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Thread: Disease and pandemics thread (because it's science)

  1. #2671
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    So in other words, we are going to have to keep paying Moderna and Pfizer and Astra Zeneca year in and year out, because their vaccines wonít stop infection but only stop severe disease. So our choice is either to let the disease go on and keep paying the companies to protect us from from severe disease, or do a sort of extreme lockdown to try to get rid of it?
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  2. #2672
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    Quote Originally Posted by Jens View Post
    So in other words, we are going to have to keep paying Moderna and Pfizer and Astra Zeneca year in and year out, because their vaccines wonít stop infection but only stop severe disease.
    I believe they usually do stop infection, but not 100% of the time.

    So our choice is either to let the disease go on and keep paying the companies to protect us from from severe disease, or do a sort of extreme lockdown to try to get rid of it?
    Itís impractical to get rid of it. Even if we could get everyone to agree on a good enough world lockdown, animal reservoirs exist and might be enough to reintroduce it. Itís now like the flu, in the sense we are unlikely to get rid of it, but can keep it fairly controlled with vaccinations.

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  3. #2673
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    Quote Originally Posted by Jens View Post
    So in other words, we are going to have to keep paying Moderna and Pfizer and Astra Zeneca year in and year out, because their vaccines won’t stop infection but only stop severe disease. So our choice is either to let the disease go on and keep paying the companies to protect us from from severe disease, or do a sort of extreme lockdown to try to get rid of it?
    Well the problem is the virus mutates as does the flu virus. It is about time we paid the vaccine companies their due, the science and the technology are both impressive and part of the improving modern world. We in the richer countries should also be paying for world wide vaccines because that is the way to halt the progress of evolved viruses. Vaccines are a better investment IMO than drugs to keep you going once infected. Those seem to work out super expensive and should be developed for diseases where vaccines are no use.

    A further step seems to be even cleverer vaccines, and that should be welcomed as these viruses seem to evolve faster than we do. Of course the transfer from animals could be reduced too, but that is another vector in the fight to stay healthy.
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  4. #2674
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    Quote Originally Posted by Jens View Post
    So in other words, we are going to have to keep paying Moderna and Pfizer and Astra Zeneca year in and year out, because their vaccines won’t stop infection but only stop severe disease. So our choice is either to let the disease go on and keep paying the companies to protect us from from severe disease, or do a sort of extreme lockdown to try to get rid of it?
    To what extent we'll have to keep paying is yet to be established, but that's how it works for every other vaccine in the world. By the known nature of coronaviruses, it's likely the model will be more like flu or tetanus than like measles--that is, we may need to cope with waves of new variants, and/or repeat booster doses as immunity wanes, rather than the more fire-and-forget approach with the measles vaccine (which is nevertheless "only" 97% effective).
    I may be reading you wrongly, but you do seem to be rather undervaluing the astonishly effective vaccines that have been produced in the space of a year. The problem here is not that we've been misled or tricked by vaccine manufacturers, but that many people (some with quite obvious agendas) have propagating a completely unrealistic view of vaccine effectiveness, and those chickens are coming home to roost as lockdowns ease.

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  5. #2675
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    Quote Originally Posted by Jens View Post
    So in other words, we are going to have to keep paying Moderna and Pfizer and Astra Zeneca year in and year out, because their vaccines won’t stop infection but only stop severe disease. So our choice is either to let the disease go on and keep paying the companies to protect us from from severe disease, or do a sort of extreme lockdown to try to get rid of it?
    We can't get rid of it as things stand; "extreme lockdown" would only be possible with universal total social control of all human populations on Earth.

    The world's unvaccinated populations (many, for numerous causes) act as both reserves of the virus and breeding grounds for new mutations. It's here to stay for the foreseeable future. Vaccines do greatly lessen the odds of infection, and severity.
    "I'm planning to live forever. So far, that's working perfectly." Steven Wright

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    What eventually protects each of us the most is the decreased prevalence that comes with widespread vaccination, rather than our own vaccination. Prevalence in my part of the world is currently higher than it has ever been, because we've come most of the way out of lockdown before the "mixer" population is fully vaccinated, and people have largely gone demob happy and are ignoring the restrictions that are still in place.
    So by my own reckoning, I'm more likely to catch Covid now, fully vaccinated as I am, than I was last year at this time when I was unvaccinated, because the prevalence is now hundreds of times higher and people around me are ignoring some of the fundamental protective measures. So if anything I've reduced my social contacts in the wake of my vaccinations.
    Fortunately, vaccine hesitancy has so far been negligible in older age groups hereabouts, with vaccine uptake routinely in excess of 90%, and the "mixers" appear to be putting a concerted effort into infecting themselves as rapidly as possible, so the combination of high infection rates and high vaccine uptake should get us well into herd immunity by the end of the summer, at which time we should see a real drop in prevalence. And then I'll actually start to feel I'm gaining some real benefit from my vaccination status.

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  7. #2677
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    Quote Originally Posted by Noclevername View Post
    The world's unvaccinated populations (many, for numerous causes) act as both reserves of the virus and breeding grounds for new mutations.
    Not just the unvaccinated populations. The vaccinated populations will also act as reserves and breeding grounds, plus weíll be given the freedom to travel and spread it around.


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    Quote Originally Posted by Jens View Post
    Not just the unvaccinated populations. The vaccinated populations will also act as reserves and breeding grounds, plus we’ll be given the freedom to travel and spread it around.
    True, though to a far lesser degree. But unvaccinated people move just as well as the vaccinated, with very few exceptions. The limits on travel affect few regions of the world and are sporadically enforced.
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  9. #2679
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    Quote Originally Posted by grant hutchison View Post
    What eventually protects each of us the most is the decreased prevalence that comes with widespread vaccination, rather than our own vaccination. Prevalence in my part of the world is currently higher than it has ever been, because we've come most of the way out of lockdown before the "mixer" population is fully vaccinated, and people have largely gone demob happy and are ignoring the restrictions that are still in place.
    I understand that, but my concern is, what if the vaccines donít actually reduce the prevalence but only the chance of getting severe disease?


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    Quote Originally Posted by Jens View Post
    I understand that, but my concern is, what if the vaccines don’t actually reduce the prevalence but only the chance of getting severe disease?
    They significantly reduce a person's chance of getting the disease, and they significantly reduce an infected person's chance of transmitting the disease. That strongly drives down the effective R number. There's currently debate about whether vaccination alone can get R below 1, or whether it will simply make it much easier to contain the disease. The next few months will be interesting.

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  11. #2681
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    Quote Originally Posted by grant hutchison View Post
    There's currently debate about whether vaccination alone can get R below 1, or whether it will simply make it much easier to contain the disease. The next few months will be interesting.
    Yes, I mean of course like everybody else my hope is that it will drive it below 1, but the concern I have is, what if it doesn't. Of course, we can try to develop more effective vaccines, but in the meantime we'll have to make choices about what to do. We often hear from Ozduck about how great things are in Australia, so certainly serious restrictions on travel, both between countries and inside countries, are something that I suppose could be considered, as well as taking the approach that's being carried out in Japan and other places, basically responding flexibly according to how the medical system is coping, and then of course boosting the number of doctors and hospitals to be able to live with it permanently.
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    Quote Originally Posted by Jens View Post
    Yes, I mean of course like everybody else my hope is that it will drive it below 1, but the concern I have is, what if it doesn't. Of course, we can try to develop more effective vaccines, but in the meantime we'll have to make choices about what to do. We often hear from Ozduck about how great things are in Australia, so certainly serious restrictions on travel, both between countries and inside countries, are something that I suppose could be considered, as well as taking the approach that's being carried out in Japan and other places, basically responding flexibly according to how the medical system is coping, and then of course boosting the number of doctors and hospitals to be able to live with it permanently.
    If you are talking a worldwide coordinated plan, that's probably not going to happen. At the state/province/national/international level it gets into politics. As individuals all we can do right now is continue the vaccinations if and as they become available, continue to take the precautions, and try to encourage others to do the same.
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  13. #2683
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    Quote Originally Posted by Jens View Post
    Yes, I mean of course like everybody else my hope is that it will drive it below 1, but the concern I have is, what if it doesn't.
    The latest stats from the Office of National Statistics here in the UK are encouraging, in that regard. The current rise in cases is driven almost entirely by the largely unvaccinated 17-24-year-old age group. Infections in the 25-34 age group were also rising sharply until recently, when the vaccine roll-out reached them, and their rise has now reversed. So clearly the combination of first-dose vaccination and naturally acquired immunity has been enough to start prevalence falling in that group. That's in the presence of some remaining restrictions on social mixing, but given that the vaccines are considerably more effective after the second dose (particularly against our dominant delta variant), we seem to be seeing an indication that vaccination and natural immunity will damp down transmission enough to allow some sort of near-normal reopening of society.

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    Quote Originally Posted by grant hutchison View Post
    The latest stats from the Office of National Statistics here in the UK are encouraging, in that regard. The current rise in cases is driven almost entirely by the largely unvaccinated 17-24-year-old age group.
    Itís interesting. In Japan as well, the other night there was a report where the anchor reported concern that most infections are among young people. And I almost shouted into the TV, why donít you see this as a sign that vaccination is working?
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    Kind of random comment, but I've heard people talking about the possibility that face masks lead to a decrease in blood oxygen levels. That seems fairly outlandish to me. My understanding is that the body is pretty sensitive to changes in blood oxygen (or perhaps carbon dioxide), and will quickly compensate for low blood oxygen by increasing the breathing rate, so it would be possible that masks make us breathe faster but I don't think it would lead to lower blood oxygen (the blood oxygen only falls when the body is unable to compensate adequately).
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    I wonder if somebody (I expect that Grant will be able to weigh in) could help me with something. There is a paper in the NEJM that discusses the safety of vaccination in pregnant women.

    https://www.nejm.org/doi/pdf/10.1056/NEJMoa2104983

    The paper itself concludes, "Preliminary findings did not show obvious safety signals among pregnant persons who received mRNA Covid-19 vaccines."

    But there are websites saying the paper concludes that 82% of the women had spontaneous abortions. Because, in the paper, it says, "Among 3958 participants enrolled in the v-safe pregnancy registry, 827 had a completed pregnancy, of which 115 (13.9%) resulted in a pregnancy loss and 712 (86.1%) resulted in a live birth (mostly among participants with vaccination in the third trimester)." So they are taking 827 out of the original 3958, and saying the remainder did not have a "completed pregnancy". Can anyone explain what that means?
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    Quote Originally Posted by Jens View Post
    I wonder if somebody (I expect that Grant will be able to weigh in) could help me with something. There is a paper in the NEJM that discusses the safety of vaccination in pregnant women.

    https://www.nejm.org/doi/pdf/10.1056/NEJMoa2104983

    The paper itself concludes, "Preliminary findings did not show obvious safety signals among pregnant persons who received mRNA Covid-19 vaccines."

    But there are websites saying the paper concludes that 82% of the women had spontaneous abortions. Because, in the paper, it says, "Among 3958 participants enrolled in the v-safe pregnancy registry, 827 had a completed pregnancy, of which 115 (13.9%) resulted in a pregnancy loss and 712 (86.1%) resulted in a live birth (mostly among participants with vaccination in the third trimester)." So they are taking 827 out of the original 3958, and saying the remainder did not have a "completed pregnancy". Can anyone explain what that means?
    I read more carefully, and I think I understand. I think that what they mean is that for the people other than the 827, they didn't know (at the time the data was collected) what happened. So they might have still been pregnant, or hadn't answered a follow-up. So I think it really means a lack of data.
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  18. #2688
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    I am not a doctor but reading the results seems to me that not all the smaller sample had completed their term. That does not mean they aborted. They say directly that the numbers were consistent with statistics before vaccination. Surely that would not say that if the losses were much higher than a normal cohort?
    sicut vis videre esto
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  19. #2689
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    Yeah, thatís the way I read it too.


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    A completed pregnancy is one that has reached a point at which a person is no longer pregnant--so the pregnancy has "resolved" as a spontaneous abortion, termination, miscarriage, stillbirth or live birth. People who have not completed a pregnancy are still pregnant.

    ETA: The websites you have seen therefore seem to be confusing "pregnancy not (yet) completed" with "pregnancy completed without live issue". I'd check for an anti-vax agenda.

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  21. #2691
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    Quote Originally Posted by Jens View Post
    Kind of random comment, but I've heard people talking about the possibility that face masks lead to a decrease in blood oxygen levels. That seems fairly outlandish to me. My understanding is that the body is pretty sensitive to changes in blood oxygen (or perhaps carbon dioxide), and will quickly compensate for low blood oxygen by increasing the breathing rate, so it would be possible that masks make us breathe faster but I don't think it would lead to lower blood oxygen (the blood oxygen only falls when the body is unable to compensate adequately).
    I recall an online video where someone was wearing an oxygen sensor with and without a mask on, and there was no difference in their blood oxygen concentration.

    For work I sometimes have to wear various types of masks and respirators (such as an N95 mask or a PAPR). You have to be tested and approved to wear these. The problem with any of these is not that they lower your blood oxygen levels, but that your lungs have to work harder - normally only very slightly harder. The only cases where I know this rises to the point of being an issue is with someone who has very serious lung disease (such as COPD) and/or you are doing very strenuous work.

    I also suspect that if you have serious COPD, that the harm from wearing a mask is much less than the harm from getting Covid-19.
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    Quote Originally Posted by Jens View Post
    Kind of random comment, but I've heard people talking about the possibility that face masks lead to a decrease in blood oxygen levels. That seems fairly outlandish to me. My understanding is that the body is pretty sensitive to changes in blood oxygen (or perhaps carbon dioxide), and will quickly compensate for low blood oxygen by increasing the breathing rate, so it would be possible that masks make us breathe faster but I don't think it would lead to lower blood oxygen (the blood oxygen only falls when the body is unable to compensate adequately).
    It is outlandish--it's a narrative specifically driven by anti-maskers.
    Our bodies are surprisingly cheerful about low oxygen levels--you need to be quite severely hypoxaemic before your respiratory centre will increase the rate and depth of breathing. The respiratory centre (in a healthy person) is much more interested in keeping carbon dioxide levels within fairly tight limits, and that provides minute-by-minute regulation of breathing. But if carbon dioxide is maintained at normal levels by healthy lungs, oxygenation will also be normal.
    What masks do is increase the resistance to breathing by a variable extent, and slightly increase the effective dead space (that is, you rebreathe a small quantity of additional carbon dioxide from the space inside the mask). Both of these will increase your work of breathing, particularly if you're wearing a properly fitted particulate mask of the sort worn by health-care workers. That can get mentally wearing during a long shift, but it doesn't affect your ability to ventilate your lungs.

    Just as a QI side note, it seems to be generally believed (even among medical practitioners) that rising carbon dioxide levels are what force you to take a breath after a period of breath-holding. That's not actually the case, because carbon dioxide rises very slowly when breathing ceases. The air-hunger you experience while holding your breath is actually mediated by the stretch receptors in your lungs, which go through a cycle of increased and decreased firing with each breath you take. The respiratory centre responds strongly if that cycle is interrupted, long before a significant change in carbon dioxide levels occurs.
    If you watch a free-diver breath-holding, many of them are constantly making respiratory efforts against closed vocal cords--alternately expanding the chest while sucking in the diaphragm, and compressing the chest while blowing out the diaphragm. That's a way of tricking the stretch receptors into believing all is well, and so controlling that aspect of air-hunger.

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    Quote Originally Posted by grant hutchison View Post

    ETA: The websites you have seen therefore seem to be confusing "pregnancy not (yet) completed" with "pregnancy completed without live issue". I'd check for an anti-vax agenda.
    Itís definitely an anti-vaccine agenda. Iím simply looking for ammunition against that.
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    Quote Originally Posted by grant hutchison View Post
    Our bodies are surprisingly cheerful about low oxygen levels--you need to be quite severely hypoxaemic before your respiratory centre will increase the rate and depth of breathing.
    Just to clarify this a little ...
    The normal partial pressure of dissolved oyxgen in arterial blood is about 13kPa (100mmHg). It needs to fall to about 8.5kPa (65mmHg) before we see a physiological response increasing the rate and depth of breathing. So a pretty big change. One reason our bodies are so tolerant of big drops in oxygen partial pressure is something called the oxy-haemoglobin dissociation curve, which has a characteristic sigmoid shape. Our haemoglobin is very good at picking up oxygen from the lungs, and so remains more than 90% saturated with oxygen all the way down to that critical 8.5kPa cut-off, at which point oxygen carriage falls off the shoulder of the curve and oxygen delivery to the tissues crashes.

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  25. #2695
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    Quote Originally Posted by grant hutchison View Post
    It is outlandish--it's a narrative specifically driven by anti-maskers.
    Our bodies are surprisingly cheerful about low oxygen levels--you need to be quite severely hypoxaemic before your respiratory centre will increase the rate and depth of breathing. The respiratory centre (in a healthy person) is much more interested in keeping carbon dioxide levels within fairly tight limits, and that provides minute-by-minute regulation of breathing. But if carbon dioxide is maintained at normal levels by healthy lungs, oxygenation will also be normal.
    What masks do is increase the resistance to breathing by a variable extent, and slightly increase the effective dead space (that is, you rebreathe a small quantity of additional carbon dioxide from the space inside the mask). Both of these will increase your work of breathing, particularly if you're wearing a properly fitted particulate mask of the sort worn by health-care workers. That can get mentally wearing during a long shift, but it doesn't affect your ability to ventilate your lungs.

    Just as a QI side note, it seems to be generally believed (even among medical practitioners) that rising carbon dioxide levels are what force you to take a breath after a period of breath-holding. That's not actually the case, because carbon dioxide rises very slowly when breathing ceases. The air-hunger you experience while holding your breath is actually mediated by the stretch receptors in your lungs, which go through a cycle of increased and decreased firing with each breath you take. The respiratory centre responds strongly if that cycle is interrupted, long before a significant change in carbon dioxide levels occurs.
    If you watch a free-diver breath-holding, many of them are constantly making respiratory efforts against closed vocal cords--alternately expanding the chest while sucking in the diaphragm, and compressing the chest while blowing out the diaphragm. That's a way of tricking the stretch receptors into believing all is well, and so controlling that aspect of air-hunger.

    Grant Hutchison
    I did not know that and I should having experimented with a neuro psychologist using elevated CO2 as a challenge that produces anxiety. And also with Wim Hoff who teaches rapid breathing to increase endurance. I thought the Wim Hoff technique was basically to expel CO2 to a minimum before strenuous exercise. I guess there must be a training effect on the breathing muscles also from your note. I can confirm that deliberately breathing high levels of CO2 makes you anxious, to get out and breathe better air ! In those experiments the oxygen saturation remains normal, while the blood CO2 rises.
    sicut vis videre esto
    When we realize that patterns don't exist in the universe, they are a template that we hold to the universe to make sense of it, it all makes a lot more sense.
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    Quote Originally Posted by Jens View Post
    It’s definitely an anti-vaccine agenda. I’m simply looking for ammunition against that.
    The normal usage is of the form "x weeks of completed pregnancy"--so there's a notional clock that starts at conception and keeps ticking until the person is no longer pregnant.
    Here you can find some definitions of stillbirth and miscarriage in terms of weeks of completed pregnancy, and here definitions of premature birth in the same units. From that it should be clear to an unbiased observer that pregnancy can be "completed" in several different ways. Your paper lists the outcomes for all completed pregancies in the dataset but (obviously) not for uncompleted pregnancies.

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    Quote Originally Posted by grant hutchison View Post
    Just to clarify this a little ...
    The normal partial pressure of dissolved oyxgen in arterial blood is about 13kPa (100mmHg). It needs to fall to about 8.5kPa (65mmHg) before we see a physiological response increasing the rate and depth of breathing. So a pretty big change. One reason our bodies are so tolerant of big drops in oxygen partial pressure is something called the oxy-haemoglobin dissociation curve, which has a characteristic sigmoid shape. Our haemoglobin is very good at picking up oxygen from the lungs, and so remains more than 90% saturated with oxygen all the way down to that critical 8.5kPa cut-off, at which point oxygen carriage falls off the shoulder of the curve and oxygen delivery to the tissues crashes.

    Grant Hutchison
    Please correct me if I am wrong, but my understanding is that this is why CPR, including chest-compression only CPR, is effective. There is still a lot of oxygen in the blood (at least for a while), you just have to circulate it.
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    Quote Originally Posted by Swift View Post
    Please correct me if I am wrong, but my understanding is that this is why CPR, including chest-compression only CPR, is effective. There is still a lot of oxygen in the blood (at least for a while), you just have to circulate it.
    Well, it depends on why the casualty has had a cardiac arrest, of course. If they've arrested as a result of suffocation, then compression-only CPR isn't going to be that useful.
    But most people who have a cardiac arrest in a public place have had a primary dysrhythmia, arresting with their haemoglobin still full of oxygen, so propelling a bit of blood around keeps their brain and cardiac muscle oxygenated for a few minutes while waiting for the defibrillator to arrive. And untrained people are pretty rubbish at lung ventilation anyway, potentially doing more harm than good.

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    Now we are seeing an attempt at a next-generation vaccine. Moderna is testing an mRNA flu vaccine with the hope of much higher efficacy, given that they can more accurately target relevant regions on the virus with this type of vaccine. They also plan on making a combination vaccine:

    In addition to influenza, this envisioned combination shot would target two other common, respiratory viruses that circulate alongside influenzaórespiratory syncytial virus (RSV) and human metapneumovirus (hMPV)óas well as the COVID-19 coronavirus, SARS-COV-2, which some experts have speculated could become seasonal. Currently, there are no licensed vaccines against either RSV or hMPV. And it's unclear if SARS-CoV-2 will become seasonal and/or if annual booster vaccines will be necessary.

    This is from https://arstechnica.com/science/2021...ial-has-begun/

    I have been hoping that this acceleration of mRNA vaccine development would lead to better vaccines faster than otherwise would have happened without COVID-19, possibly ultimately saving more lives than the disease took. A silver lining, in other words. I hope this is the start of it.

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    Or we are looking at a human version of Marekís disease in our future

    (something vaccine makers would actually love)

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