REALLY sobering predictions about what a post-fax future might look like (at least for the next year or so) . . .

      https://www.nytimes.com/2020/10/12/health/covid-vaccines.html

    2. confused says:

      Well…

      a) I’m not convinced 50% wouldn’t be enough; combined with the level of infection we’ll probably have by then, that should be herd immunity.

      b) I think *actual* uptake will be much better than current polls suggest, for two reasons…
      – people right now are seeing it as an unknown. A known, approved vaccine will be something quite different; and due to limited supply at first the “general public” won’t be getting it day-after-approval.

      – currently Biden seems very likely to win the election, and I think that would mean a reduction in the sense of chaos in the US. Even if a vaccine is approved in November or December, it won’t be generally-available until after the new administration is in place, so fears that it was a purely political move will go away.

      So I’d expect very high uptake, and the areas with low uptake largely being ones that have little fear of COVID… so have few/no restrictions now anyway (eg South Dakota, much of Florida and Kansas, the more rural parts of TX…)

      1. Dark Day says:

        I agree that if (1) Biden wins the election, allowing saner voices (Fauci et al.) to truly take the lead in the discussoni, and (2) the early phases of the vaccine rollout appear successful, overall confidence in the vaccine can grow, and uptake will improve over the course of the year.

        However, given the recent news about a fatal case of COVID reinfection, I’m concerned about “herd immunity” ever being a viable option, unless somehow the immune response from the vaccine is much more powerful and long-lasting than the immune response from actuall having contracted the disease itself and recovered. I also think that if areas like S.D., Florida, rural Texas, et al. have “low uptake,” the result will be continued high case positivity rates and relatively high death rates. The result will be that the overall U.S. will still be living under the ongoing specter of the pandemic. To paraphrase the old freedom song (“None of us is free until all of us are free”), none of us is safe until all of us are safe.

        1. confused says:

          >>I agree that if (1) Biden wins the election, allowing saner voices (Fauci et al.) to truly take the lead in the discussoni, and (2) the early phases of the vaccine rollout appear successful, overall confidence in the vaccine can grow, and uptake will improve over the course of the year.

          Yeah, although I don’t think it will even be “over the course of the year” given how fast & chaotic the media cycle is right now – I think if Biden wins much of this will be “water under the bridge” by January.

          >>However, given the recent news about a fatal case of COVID reinfection, I’m concerned about “herd immunity” ever being a viable option,

          One case, or even a few, tells us nothing useful about a disease with 30+ million confirmed cases and probably hundreds of millions of infections.

          People vary. I don’t think it would ever really have been expected to see zero reinfections, and given reinfections existing, someone would eventually die from one (even if not generally serious, some people are very fragile/near death already).

          >> unless somehow the immune response from the vaccine is much more powerful and long-lasting

          I don’t think that would be surprising either.

          >>The result will be that the overall U.S. will still be living under the ongoing specter of the pandemic.

          Not really, for two reasons…

          1) If uptake is low and people go back to normal, high immunity levels would occur due to natural infection, and deaths would then drop dramatically;

          2) I think you greatly overestimate how much people in the rest of the US, especially the big cities that drive the news and media (eg NYC and LA), are really aware of what happens in these rural areas. If COVID in the US had started in Kansas (like 1918 flu) rather than Seattle and NYC, the early response would have been very different!

          I mean, if high numbers kept getting reported on the media, maybe that would drive fear nationwide. But if these places – where there is little fear of it – were the only ones still dealing with much COVID, there probably would be little testing outside hospitals (due to little concern) and low deaths (since populations are generally smaller than big cities), so there *wouldn’t* be high numbers to report.

          1. Dark Day says:

            Not sure what you’re arguing here. How would the response have been different if COVID had started in Kansas instead of in Seattle or NYC? If anything, response would have been WORSE — Even now, there’s a lot more COVID denial as one travels farther South and West from our major northern metropolitan areas.

            Numbers in low-population areas would be lower, of course, but the rates of infection and death would be just as high. And the disease would not remain isolated in those rural areas. It would only be a matter of time before it began spiraling out again into higher-population-density regions. (A lot of people in northern cities, for example, families and loved ones down South and/or out West, and they travel back and forth to visit on a regular basis.)

          2. confused says:

            “Different” doesn’t mean “better”. I think the response would have been bad in different ways & for different reasons – taken even less seriously early on, and would spread farther before any measures were taken, but less politicized as there wouldn’t be the “it’s only in big coastal cities” idea in the rest of the US.

            But my point is that if everybody in big cities is vaccinated, continuing deaths from COVID in places like rural Texas and South Dakota due to low vaccine uptake there won’t have much impact on the overall national opinion. Occurrences there aren’t terribly visible to the national news, the populations affected wouldn’t be large enough to drive really frightening overall numbers, and people would probably just stop tracking/reporting the numbers in real time anyway.

          3. Dark Day says:

            Well, maybe I’m being selfish — some of my dearest friends in life live in places like Mississippi, Tennessee, Georgia, etc., and I want to be able to visit them and spend time with them again! (And I know I’m not the only one).

          4. confused says:

            Sure, but if the vaccine has good effectiveness, if *you’re* vaccinated, maybe you can not worry about interacting w/ people who aren’t.

            Of course that depends on how effective it is, and what your baseline risk is, and whether you interact with lots of high-risk people who might not be vaccinated.

            I plan to stop worrying about it entirely once vaccinated, but then my baseline risk is pretty low (and all my elderly relatives live far away, but they’d be vaccinated before me anyway).

      2. Dark Day says:

        p.s. RE: “I’m not convinced 50% wouldn’t be enough; combined with the level of infection we’ll probably have by then, that should be herd immunity.”

        I think 50% is too optimistic, but I do see your point (and if we include the near-certainty that the number of cases has been, and continues to be, significantly under-reported, this buttresses your argument even more). So again, we have this deady, tragic irony — just as having a lot of infections was, perversely, “good” news for Phase III trials (a better chance of getting enough cases to attain statistical significance), this so-called “Second Wave” (which is really a continuation of the “First Wave”, both in the U.S. and abroad), could be “good” news for vaccine efficacy, for the reason you state.

        I’m beginning to think that immunology, not economics, should be called the “dismal science.”

        1. confused says:

          >>I think 50% is too optimistic,

          Well, I’m thinking the US could easily be 20-25% infected by then (depending on how much of a fall wave there is), so we’d probably be looking at more like 60%-70% overall (depending on how much overlap there is between “people already infected” and “people vaccinated”).

          Sure, reinfections happen occasionally, but I am very skeptical they are significant on a whole-population level on this timescale.

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