Immunity passport [Merged thread]
 

Another very frustrating press release from the WHO:

https://www.who.int/news-room/commen...xt-of-covid-19

This is exactly the kind of panic-inducing message which leads to a loss of public trust in governments/NGOs. It would be just as accurate to have stated, "There is currently no evidence that people who have recovered from COVID-19 and have antibodies aren't protected from a second infection." Quite why they have chosen to make this kind of statement publicly, I don't know.

I agree that the way those articles are presented comes off as fear mongering, but it's also kind of crucial that they do word it that way, because there are literally governments around the world preparing immunity certificates. While it would be extremely unlikely that you aren't granted a fairly substantial immunity from coronavirus, granting immunity cards and making decisions about funneling people into high risk areas on the basis that they "are immune" for a disease we know very little about... Is something they are understandably worried about.

Nevertheless - they could have shown a bit more mettle and responsibility and said something like: It is too early to be sure whether recovered Covid-19 patients are protected from repeat infection, and if so how long that protection might last. However, we have begun trials and are co-coordinating an international approach to secure the necessary data to answer this question with preliminary findings due in September 2020.

Or some such. The type of statement WHO put out ,as posted above, really undermines my confidence it that organisation.

I agree, but then the correct message would be, "we do not yet know if antibody tests can determine if someone is protected from future infection".

To tell people that there is "no evidence" they can develop immunity after being infected could lead to all sorts of panic around a future vaccine, even though vaccine-induced immunity is different to immunity developed from natural infection. But people will hear that message and easily misinterpret it.

Tedros specifically and the WHO in general has been underwhelming from before the start, since he is a PhD and apparently has no clinical experience. The CDC finally has come around, after kinda splitting with them over study interpretation for masking. I think the real issue has been the loudest voices at the decision making and messaging level are going with hard data, peer reviewed, and from what they knew before. They didnt get it that you can't run a good pandemic response based upon the 9-12 months it takes a truly peer reviewed paper to get published. This is damage control in a mass casualty event, so peer review will be months too late. You have got to make decisions on minimally evaluated and limited data and don't look back right now. And so I offer some data. It is at least the third item suggesting prone breathing for symptomatic COVID patients. if you are feeling a little short of breath try this.

Study Shows Benefits of Self-Proning in COVID-19 ED Patients

A pilot study carried out in a New York, NY, emergency department (ED) shows that awake early self‐proning improves oxygen saturation in COVID‐19-positive patients, according to a report published in Academic Emergency Medicine. The study included 50 patients suspected of having COVID-19 with hypoxia on arrival in the ED. A standard pulse oximeter was used to measure SpO2 (peripheral capillary oxygen saturation). SpO2 measurements were recorded at triage and after five minutes of proning. Supplemental oxygenation methods included non‐rebreather mask and nasal cannula. Investigators also characterized post‐proning failure rates of intubation within the first 24 hours of arrival to the ED.

Overall, the median SpO2 at triage was 80 percent (interquartile range [IQR] 69 to 85). After application of supplemental oxygen was given to patients on room air it was 84 percent (IQR 75 to 90). After five minutes of proning was added, SpO2 improved to 94 percent (IQR 90 to 95). Comparison of the pre- to postmedian by the Wilcoxon rank-sum test yielded P=0.001. A total of 13 patients (24 percent) failed to improve or maintain their oxygen saturations and required endotracheal intubation within 24 hours of arrival to the ED.

Further studies are needed to support causality and determine the effect of proning on disease severity and mortality.

What is their reasoning for issuing this announcement?

I heard Ecuador was planning to issue "immunity cards" to those thought to be recovered from infections. Similar schemes under consideration in other countries.

Maybe they wanted certain studies to be completed before people rush to declare people immune?

They’re taking advantage of sophisticated technologies developed over the past two decades to create exquisitely targeted medicines. If they work, the therapies could be used in two crucial ways: to treat those already infected and, in the absence of a vaccine, as a short-term prophylactic for those at high risk.

Normally it can take five or more years to develop a drug and move it into human trials. No one wants to wait that long. AstraZeneca, Vir Biotechnology, and Eli Lilly and its biotech partner, AbCellera Biologics, as well as several academic labs, are hoping to start human trials by the end of summer. If all goes well, antibody treatments for those most in need could be available by fall.

An overview of antibody therapies, including existing ones being tested and new ones being developed for C19.

https://www.bloomberg.com/news/featu...ntil-a-vaccine

Monoclonal antibody technology was created in 1975 but it's very expensive. They aren't typically used for infectious diseases, rather cancer and autoimmune diseases.

But a Vancouver company developed a process to use machine vision to sort through millions of antibodies:

Rick Bright, the guy Trump fired from the HHS department for vaccine development, contacted Regeneron to have them work on a therapy for C19:


Researchers are looking for specific parts fo the spike protein to target, because the virus is mutating, including parts of the spike protein:

Regeneron hopes to start human trials by end of June. Other companies such as Lilly are around July:

The bottleneck is manufacturing. Monocolonal antibodies are typically specialty medications so there isn't high volume manufacturing capacity. There is talk of competitors sharing manufacturing capacity for the first therapy which proves effective. Regeneron hopes to produce 200k prophylactic doses a month in August. But for treatment, patients may require as much as 10x the prophylactic dose so in that case, the volume decreases by an order of magnitude, 20k doses a month.

Delta CEO open to requiring “Immunity passports” to fly
 

https://www.cntraveler.com/story/cou...term=CNT_Daily

I would call this the stupidest idea I’ve heard for a while, but these days it’s just par for the course.



from article:
...but another possible preventative step has surfaced in the industry: immunity passports for COVID-19. Delta Air Lines' CEO became the latest person to embrace the potential document on Wednesday.

Speaking on the airline's first quarter earnings call, Delta CEO Ed Bastian noted that the carrier was open to the idea if it helped passengers feel more comfortable on board aircraft again

Maybe b/c there's a lot of antibody tests being put out and media reporting that testing positive (having anti-Covid-19 antibody) likely confers immunity, when we really have no idea whether it does or not. For example, even if there is immunity, what if it's from the T cell. People need to understand this is just an unproven hypothesis, which has not always been clearly stated.

From WHO (dated April 24, 2020):
https://www.who.int/news-room/commen...xt-of-covid-19

This is my concern too -- as FlyBitCoin points out, it's almost certain that actual antibodies give some sort of immunity, but:

- Are there levels of antibodies from exposure that don't confer full immunity, i.e. if I was exposed to a very light dose and never showed symptoms but test positive for antibodies, and a few months later get coughed on by 10 super-spreaders, am I guaranteed not to get it? I truly don't know the answer, looking for medical insight here.

- What tests are being used and how sure are we/they about their accuracy of measuring antibodies for this specific coronavirus? The criteria for determining overall group exposure numbers (and potential future herd immunity) might be different than the criteria for an "immunity passport"

I have some very deep concerns about the "immunity passport" concept. For those concerned about government overreach, this goes so far beyond anything that's been done so far. Not only does it require a huge regulation and enforcement system (to authenticate testing and enforce restrictions on everyone else), but it requires huge social safety net decisions. Read about the chinese smartphone system and people who are all of a sudden told to isolate and are barred from stores and transport, with no reason given. Think that can't be abused? Make the financial or privilege incentive for having it/working too high, and people in and in contact with higher risk groups will flock to parties to try to get it, or forge certificates. Make the compensation for not being allowed to go out/go on vacation/etc too high, and people who have immunity will be resentful of the rest of us laying around while they do all the work. Expecting the government to balance all that right, well...

And of course, if the false positive rate is even 1% and you send thousands of supposedly "immune" workers into nursing homes with less protection...

Immunity passports are a terrifying concept. We have no idea the long term consequences of this disease. Yet if being immune opens doors and let's you be in a financially better position than others, then I can imagine we will indeed see coronavirus parties, with people willingly exposing themselves to it, so they can go back to work.

You all realize we already have health passports, right?
See: WHO certificates for yellow fever.

Yellow fever certificates are only relevant for people who travel to or from certain parts of the world. This has the possibility of being universal. And of being universal based on a test for which some versions have a pretty high false positive rate.

That may be true. But it doesn't change the fact that we will likely need some way to see who is immune and who is not - whether its the result of a vaccine, more reliable antibody testing, etc.

People are welcome to protest data privacy. They're welcome to claim that we have no way to implement it, even though we already did for yellow fever. While some people are paralyzed with indecision, others will happily get a test/shot and their certificate so they can get on a plane.

Decision. Consequence.

I’m not talking about a vaccine nor data privacy. I’m saying that a very limited test for people traveling certain ways is very different than a test that in some cases will be faulty and is applied globally to reduce rights like working for people. And you selectively quoted me by the way.