Vaccine efficacy - Printable Version
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RE: Vaccine efficacy - teejers1 - 09-10-2020
(09-10-2020, 11:55 AM)Goose Wrote: I think that is what a lot of people are going to do, myself included. However, that also means I am not going to be dining indoors in a restaurant or drinking in a bar. I also won't be attending a Stanford football game with even our naturally socially distanced fan base. One might say there are different levels of caution, but for "most people" who want to live their life as they did before COVID-19, the only two options are a vaccine or risk getting COVID-19. Note that risking getting COVID-19 isn't the same as getting COVID-19. Most people who take some risks will get away with it and not get sick. They know that, and they aren't going to wait for a vaccine "forever". In fact, many of them aren't waiting now. That is one big reason why our society is seeing lots of people die who didn't have to do so.
How is Sweden doing these days? I presume reasonably well, because we don't see as many headlines about how Sweden clustered this thing to infinity. (In truth, I did hear some guy on the radio say cases there were low and death rate almost zero - and that Sweden is not seeing surges that are seen in some other European countries). I have no idea if this is true or not - don't pay much attention to numbers beyond SCC.
The US is going to stumble through this, with mask-wearing indoors and mostly self-regulation (like you're going to do). If old folks and comorbidity folks are especially careful, then hopefully deaths will be limited.
RE: Vaccine efficacy - BostonCard - 09-10-2020
Sweden's main surge has passed, and new cases and deaths are pretty low. Their seven-day average number of new cases are about 200, and new deaths are about 1 a day.
In terms of per capita deaths, Sweden is fourth in Europe among large companies (excluding San Marino and Andorra), behind Belgium, Spain, the UK, and Italy at 578 deaths/million.
Compared to other Nordic countries, Denmark is at 109 deaths/million, Finland has 51 deaths/million, Norway has 49 deaths/million, so they have had between 1/5 and 1/10 the number of deaths.
Daily cases in Denmark are about the same as Sweden (7-day average of 202), but this number is rising. The 7-day average deaths are at 0-1. Daily cases in Norway are at 102; average daily deaths are at <1. Daily cases in Finland are at 35; deaths are basically 0 (they have had one COIVD death in September).
So, to sum up, the current state, all the Nordic countries are at more or less the same place (though there has been a rising number of cases in Denmark). However, the total number of deaths in Sweden has much higher than for its peer countries.
In exchange for that, Sweden actually had a worse economic performance in the second quarter.
https://www.businessinsider.com/coronavirus-sweden-gdp-falls-8pc-in-q2-worse-nordic-neighbors-2020-8
Quote:Sweden's GDP fell 8.6% during the second quarter of the year, according to its statistics body.
The fall is sharper than its neighbors — Denmark registered a 7.4% fall, and Finland a 3.2% fall. Statistics suggest Norway also fared better than Sweden.
It remains to be seen what happens in the third quarter, but given that the pandemic was more controlled in Denmark, Finland, and Norway, I would expect that the economic rebound would be at the very least similar to Sweden's.
So, to sum up, Sweden's strategy left it with a worse economy and more deaths than its neighbors, and amongst the worst in Europe (worse than hard-hit France, for example). That strikes me as a bad strategy.
BC
RE: Vaccine efficacy - Mick - 09-10-2020
(09-10-2020, 01:19 PM)BostonCard Wrote: So, to sum up, Sweden's strategy left it with a worse economy and more deaths than its neighbors, and amongst the worst in Europe (worse than hard-hit France, for example). That strikes me as a bad strategy.
BC
I don't know that I agree with the "worse economy" statement. According to Eurostat, seasonally adjusted GDP decreased by -12.1% in the Euro area and -11.7% in the EU during Q2 2020. French GDP declined -13.8% compared to last quarter and -19.0% compared to the same quarter last year. As noted, Sweden declined -8.6% compared to last quarter and if you compare it to the 2nd quarter of last year, Sweden's -8.3% decline is only fourth worst in the EU of 21 countries that had measureable data. It was 8th worst of the 21 Euro countries a year ago. By that measure, Sweden significantly improved their position relative to the other European countries.
Of the 21 European countries for which data is available, Sweden's -8.6% GDP decline from Q1 to Q2 was 8th smallest. Finland "led" the way with a -3.2% decline, Lithuania was -5.1%. Denmark and Latvia were -7.4% and -7.5%.
Large, double digit declines were felt by Belgium (-12.2%), Germany (-10.1%), Spain (-18.5%), France (-13.8%), Italy (-12.4%), Cyprus (-11.6%), Hungary (-14.5%), Austria (-10.7%), Portugal (-13.9%), Romania (-12.3%) and the UK (-20.4%). USA was -9.5%.
See page three of this release:
https://ec.europa.eu/eurostat/documents/2995521/10545332/2-14082020-AP-EN.pdf/7f30c3cf-b2c9-98ad-3451-17fed0230b57
RE: Vaccine efficacy - BostonCard - 09-10-2020
Obviously the basis for comparison is important. Ideally, what we would like to determine is what the effect of a shutdown in Sweden would have been, in the alternative universe where the Swedish government imposes one. Since we obviously don't have that luxury, we have to pick one or more countries to compare to Sweden.
You could compare Sweden to all of Europe, and note that Sweden's GDP drop is one of the least bad, and that Sweden's death rate is among the highest. However, I'm not sure all of Europe is the right basis of comparison, since the situation in Italy and Spain when those countries made a decision to lock down was very different from the situation in Sweden when it decided not to lock down.
To me, the best comparator would seem to be geographically and demographically similar countries: Denmark, Norway, and Finland (ergo my statement comparing Sweden to its "neighbors"). All three of those countries were facing a similar choice in March as Sweden: deciding between locking down even though the number of cases and deaths were low or continuing business as usual as Sweden did. And compared to each of those countries, Sweden suffered a bigger economic decline, and more deaths.
BC
RE: Vaccine efficacy - Goose - 09-10-2020
(09-10-2020, 02:01 PM)BostonCard Wrote: To me, the best comparator would seem to be geographically and demographically similar countries: Denmark, Norway, and Finland (ergo my statement comparing Sweden to its "neighbors"). All three of those countries were facing a similar choice in March as Sweden: deciding between locking down even though the number of cases and deaths were low or continuing business as usual as Sweden did. And compared to each of those countries, Sweden suffered a bigger economic decline, and more deaths.I understand your basis for selecting "similar" countries, but I believe that economically Sweden, Norway, and for certainly Denmark are very different beasts. I think Sweden is much more sensitive to downturns in the other EU economies.
BC
RE: Vaccine efficacy - chrisk - 09-10-2020
(09-10-2020, 05:14 PM)Goose Wrote:(09-10-2020, 02:01 PM)BostonCard Wrote: To me, the best comparator would seem to be geographically and demographically similar countries: Denmark, Norway, and Finland (ergo my statement comparing Sweden to its "neighbors"). All three of those countries were facing a similar choice in March as Sweden: deciding between locking down even though the number of cases and deaths were low or continuing business as usual as Sweden did. And compared to each of those countries, Sweden suffered a bigger economic decline, and more deaths.I understand your basis for selecting "similar" countries, but I believe that economically Sweden, Norway, and for certainly Denmark are very different beasts. I think Sweden is much more sensitive to downturns in the other EU economies.
BC
The reporting on the Nordic countries has not addressed intrinsic differences between the Swedish economy and the others, but if all Nordic countries are in similar position now, what is there to recommend or support the Swedish poicy as a desirable one, given the large number of excess deaths.
RE: Vaccine efficacy - BostonCard - 09-10-2020
https://en.wikipedia.org/wiki/List_of_countries_by_trade-to-GDP_ratio
Exports are about 45% of Sweden’s GDP, compared to 39% for Finland, 36% for Norway, but 55% for Denmark. If exposure to trade were the biggest factor, you’d have expected Denmark’s economy to be the most affected, not Sweden’s.
BC
RE: Vaccine efficacy - Mick - 09-11-2020
From Professor Johan Strang of the University of Helsinki as to the administrative and economic differences between Sweden, Finland, Norway and Denmark. He outlines the differences between the countries and their impact on each country's response to the COVID crisis.
https://nordics.info/show/artikel/the-nordic-countries-react-differently-to-the-covid-19-crisis/
RE: Vaccine efficacy - Goose - 09-11-2020
(09-10-2020, 10:04 PM)BostonCard Wrote: https://en.wikipedia.org/wiki/List_of_countries_by_trade-to-GDP_ratioIt isn't just the trade quantity, it is what the goods are. Denmark exports lots of agricultural products, like particularly beef, to the rest of the EU. Norway exports among other important products lots of oil. Sweden exports more high-end manufactured products and high grade industrial items. These tend to be items one doesn't buy in a pandemic. Food and gas you still do. Each country is going to be affected differently.
Exports are about 45% of Sweden’s GDP, compared to 39% for Finland, 36% for Norway, but 55% for Denmark. If exposure to trade were the biggest factor, you’d have expected Denmark’s economy to be the most affected, not Sweden’s.
BC
RE: Vaccine efficacy - BostonCard - 09-11-2020
(09-11-2020, 08:40 AM)Mick Wrote: From Professor Johan Strang of the University of Helsinki as to the administrative and economic differences between Sweden, Finland, Norway and Denmark. He outlines the differences between the countries and their impact on each country's response to the COVID crisis.
https://nordics.info/show/artikel/the-nordic-countries-react-differently-to-the-covid-19-crisis/
Thanks Mick, that was a great article. It is a good reminder that Sweden's approach is very popular amongst Swedes. It might not have been the approach I would have wanted (at least not if the approach taken and outcomes observed by Denmark or Norway) are the alternative, but I'm not in Sweden, so it's not really relevant to me.
Now, the real question is whether the US would have been better off just following Sweden's approach, if there is an acknowledgment that probably couldn't have gotten the population to take a Germany/Denmark/Norway approach.
BC
RE: Vaccine efficacy - Goose - 09-11-2020
(09-11-2020, 02:08 PM)BostonCard Wrote: Now, the real question is whether the US would have been better off just following Sweden's approach, if there is an acknowledgment that probably couldn't have gotten the population to take a Germany/Denmark/Norway approach.I think the answer is probably we would not have been better off. As the article pointed out, Swedes follow the regulations precisely. If you have fewer regulations to reduce the spread of disease, in order to have any chance at all of keeping spread under control those few regulations must be followed. In the USA, even if we had fewer, less invasive restrictions, IMHO the remaining regulations would not have been followed "religiously" and we wouldn't replicate even Sweden's death rate.
BC
I think that the situation in New York got so bad so rapidly that a lockdown there was essential. Sweden never had to deal with that level of initial spread. It could be argued that the Bay Area would have been able to escape an initial lockdown and do OK. However, we are now de facto in a "Sweden Lite" model and aren't doing so well, so I wonder about even that. We are nowhere near opening the schools. It may be we could do that without a big increase in cases, but for some reason I doubt it.
I have done business in Norway, Sweden, and Denmark. It is true that while there are similarities, there are differences, as the article points out. There are also many others not highlighted in the article. I have never sold anything to the Finns. FWIW, Denmark is the only country where I have ever been berated for NOT walking against the pedestrian light. The explanation was "We are Danes. We don't do what they tell us. We do what we want." This was said literally, in so many words.
RE: Vaccine efficacy - BostonCard - 09-11-2020
Speaking of Scandinavian stereotypes...
https://www.economist.com/europe/2020/07/02/covid-19-is-scrambling-scandinavian-stereotypes
You are probably right about the impact of a Sweden-like approach to the US.
BC
RE: Vaccine efficacy - 2006alum - 09-11-2020
I'm ordinarily very pro vaccine, but even I am hesitant to be in the first wave, given how politicized this has been, and how clear it is some in charge want to rush the announcement of a vaccine for political gains.
And speaking of getting shots in the first wave, many thanks for all the helpful insights on the timing of the flu shot. Some Labor Day Weekend travel necessitated I get a COVID test this AM and when my primary doc offered me the flu shot too, I availed myself of the opportunity. I also learned my boomer mother "doesn't believe in flu shots" and has never gotten one, although she could not actually state a reason other than "I just don't do flu shots." Dot. Dot. Dot. (And she is as anti-Trump as anyone I've ever met, so it's clear American anti-vax sentiments run even deeper than partisanship does...)
RE: Vaccine efficacy - dabigv13 - 09-11-2020
The most common response when I ask why a patient hasn't gotten a flu shot is no good reason. Very few worry it will give them the flu or a fever or a sore arm. They just say they never have, they've always been ok, and maybe they'll think about it and get one next time.
Very few are convinceable, even when I tell them of a healthy 40 year old friend of my wife who died within a week of getting the flu. It's frustrating.
RE: Vaccine efficacy - Goose - 09-12-2020
(09-11-2020, 06:45 PM)dabigv13 Wrote: The most common response when I ask why a patient hasn't gotten a flu shot is no good reason. Very few worry it will give them the flu or a fever or a sore arm. They just say they never have, they've always been ok, and maybe they'll think about it and get one next time.
Very few are convinceable, even when I tell them of a healthy 40 year old friend of my wife who died within a week of getting the flu. It's frustrating.
For us "older" people, and myself in particular, their friend's experience with the vaccine has been a driver. The number of people who got a seriously bad reaction to the flu vaccines when they first came out was significant. Several people I knew were were sick for days. Almost everybody who got a flu shot complained about something. When you are younger and see that situation you basically say "I would rather take my chances with the flu than be sick for sure". Now that I am significantly older and the number of people who have bad experiences seems to be about zero, I have started getting a flu shot.
RE: Vaccine efficacy - dabigv13 - 09-13-2020
https://www.nytimes.com/2020/09/12/health/astrazeneca-coronavirus-vaccine-trial-resumes.html
Oxford AstraZeneca vaccine resumes trials, but only in UK, not US and other trial sites. No reason given for that, or any information given about why they felt it was safe to resume at all.
Also I think more notably, the Pzifer BioNTech vaccine is expanding their trial from 30k to 44k. They are still saying they could have early data by end of October.
Considering their protocol is two injections a month apart, I think that is really optimistic to have data by then as they have not even finished enrolling their original 30k. In the press release they mention their goal is to include more patients with other comorbidities.
Only way to have any data by end of October in my mind is if a substantial effect is seen, and that after only one injection.
Another reason you might expand a trial is because the effect of the intervention is not as strong as initially hoped, or that the prevalence of the disease is not high enough to see an effect, quickly enough.
I think the expansion is an ominous sign But more data is always welcome.
I suspect we will see trials ended early without as clear data on efficacy and safety as we would like.
RE: Vaccine efficacy - Goose - 09-13-2020
(09-13-2020, 12:46 PM)dabigv13 Wrote: Another reason you might expand a trial is because the effect of the intervention is not as strong as initially hoped, or that the prevalence of the disease is not high enough to see an effect, quickly enough.Expansion could be neutral if for example they wanted to increase representation of some particular group. If they are doing it because there is concern for the "power" of the trial you are surely correct that it is not a positive sign.
I think the expansion is an ominous sign But more data is always welcome.
I suspect we will see trials ended early without as clear data on efficacy and safety as we would like.
I don't think we are going to see the trials end early. If an approval was granted and they haven't actually met their endpoint (for whatever reason) the "stink" would be brobdingnagian. I just don't see that happening. I do however think that a "normal" safety trial has to involve following patients for at least a year. That we aren't going to get, obviously.
RE: Vaccine efficacy - BostonCard - 09-13-2020
(09-13-2020, 02:24 PM)Goose Wrote:(09-13-2020, 12:46 PM)dabigv13 Wrote: Another reason you might expand a trial is because the effect of the intervention is not as strong as initially hoped, or that the prevalence of the disease is not high enough to see an effect, quickly enough.Expansion could be neutral if for example they wanted to increase representation of some particular group. If they are doing it because there is concern for the "power" of the trial you are surely correct that it is not a positive sign.
I think the expansion is an ominous sign But more data is always welcome.
I suspect we will see trials ended early without as clear data on efficacy and safety as we would like.
I don't think we are going to see the trials end early. If an approval was granted and they haven't actually met their endpoint (for whatever reason) the "stink" would be of immense proportions. I just don't see that happening. I do however think that a "normal" safety trial has to involve following patients for at least a year. That we aren't going to get, obviously.
It could be a sign that they simply haven't gotten enough events (that is, not enough trial participants have gotten COVID-19). An adequately powered trial would need about 75 volunteers to get COVID-19 (by my back-of-the-envelope calculation) to have adequate power to show a 50% efficacy and a 30% lower bound to the 95% confidence interval, as required by the FDA. If the pandemic is subsiding in the areas of the world that they are vaccinating, it is possible that they are accruing cases of COVID-19 too slowly to be powered to determine efficacy anytime soon (of course, the alternative to recruiting more patients is just to wait until you have enough cases).
BC
RE: Vaccine efficacy - OutsiderFan - 09-16-2020
How much time do we waste as a country thinking things might happen because idiots in government are lying to us? I was so pissed when people started talking about a vaccine maybe being available by November. Finally, someone tells the truth:
[tweet]https://twitter.com/NPRHealth/status/1306292030570557440[/tweet]
And, the CEO of Phizer IIRC, said if the vaccine requires two doses, we won't be able to get the world immunized until 2024.
RE: Vaccine efficacy - BostonCard - 09-16-2020
Bill Gates is considerably more optimistic. He thinks vaccination will start to get the pandemic under control by next year, and most of the world can be vaccinated by 2022.
https://www.economist.com/international/2020/08/18/the-covid-19-pandemic-will-be-over-by-the-end-of-2021-says-bill-gates
BC