COVID questions for user Hopeful Doc - and others too I guess

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What is our best path back to “normal” as a society?

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The best path is to lift all restrictions bit nobody has the balls to do that.

It seems every couple of weeks we have new information and different ideas/opinions on what is best for the virus. Reality what may be best is the herd immunity since they will not develop a vaccine for the virus for awhile. People will die just like with any virus but exposing people to it will build an immunity for the Covid strands so that other strands won't impact people as violently.

Eh, I think you're overselling me. I try to not inject personal feeling into most posts in attempt to be objective, but I'm not free from bias. I don't have any overt biases other than being a general skeptic of essentially everything.

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Is it a vaccine?

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personally, I do not think so. I'm not aware of a coronavirus vaccine in existence (and we have tons of coronavirus strains out there...they just generally cause the common cold). I really don't know enough about this one to naysay it, but as I understand it (and I'm not checking myself here, so please feel free to call me out, anyone) coronaviruses tend to change/mutate over time. The problem here is that you have a novel strain. So let's say there are 100 antigens on a virus that you've seen before. You have caught it once. You got the sniffles. A year later, it's mutated 20-30 times. Depending on what's mutated, you may or may not have immunity to some/all. Fairly impossible to tell as we don't really test for it because it doesn't cause serious disease. If you ever took a college biology course, this is referred to as antigenic drift.

Same concepts apply to the new, novel coronavirus (a product of the distinctly different antigenic shift). I'm probably 4 weeks behind on reading data about this subject at all, but there hasn't been confirmation that a patient mounts a lasting immune response to the virus. They probably do. How strong, how good, and how bad is the 2nd vs 5th infection with it? Who knows? These have to be answered and observed before we find out if a vaccine is going to be useful. And how effective is the response from this strain vs that strain of mutant (and there is evidence of multiple distinct mutations out there already)? We don't know.

I hope there is one eventually, but I'm not a vaccine developer, epidemiologist, or geneticist, so in terms of why we don't vaccinate against coronaviruses now because they tend to be mild vs vaccination generally uneffective because of the rate or drift would be something I defer to answer.

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Is it some form of herd immunity? Is it a treatment?

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You should realize none of these three (including the one above) are mutually exclusive.
I doubt we find an effective antiviral. It just isn't a huge field in medicine. I don't know whether its lack of efficacy or lack of cost/benefit to prevent colds in workplaces, or the fact that, generally, when someone walks in with a cold to be able to correctly identify it would be 1-2 hours and a few hundred (and I have heard as high as $2400, but I'm sure that's the billed charge, not the cost or the allowable (another rant for another day)) to determine which specific virus it is to use a specific antiviral that would be effective, all of which is way more burdensome on a medical system that could just ask the employee to stay home from work for 1-3 days.
Herd immunity, in any event, is what is going to win out. Whether that takes 0, 100, or 1,000,000 more deaths to be reached is the question. Viruses can't live without hosts. So when enough are immune and can identify symptoms while sick, it dies out.
You can really only identify it in retrospect, unfortunately. And I don't think it's really easy to predict accurately.
Very not my field as well, for the record.

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What level of personal concern/action do you advocate for “healthy” individuals under 50, above and beyond traditional preventative measures (wash hands, etc) Masks? Social Distancing? Stay at home? Or do you advocate this age group return to “normal” (or some version) now?

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This is just too difficult to answer.
For the fewest people to die? Everyone stays home. But people generally don't have 3 months of living supplies stocked up, so that's not really going to happen outside of a utopian world where man in magic suits deliver meals daily to...the entire world
For the world to turn on? Everyone can go back to normal.
I really don't think my opinion on a practical approach for returning to normal carries any water and would amount to little more than a "what would you do if you won the lottery?" discussion with friends. I'm just not educated enough on the fields of macroeconomics, international relations, the education system, etc enough to way how much any one system could take vs how many human lives are worth an increment of that. And I don't think anyone really has an answer to it. I wish I did have any sort of idea that seemed good. But I don't really have time to think them up, because I'm nobody and my opinion doesn't matter very much.

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What do you advocate for the group over 50, or those with comorbidities? (Or draw any other age/condition delineation you’d like)

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Anyone who would be at-risk ie: sees a doctor for an ongoing medical reason that is on chronic medication for it or is 65+ (very loose rules) is probably, in terms of their own health, best at home as much as they can be. I stay home as much as I can. Wife and I walk the neighborhood about 1-2 times daily. I believe we totaled the number of times we walked inside of non-essential places yesterday at something like 10. We mostly get grocery delivery. We quit going to church since the Diocese dispensed the obligation of Mass and have been for a single special occasion since. Neither of us have any serious medical condition and are both young, healthy. But we both see high-risk people all day long and feel we are very likely to be huge sources of infection to the general public because we both see COVID patients quite often.
Problem with a message board is one-way, timed-spaced communication
That doesn't mean I think any of those things should be illegal. That doesn't mean I think any of those locations (restauarants, bars, home decor stores) should be forcibly closed. I, again, don't think my opinion on that matters much. But my opinion tends to be that those places should be allowed to open and operate as they please (I'm fairly pro-liberty) but think that basically anyone that goes to a bar full of strangers is making a poor decision for their own and for population-wide health.

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How concerned are you about re-infection?

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I doubt it's significant. I acknowledge it is relatively unknown at present.




Again, I say essentially none of this with authority. I don't generally like to opine as much as I like to share digested information, usually in the form of diarrhea-of-the-keyboard way-too-long-due-to-attempted-carefulness posts as above.

Wouldn’t the same factors affecting the viability of a vaccine also apply to herd immunity? It seems like if the virus is mutating fast enough for people to catch it multiple times, neither route - herd immunity via vaccination or via widespread infection - would be all that effective. At that point you’re just hoping that the antibodies either reduce the severity or reduce the spread (or both). But maybe I’m fundamentally misunderstanding something here?

I do think you hit the nail on the head regarding the best path forward. It’s kind of like the old sci-fi trope of an AI being tasked with “saving the world.” That can be interpreted a lot of different ways depending on your priorities. We could stop the virus in its tracks if we all locked ourselves inside, but we might starve to death in the process. We could have avoided any economic damage if we had been content to let the virus spread unchecked. All decisions require compromise one way or the other.

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Wouldn’t the same factors affecting the viability of a vaccine also apply to herd immunity? It seems like if the virus is mutating fast enough for people to catch it multiple times, neither route - herd immunity via vaccination or via widespread infection - would be all that effective. At that point you’re just hoping that the antibodies either reduce the severity or reduce the spread (or both). But maybe I’m fundamentally misunderstanding something here?

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Nah, you've pretty much got it. Basically if you get vaccinated with strain A, how effective is it for strain B-Z? We don't even really understand the immunity from a single exposure to begin with, so understanding re-exposure to the same strain can't even be described at this point.
Vaccine immunity and immunity from getting the virus can be different, though. The explanation is fairly long and pretty dull, but it boils down to this:
your body makes antibodies to just about everything- including HIV
your body doesn't necessarily make antibodies that can neutralize the target- see HIV
vaccines can vary in their delivery and their antigens. Generally, they pick the most prevalent type of antibody in people that got better, find out if that kills the virus in culture, find what that antibody binds to, and create/purify that.
A shortcoming of vaccination research is being able to find that target and being right about finding that target.
If you develop immunity from live-virus exposure (real infection, that is), then the 'natural' one may have more targets and won't be reliant on researchers attempting to find the right target.


Please don't read this as:
1) natural immunity is always better than vaccinated immunity
2) vaccines always carry a single antigenic target for your body to create antibodies to
NEITHER of those are true. But in a virus (and bacteria, too), it is possible that you get a drift in the chosen antigen that would have been present in a post-infected person, theoretically.


All conjecture and rambling for the most part. As I sort of stated above, this really isn't my field and I am not trying to speak as anything other than a more-than-average level of information on the subject. I'm far from an expert. But that was sort of the meaning behind my separating them out and also including that none of them are mutually exclusive. They could all work together, none of them could work (unlikely). Believe it or not, I actually try to limit myself when explaining things so that my posts aren't unreadable.

I've read before that viruses tend to mutate into weaker strains... essentially the less deadly they are the better it is for their survival. Any thoughts on that concept?

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He doesn't know. No other doctors know. The CDC doesn't know.

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Pretty much this

Any response to the questions OP asked is mostly opinion

The most interesting research I’ve seen lately is the lack of traditional antibodies in mild/asymptomatic cases but much higher numbers when looking for IgA and T cells.

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Any response to the questions OP asked is mostly opinion

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Which is what I asked for

What I’ve learned is there is a lot of data out there, and putting it all into some type of story or scenario is difficult and ends up being a matter of opinion (some very good opinions, albiet). I’m good to call it what it is. What annoys me is stating some data, then interpreting it (but calling that more data), and acting like its not opinion.

If opinions are all we have at this point, I want to collect as many good ones as I can

Several health professionals I know believe what we are seeing right now is a weaker strain or mutated strain of the original Cornovirus, which is why you are seeing varying symptoms. Some are only suffering from fatigue and stomach pain while testing positive, some only have body aches, some just feel drained but testing positive. It isn't fever/loss of taste anymore.