- 75% chance that there will be a new wave peaking in March or April, with a peak at least half again as high as the preceding trough.
- 66% chance that sometime this year, the South African and Brazilian strains – or other new strains with similar dynamics – will be a majority of coronavirus cases in the US.
- 55% chance that later, when we have great evidence on this, we’ll find that P/M, Novavax, AZ, and J&J all cut deaths from all extant strains by at least 80%.
- 60% chance that in 2022, public health officials recommend that you get “your yearly COVID shot”, even if you have previously been vaccinated against COVID
- 90% chance that on an average day in mid-2022, on an average street in the SF Bay Area, fewer than 10% of people will be wearing face masks.
- 50% chance that sometime in 2021, the FDA grants a pharmaceutical company general approval for coronavirus vaccines which can adapt to changing virus strains without going through the entire FDA approval process again, and that whatever fast-track lane they get takes less than 3 months between creating the vaccine and it being approved for general use.
Tag: medicine
Semaglutide
The mean change in body weight from baseline to week 68 was −14.9% in the semaglutide group as compared with −2.4% with placebo, for an estimated treatment difference of −12.4% (95% confidence interval [CI], −13.4 to −11.5; P<0.001). More participants in the semaglutide group than in the placebo group achieved weight reductions of 5% or more (1047 participants [86.4%] vs. 182 [31.5%]), 10% or more (838 [69.1%] vs. 69 [12.0%]), and 15% or more (612 [50.5%] vs. 28 [4.9%]) at week 68 (P<0.001 for all 3 comparisons of odds). The change in body weight from baseline to week 68 was −15.3 kg in the semaglutide group as compared with −2.6 kg in the placebo group (estimated treatment difference, −12.7 kg; 95% CI, −13.7 to −11.7). Participants who received semaglutide had a greater improvement with respect to cardiometabolic risk factors and a greater increase in participant-reported physical functioning from baseline than those who received placebo.
this could be the first weight loss drug that actually works. if true, huge public health implications.
Mendelian randomization
by employing innate genetic differences between people—an inborn susceptibility to alcohol, say, or to higher cholesterol levels in the arteries—they can now mimic, at much less effort and expense, the kinds of large trials that would be necessary to determine if an HDL-lowering medicine is really beneficial. The new technique, called Mendelian randomization, is already being used by drug companies to make billion-dollar decisions about which drugs to pursue. What may worry Davey Smith and others most is that as genetic databases have multiplied, tying genes to virtually any imaginable biological or even behavioral variable, studies of cause and association have become almost effortless.
The University of Bristol hosts a platform called MR-Base that lets anyone carry out virtual experiments without collecting any new data.
“You can do these studies now, sitting at your desk, in 10 minutes. It’s just too easy. Because of the flood of studies coming out, it may very well fall into disrepute.”
Orphan Vaccine Carriers
humanity was a lot braver / ingenious 200 years ago. today, people sit on their fat asses debating useless things, like whether human challenge trials are “ethical”:
At the end of the 18th century, smallpox was probably the scariest disease on Earth. It spread alarmingly quickly, and every cm of people’s skin, including their face, would erupt with 1000s upon 1000s of painful, pus-filled sores. Edward Jenner observed something strange, however: People who caught a related disease called cowpox never came down with its deadlier cousin. So in 1796, he began giving people cowpox intentionally, rendering them immune to smallpox and creating the first vaccine.
But the breakthrough introduced another dilemma: How could doctors deliver vaccines to people who needed them? The real trouble started when doctors tried to vaccinate people who were far away. The lymph could lose its potency traveling even the 350km from London to Paris, let alone to the Americas, where it was desperately needed: Smallpox outbreaks there were verging on apocalyptic, killing up to 50% of people who got the virus. Every so often threads of dried lymph did survive an ocean journey—a batch reached Newfoundland in 1800—but the lymph was typically rendered impotent after months at sea. Spain especially struggled to reach its colonies in Central and South America, so in 1803, health officials in the country devised a radical new method for distributing the vaccine abroad: orphan boys.
The plan involved putting 24 Spanish orphans on a ship. Right before they left for the colonies, a doctor would give 2 of them cowpox. After 10 days at sea, the sores on their arms would be nice and ripe. A team of doctors onboard would lance the sores, and scratch the fluid into the arms of 2 more boys. 10 days later, once those boys developed sores, a third pair would receive fluid, and so on.
Flying ambulances in NYC
Hatzolah Air, the air division of the volunteer emergency medical service organization pre-ordered 4 air ambulances from Urban Aeronautics. Renderings from press releases announcing the purchase show a futuristic-looking vehicle landing on crowded city streets to assist at the site of an accident.
“Its compact size will enable it to land in the middle of a busy city street, making it a perfect fit for medical evacuation missions by dramatically decreasing the time it takes to arrive on-scene, treat and transport sick or injured patients to appropriate medical facilities,”
while the flying car cosplay on display is a bit premature, there are prototypes, and they seem to at least be thinking about noise.
2020 -98% flu
In 2019, during the third week of December, the CDC reported that 16% of samples were positive for influenza A. During the same week in 2020, the rate was 0.3%.The question, of course, is why SARS-CoV-2 continues to spread like wildfire when so many other viruses have been crushed. Viruses that have circulated for years are endemic. Because many of us have previously been exposed and therefore have developed immunity to them, social distancing can more easily cut the chain of transmission. Social distancing is probably not the only factor suppressing endemic pathogens. Walgreens, for instance, has seen “unprecedented demand” for flu vaccine shots this season
2021-06-03: Flu clade extinction?
With Covid suppression measures like mask wearing, school closures, and travel restrictions driving flu transmission rates to historically low levels around the world, it appears that 1 of the H3N2 clades may have gone extinct. The same phenomenon may also have occurred with 1 of the 2 lineages of influenza B viruses, known as B/Yamagata. “Without doubt this is definitely going to change something in terms of the diversity of flu viruses out there. The extent to which it changes and how long it stays changed are the big question marks. But we have never seen this before. I do think we’re likely to lose a little bit of the H3N2 diversity. That’s a great thing. Currently when we make recommendations for vaccine strains, it’s always the headache virus.”
Flu, HIV, Nipah vaccines
Even as we have shown that our mRNA-based vaccine can prevent COVID-19, this has encouraged us to pursue more-ambitious development programs within our prophylactic vaccines modality. Today we are announcing 3 new vaccine programs addressing seasonal flu, HIV and the Nipah virus, some of which have eluded traditional vaccine efforts, and all of which we believe can be addressed with our mRNA technology. Beyond vaccines, we are extending our mRNA development work to a total of 24 programs across 5 therapeutic areas
Health Trends
For too long, we’ve confused the status quo for stasis in healthcare. We’ve accepted certain things as true, things we believed to be immutable, intractable, or at the very least, extremely hard to change—like that it takes years to develop a vaccine, or that virtual medicine will never scale for doctors or patients, or that the regulatory system can’t adapt to innovation quickly enough to support lasting change. But then came 2020.
- Patient data moves beyond the EHR.
- Health insurance gets unbundled.
- Virtual care becomes a first-class citizen…
- …with its own operating system.
- The home becomes a primary site of care (again).
- Mental health gets engineered.
- Value-based care comes for Rx.
- Illumina for X.
- Infectious diseases attract investment again.
- Clinical trials (finally) go digital
- Personal genomics finally goes clinical.
- Working on rare diseases gets more common.
- Biotech reaches the industrial age.
- Targeted delivery of complex therapies.
- Biotech R&D goes more virtual.
- The bright line between life sciences and care delivery blurs.
Continuous blood tests
“A blood test is great, but it can’t tell you, for example, whether insulin or glucose levels are increasing or decreasing in a patient” The Real-time ELISA is essentially an entire lab within a chip with tiny pipes and valves no wider than a human hair. An intravenous needle directs blood from the patient into the device’s tiny circuits where ELISA is performed over and over.
Immune System Arms Race
The challenge for the immune system is that mammals do not evolve as fast as viruses. How then, in the face of this disadvantage, can the immune system hope to keep pace with viral evolution? If a protein is fragile, even small changes can render it completely unable to do its job. TRIM5α is not fragile; most random mutations increased, rather than decreased, the protein’s ability to prevent viral infection. TRIM5α can readily gain antiviral activity and, once gained, does not lose it easily during subsequent mutation.
2022-12-02: And new infections can be filmed
The early stages of the virus–cell interaction have long evaded observation by existing microscopy methods due to the rapid diffusion of virions in the extracellular space and the large 3D cellular structures involved. We present an active-feedback single-particle tracking method with simultaneous volumetric imaging of the live cell environment called 3D-TrIm to address this knowledge gap. 3D-TrIm captures the extracellular phase of the infectious cycle in what we believe is unprecedented detail. We report previously unobserved phenomena in the early stages of the virus–cell interaction, including skimming contact events at the millisecond timescale, orders of magnitude change in diffusion coefficient upon binding and cylindrical and linear diffusion modes along cellular protrusions. We demonstrate how this method can move single-particle tracking from simple monolayer culture toward more tissue-like conditions by tracking single virions in tightly packed epithelial cells. This multiresolution method presents opportunities for capturing fast, 3D processes in biological systems.