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Papers on asymptomatic transmission and serology

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Barry MacKichan

Papers on asymptomatic transmission and serology

In the distributed FRIAM meeting yesterday I mentioned these results, but I thought you might also want to see the commentary with them. This is an email from last week from one of my daughters (Joanna) who is a microbiologist at Victoria University in Wellington, NZ.

—Barry

————————————

First, the tests. I don't know what happened in the US with testing, maybe some of that has come out or maybe will come out. What I do know is that testing for RNA viruses is pretty straightforward - you extract RNA from the sample and try to quantify it using a PCR-based method. This is done around the world for routine surveillance of various RNA viruses (norovirus, influenza). There may be a few viruses that use antibody-based testing, but that wouldn't be used for the coronavirus. The RNA genome sequence of this virus was published early on by Chinese scientists, which countries were meant to use to design tests. The WHO normally only provides tests to low income countries, relying on high income countries (like the US or NZ) to develop their own tests. The primers and other reagents that work, all that information is out there. There was no need to reinvent the wheel with the tests, but from what I understand, the problem with some of the kits sent out by the CDC early on had a problem with one of the reagents (not the science behind the test). Validation is of course important, but again, tests have been clearly validated overseas. The usual regulatory safeguards will have to be relaxed around the world to keep up with the need for mass testing. The WHO says, test, test, test! That is going to be the key to beating this thing. I should add that I have full confidence that, despite initial missteps, the US is going to eventually get the testing right. It's absolutely essential if you (1) don't want to be under nationwide lockdown for 18 months, or (2) don't want 2 million Americans to die.

The craziest thing about this virus is the degree to which transmission is being driven by asymptomatic people. A Science paper just came out claiming about 85% of cases were transmitted by an asymptomatic person. Asymptomatic people may be less contagious, but they likely make up for it by going to family dinners, work, getting on airplanes, shaking hands, giving hugs, etc. Here's the Science paper:

https://science.sciencemag.org/content/early/2020/03/13/science.abb3221

When I first heard about asymptomatic transmission of the virus being key, I was very skeptical. Asymptomatic people don't cough or sneeze - so how do they transmit the virus? It turns out that they shed large amounts of virus anyway - such that breathing or talking is enough to infect someone nearby. I became less skeptical when I saw how insanely rapid the spread of this thing has been around the world. When asymptomatic people are your vectors, tests are absolutely critical. It's the only way of knowing if someone could be transmitting the disease. And if you don't have testing, you have to assume everyone is infected, which is why lockdown is the only alternative response.

The other reason I was skeptical about asymptomatic transmission, or the presence of a lot of asymptomatic people, is that this virus kills. How can it kill 15-20% of people over 80 but cause an asymptomatic infection in so many other people? I don't have an answer for that, but it's the essential reason that this virus has shut down the globe like it has. All our usual tricks don't work particularly well. I will say that microbes with these two extreme outcomes (no apparent illness, vs deadly infection) are relatively unusual, and that's why we are in this unprecedented situation. On the other hand, that particular combination is probably what largely drove the AIDS epidemic, so some of this is not new. But for a respiratory infection, it is unusual, and unlike AIDS, it is spreading much more rapidly.

And there is still much we don't know about asymptomatic people. Are many people never showing symptoms? Or do most of those asymptomatic people eventually go on to develop illness? This information is coming - for that you need serology - a retrospective look into a population to see who was actually exposed to the virus. The great news is that a paper that was posted in the past couple of days describes the first ELISA test for the virus. That is, they synthesised the (presumed) main viral antigen, the spike protein, in the lab, coated plates with it, and are now able to tell whether people have antibodies to that spike protein. Although this paper hasn't been peer-reviewed yet, it is out of a credible lab.

If you want to read the paper yourself:
https://www.medrxiv.org/content/10.1101/2020.03.17.20037713v1

The implications of this paper are important:
They only tested a small sample, but people who'd recovered from the virus clearly had antibodies to the spike protein. Non-infected people, and one person who had recently recovered from a confirmed infection with a common, milder coronavirus (which has a similar spike protein, attaches to the same human cell receptor) had ZERO antibodies. To make a huge extrapolation, there is likely little or no existing immunity to this thing (possible exception of SARS survivors), which is another explanation for why it has spread so rapidly.
Scaling up will enable screening of people to see whether they have protective immunity to the virus (due to natural infection). This would enable you to deploy healthcare workers with immunity to the frontlines - i.e., hospitals, caretakers in nursing homes.

This will also enable people to go back and study the wider population of places like Wuhan or Seattle. The current data suggest that about 20% of Wuhan residents got the illness. But it's possible that many more people were infected entirely asymptomatically (i.e., never became ill but carry antibodies to the virus). If only 20% of your population infected crashes the healthcare system, there is no clear strategy for relying on herd immunity. If it turns out it was actually closer to 60 or 80% who were infected (enough for herd immunity) that changes things. Specifically, it would suggest that Wuhan is less likely to get a resurgence of disease if restrictions are eased. At this point we have no idea.
Adoptive antibody transfer - giving antibodies from someone who has recovered to someone fighting off the illness - can be explored.

To extrapolate even further, it may turn out that the differences in mortality or degree of sickness are not due to preexisting immunity; more likely the answer will be in variations in our underlying physiology (for example, maybe the virus mainly infects a cell type that hasn't matured in most children, rather than that children are largely immune).
In the meantime, we all want to avoid crashing the healthcare system, as has now happened in Wuhan, Italy, and Iran. And avoid getting ill, especially if in a more vulnerable category. I don't think there's any reason to assume that you will necessarily eventually get it. Even in the worst case scenarios being played out, it is not 100% of the population that is infected. Being very careful, until there is a vaccine, can ensure you can be in that part of the population that can avoid it altogether. Life is long, and we'll get through this challenge together!

============================================================
FRIAM Applied Complexity Group listserv
Meets Fridays 9a-11:30 at cafe at St. John's College
to unsubscribe http://redfish.com/mailman/listinfo/friam_redfish.com
archives back to 2003: http://friam.471366.n2.nabble.com/
FRIAM-COMIC http://friam-comic.blogspot.com/ by Dr. Strangelove

Steve Smith

Re: Papers on asymptomatic transmission and serology

Barry -

Really great writeup from your daughter in Wellington. It reinforces and adds well to what I've been hearing from my own daughter (Molecular Biologist in FlaviVirus lab at OHSU in Oregon) who have actually run PCR based tests using the WHO information on themselves (a dozen or so scientists/techs) as preparation for possibly participating in the testing with their own gear.

Joanna's clarification on the likely problem with the "failed" test kits was useful in particular.

The talk about asymptomatic transmission is central to my own personal thinking and the models we are assuming in the SimTable work in-progress that Stephen described yesterday. It doesn't do as much good to only build contact graphs with people who are already diagnosed (or self-diagnosed via symptoms) as it does to have location/contact information for the pre-symptomatic as well as (fully?) a-symptomatic.

I am also wondering what others are hearing about (or better have references to) the possibility of COVID19 survivors antibodies being a resource for transmitted (via transfusion?) immunity. Something to recruit all those "irresponsible youth" for... as I said on the call yesterday "pay them to stay on the beach in drunken revelry another month until they all pass it around and recover" and THEN impress (persuasively not conscriptively) them into providing serum to their grandparents instead of having them return from Spring break to closed schools and moving in with their grandparents, accidentally killing them in the process <satire>.

How, by the way, is NZ doing with this themselves? I always think of them as a sort of safe-haven being as relatively isolated as they are yet with an anglophone first-world embedding.

- Steve

In the distributed FRIAM meeting yesterday I mentioned these results, but I thought you might also want to see the commentary with them. This is an email from last week from one of my daughters (Joanna) who is a microbiologist at Victoria University in Wellington, NZ.

—Barry

————————————

First, the tests. I don't know what happened in the US with testing, maybe some of that has come out or maybe will come out. What I do know is that testing for RNA viruses is pretty straightforward - you extract RNA from the sample and try to quantify it using a PCR-based method. This is done around the world for routine surveillance of various RNA viruses (norovirus, influenza). There may be a few viruses that use antibody-based testing, but that wouldn't be used for the coronavirus. The RNA genome sequence of this virus was published early on by Chinese scientists, which countries were meant to use to design tests. The WHO normally only provides tests to low income countries, relying on high income countries (like the US or NZ) to develop their own tests. The primers and other reagents that work, all that information is out there. There was no need to reinvent the wheel with the tests, but from what I understand, the problem with some of the kits sent out by the CDC early on had a problem with one of the reagents (not the science behind the test). Validation is of course important, but again, tests have been clearly validated overseas. The usual regulatory safeguards will have to be relaxed around the world to keep up with the need for mass testing. The WHO says, test, test, test! That is going to be the key to beating this thing. I should add that I have full confidence that, despite initial missteps, the US is going to eventually get the testing right. It's absolutely essential if you (1) don't want to be under nationwide lockdown for 18 months, or (2) don't want 2 million Americans to die.

The craziest thing about this virus is the degree to which transmission is being driven by asymptomatic people. A Science paper just came out claiming about 85% of cases were transmitted by an asymptomatic person. Asymptomatic people may be less contagious, but they likely make up for it by going to family dinners, work, getting on airplanes, shaking hands, giving hugs, etc. Here's the Science paper:

https://science.sciencemag.org/content/early/2020/03/13/science.abb3221

When I first heard about asymptomatic transmission of the virus being key, I was very skeptical. Asymptomatic people don't cough or sneeze - so how do they transmit the virus? It turns out that they shed large amounts of virus anyway - such that breathing or talking is enough to infect someone nearby. I became less skeptical when I saw how insanely rapid the spread of this thing has been around the world. When asymptomatic people are your vectors, tests are absolutely critical. It's the only way of knowing if someone could be transmitting the disease. And if you don't have testing, you have to assume everyone is infected, which is why lockdown is the only alternative response.

The other reason I was skeptical about asymptomatic transmission, or the presence of a lot of asymptomatic people, is that this virus kills. How can it kill 15-20% of people over 80 but cause an asymptomatic infection in so many other people? I don't have an answer for that, but it's the essential reason that this virus has shut down the globe like it has. All our usual tricks don't work particularly well. I will say that microbes with these two extreme outcomes (no apparent illness, vs deadly infection) are relatively unusual, and that's why we are in this unprecedented situation. On the other hand, that particular combination is probably what largely drove the AIDS epidemic, so some of this is not new. But for a respiratory infection, it is unusual, and unlike AIDS, it is spreading much more rapidly.

And there is still much we don't know about asymptomatic people. Are many people never showing symptoms? Or do most of those asymptomatic people eventually go on to develop illness? This information is coming - for that you need serology - a retrospective look into a population to see who was actually exposed to the virus. The great news is that a paper that was posted in the past couple of days describes the first ELISA test for the virus. That is, they synthesised the (presumed) main viral antigen, the spike protein, in the lab, coated plates with it, and are now able to tell whether people have antibodies to that spike protein. Although this paper hasn't been peer-reviewed yet, it is out of a credible lab.

If you want to read the paper yourself:
https://www.medrxiv.org/content/10.1101/2020.03.17.20037713v1

The implications of this paper are important:
They only tested a small sample, but people who'd recovered from the virus clearly had antibodies to the spike protein. Non-infected people, and one person who had recently recovered from a confirmed infection with a common, milder coronavirus (which has a similar spike protein, attaches to the same human cell receptor) had ZERO antibodies. To make a huge extrapolation, there is likely little or no existing immunity to this thing (possible exception of SARS survivors), which is another explanation for why it has spread so rapidly.
Scaling up will enable screening of people to see whether they have protective immunity to the virus (due to natural infection). This would enable you to deploy healthcare workers with immunity to the frontlines - i.e., hospitals, caretakers in nursing homes.

This will also enable people to go back and study the wider population of places like Wuhan or Seattle. The current data suggest that about 20% of Wuhan residents got the illness. But it's possible that many more people were infected entirely asymptomatically (i.e., never became ill but carry antibodies to the virus). If only 20% of your population infected crashes the healthcare system, there is no clear strategy for relying on herd immunity. If it turns out it was actually closer to 60 or 80% who were infected (enough for herd immunity) that changes things. Specifically, it would suggest that Wuhan is less likely to get a resurgence of disease if restrictions are eased. At this point we have no idea.
Adoptive antibody transfer - giving antibodies from someone who has recovered to someone fighting off the illness - can be explored.

To extrapolate even further, it may turn out that the differences in mortality or degree of sickness are not due to preexisting immunity; more likely the answer will be in variations in our underlying physiology (for example, maybe the virus mainly infects a cell type that hasn't matured in most children, rather than that children are largely immune).
In the meantime, we all want to avoid crashing the healthcare system, as has now happened in Wuhan, Italy, and Iran. And avoid getting ill, especially if in a more vulnerable category. I don't think there's any reason to assume that you will necessarily eventually get it. Even in the worst case scenarios being played out, it is not 100% of the population that is infected. Being very careful, until there is a vaccine, can ensure you can be in that part of the population that can avoid it altogether. Life is long, and we'll get through this challenge together!
============================================================
FRIAM Applied Complexity Group listserv
Meets Fridays 9a-11:30 at cafe at St. John's College
to unsubscribe http://redfish.com/mailman/listinfo/friam_redfish.com
archives back to 2003: http://friam.471366.n2.nabble.com/
FRIAM-COMIC http://friam-comic.blogspot.com/ by Dr. Strangelove

Barry MacKichan

Re: Papers on asymptomatic transmission and serology

The case count in New Zealand is at least 100. The early cases were from travelers who had been in Italy and Iran. Then the word went out that citizens needed to come back to NZ, and some cases were among this counter-diaspora. Then a group from a cruise ship went on a tour through Te Papa, a national museum in Wellington and infected a number of others on the tour. As of this weekend, they were at threat level 2 (I don’t know precisely what that meant) and with clear community transmission, they upped it to level 3 which means ‘You have two days to get ready for total lockdown’. After two days, they will go to level 4 — total lockdown. The schools are closed, university students have been sent home and classes are canceled for four weeks. When they resume they will be online.

—Barry

On 21 Mar 2020, at 13:09, Steven A Smith wrote:

How, by the way, is NZ doing with this themselves? I always think of
them as a sort of safe-haven being as relatively isolated as they are
yet with an anglophone first-world embedding.

- Steve

Edward Angel

Re: Papers on asymptomatic transmission and serology

This weekend I received an email from a good friend in NZ. Unlike the U.S, NZ spent the last two months preparing for what is happening now. For example, the schools spent a lot of time preparing teachers to be able to teach effectively on line.

_______________________

Ed Angel

Founding Director, Art, Research, Technology and Science Laboratory (ARTS Lab)
Professor Emeritus of Computer Science, University of New Mexico

1017 Sierra Pinon

Santa Fe, NM 87501
505-984-0136 (home) [hidden email]

505-453-4944 (cell) http://www.cs.unm.edu/~angel

On Mar 23, 2020, at 8:36 AM, Barry MacKichan <[hidden email]> wrote:

The case count in New Zealand is at least 100. The early cases were from travelers who had been in Italy and Iran. Then the word went out that citizens needed to come back to NZ, and some cases were among this counter-diaspora. Then a group from a cruise ship went on a tour through Te Papa, a national museum in Wellington and infected a number of others on the tour. As of this weekend, they were at threat level 2 (I don’t know precisely what that meant) and with clear community transmission, they upped it to level 3 which means ‘You have two days to get ready for total lockdown’. After two days, they will go to level 4 — total lockdown. The schools are closed, university students have been sent home and classes are canceled for four weeks. When they resume they will be online.
—Barry
On 21 Mar 2020, at 13:09, Steven A Smith wrote:

How, by the way, is NZ doing with this themselves? I always think of
them as a sort of safe-haven being as relatively isolated as they are
yet with an anglophone first-world embedding.

- Steve

============================================================
FRIAM Applied Complexity Group listserv
Meets Fridays 9a-11:30 at cafe at St. John's College
to unsubscribe http://redfish.com/mailman/listinfo/friam_redfish.com
archives back to 2003: http://friam.471366.n2.nabble.com/
FRIAM-COMIC http://friam-comic.blogspot.com/ by Dr. Strangelove

cody dooderson

Re: Papers on asymptomatic transmission and serology

[hidden email]. You mentioned that someone who has become resistant to a virus may be able to donate their blood to someone struggling with symptoms. does that actually work?

Cody Smith

On Mon, Mar 23, 2020 at 8:48 AM Edward Angel <[hidden email]> wrote:

This weekend I received an email from a good friend in NZ. Unlike the U.S, NZ spent the last two months preparing for what is happening now. For example, the schools spent a lot of time preparing teachers to be able to teach effectively on line.

Ed

_______________________

Ed Angel

Founding Director, Art, Research, Technology and Science Laboratory (ARTS Lab)
Professor Emeritus of Computer Science, University of New Mexico

1017 Sierra Pinon
Santa Fe, NM 87501
505-984-0136 (home) [hidden email]
505-453-4944 (cell) http://www.cs.unm.edu/~angel

On Mar 23, 2020, at 8:36 AM, Barry MacKichan <[hidden email]> wrote:

The case count in New Zealand is at least 100. The early cases were from travelers who had been in Italy and Iran. Then the word went out that citizens needed to come back to NZ, and some cases were among this counter-diaspora. Then a group from a cruise ship went on a tour through Te Papa, a national museum in Wellington and infected a number of others on the tour. As of this weekend, they were at threat level 2 (I don’t know precisely what that meant) and with clear community transmission, they upped it to level 3 which means ‘You have two days to get ready for total lockdown’. After two days, they will go to level 4 — total lockdown. The schools are closed, university students have been sent home and classes are canceled for four weeks. When they resume they will be online.
—Barry
On 21 Mar 2020, at 13:09, Steven A Smith wrote:

How, by the way, is NZ doing with this themselves? I always think of
them as a sort of safe-haven being as relatively isolated as they are
yet with an anglophone first-world embedding.

- Steve

============================================================
FRIAM Applied Complexity Group listserv
Meets Fridays 9a-11:30 at cafe at St. John's College
to unsubscribe http://redfish.com/mailman/listinfo/friam_redfish.com
archives back to 2003: http://friam.471366.n2.nabble.com/
FRIAM-COMIC http://friam-comic.blogspot.com/ by Dr. Strangelove

============================================================
FRIAM Applied Complexity Group listserv
Meets Fridays 9a-11:30 at cafe at St. John's College
to unsubscribe http://redfish.com/mailman/listinfo/friam_redfish.com
archives back to 2003: http://friam.471366.n2.nabble.com/
FRIAM-COMIC http://friam-comic.blogspot.com/ by Dr. Strangelove

thompnickson2

Re: Papers on asymptomatic transmission and serology

In reply to this post by Edward Angel

Ed,

How do you read this? It sort of seems like, even with all that sane preparation, they ended up in the same stupid stew we are in. No? I guess, we’ll see. The needed to put all the returnees on islands and send people out to the islands to live with and take care of them until the damn thing had worked its way through that island. Tuberculosis colonies.

I tell you one thing; I aint ever going on any damned cruise again. That’s one lesson I’ve learned. That’s one phase that’s changed.

Oh. Wait a minute! Hang on! I’ve never been on a cruise.

Nick

Nicholas Thompson

Emeritus Professor of Ethology and Psychology

Clark University

[hidden email]

https://wordpress.clarku.edu/nthompson/

From: Friam <[hidden email]> On Behalf Of Edward Angel
Sent: Monday, March 23, 2020 8:48 AM
To: The Friday Morning Applied Complexity Coffee Group <[hidden email]>
Subject: Re: [FRIAM] Papers on asymptomatic transmission and serology

_______________________

Ed Angel

Founding Director, Art, Research, Technology and Science Laboratory (ARTS Lab)
Professor Emeritus of Computer Science, University of New Mexico

1017 Sierra Pinon

Santa Fe, NM 87501
505-984-0136 (home) [hidden email]

505-453-4944 (cell) http://www.cs.unm.edu/~angel

On Mar 23, 2020, at 8:36 AM, Barry MacKichan <[hidden email]> wrote:

The case count in New Zealand is at least 100. The early cases were from travelers who had been in Italy and Iran. Then the word went out that citizens needed to come back to NZ, and some cases were among this counter-diaspora. Then a group from a cruise ship went on a tour through Te Papa, a national museum in Wellington and infected a number of others on the tour. As of this weekend, they were at threat level 2 (I don’t know precisely what that meant) and with clear community transmission, they upped it to level 3 which means ‘You have two days to get ready for total lockdown’. After two days, they will go to level 4 — total lockdown. The schools are closed, university students have been sent home and classes are canceled for four weeks. When they resume they will be online.
—Barry
On 21 Mar 2020, at 13:09, Steven A Smith wrote:
How, by the way, is NZ doing with this themselves? I always think of
them as a sort of safe-haven being as relatively isolated as they are
yet with an anglophone first-world embedding.

- Steve
============================================================
FRIAM Applied Complexity Group listserv
Meets Fridays 9a-11:30 at cafe at St. John's College
to unsubscribe http://redfish.com/mailman/listinfo/friam_redfish.com
archives back to 2003: http://friam.471366.n2.nabble.com/
FRIAM-COMIC http://friam-comic.blogspot.com/ by Dr. Strangelove

Barry MacKichan

Re: Papers on asymptomatic transmission and serology

In reply to this post by cody dooderson

Wasn’t that used in the ebola epidemic?

—Barry

On 23 Mar 2020, at 12:15, cody dooderson wrote:

[hidden email]. You mentioned that someone who has become resistant to a virus may be able to donate their blood to someone struggling with symptoms. does that actually work?

Cody Smith

On Mon, Mar 23, 2020 at 8:48 AM Edward Angel <[hidden email]> wrote:
This weekend I received an email from a good friend in NZ. Unlike the U.S, NZ spent the last two months preparing for what is happening now. For example, the schools spent a lot of time preparing teachers to be able to teach effectively on line.

Ed

_______________________

Ed Angel

Founding Director, Art, Research, Technology and Science Laboratory (ARTS Lab)
Professor Emeritus of Computer Science, University of New Mexico

1017 Sierra Pinon
Santa Fe, NM 87501
505-984-0136 (home) [hidden email]
505-453-4944 (cell) http://www.cs.unm.edu/~angel

On Mar 23, 2020, at 8:36 AM, Barry MacKichan <[hidden email]> wrote:

The case count in New Zealand is at least 100. The early cases were from travelers who had been in Italy and Iran. Then the word went out that citizens needed to come back to NZ, and some cases were among this counter-diaspora. Then a group from a cruise ship went on a tour through Te Papa, a national museum in Wellington and infected a number of others on the tour. As of this weekend, they were at threat level 2 (I don’t know precisely what that meant) and with clear community transmission, they upped it to level 3 which means ‘You have two days to get ready for total lockdown’. After two days, they will go to level 4 — total lockdown. The schools are closed, university students have been sent home and classes are canceled for four weeks. When they resume they will be online.
—Barry
On 21 Mar 2020, at 13:09, Steven A Smith wrote:

How, by the way, is NZ doing with this themselves? I always think of
them as a sort of safe-haven being as relatively isolated as they are
yet with an anglophone first-world embedding.

- Steve

============================================================
FRIAM Applied Complexity Group listserv
Meets Fridays 9a-11:30 at cafe at St. John's College
to unsubscribe http://redfish.com/mailman/listinfo/friam_redfish.com
archives back to 2003: http://friam.471366.n2.nabble.com/
FRIAM-COMIC http://friam-comic.blogspot.com/ by Dr. Strangelove

============================================================
FRIAM Applied Complexity Group listserv
Meets Fridays 9a-11:30 at cafe at St. John's College
to unsubscribe http://redfish.com/mailman/listinfo/friam_redfish.com
archives back to 2003: http://friam.471366.n2.nabble.com/
FRIAM-COMIC http://friam-comic.blogspot.com/ by Dr. Strangelove

============================================================
FRIAM Applied Complexity Group listserv
Meets Fridays 9a-11:30 at cafe at St. John's College
to unsubscribe http://redfish.com/mailman/listinfo/friam_redfish.com
archives back to 2003: http://friam.471366.n2.nabble.com/
FRIAM-COMIC http://friam-comic.blogspot.com/ by Dr. Strangelove

Barry MacKichan

Re: Papers on asymptomatic transmission and serology

In reply to this post by Edward Angel

Good government. What a concept!

—Barry

On 23 Mar 2020, at 10:48, Edward Angel wrote:

This weekend I received an email from a good friend in NZ. Unlike the U.S, NZ spent the last two months preparing for what is happening now. For example, the schools spent a lot of time preparing teachers to be able to teach effectively on line.

Ed

_______________________

Ed Angel

Founding Director, Art, Research, Technology and Science Laboratory (ARTS Lab)
Professor Emeritus of Computer Science, University of New Mexico

1017 Sierra Pinon
Santa Fe, NM 87501
505-984-0136 (home) [hidden email]
505-453-4944 (cell) http://www.cs.unm.edu/~angel

On Mar 23, 2020, at 8:36 AM, Barry MacKichan <[hidden email]> wrote:

The case count in New Zealand is at least 100. The early cases were from travelers who had been in Italy and Iran. Then the word went out that citizens needed to come back to NZ, and some cases were among this counter-diaspora. Then a group from a cruise ship went on a tour through Te Papa, a national museum in Wellington and infected a number of others on the tour. As of this weekend, they were at threat level 2 (I don’t know precisely what that meant) and with clear community transmission, they upped it to level 3 which means ‘You have two days to get ready for total lockdown’. After two days, they will go to level 4 — total lockdown. The schools are closed, university students have been sent home and classes are canceled for four weeks. When they resume they will be online.
—Barry
On 21 Mar 2020, at 13:09, Steven A Smith wrote:

How, by the way, is NZ doing with this themselves? I always think of
them as a sort of safe-haven being as relatively isolated as they are
yet with an anglophone first-world embedding.

- Steve

============================================================
FRIAM Applied Complexity Group listserv
Meets Fridays 9a-11:30 at cafe at St. John's College
to unsubscribe http://redfish.com/mailman/listinfo/friam_redfish.com
archives back to 2003: http://friam.471366.n2.nabble.com/
FRIAM-COMIC http://friam-comic.blogspot.com/ by Dr. Strangelove

============================================================
FRIAM Applied Complexity Group listserv
Meets Fridays 9a-11:30 at cafe at St. John's College
to unsubscribe http://redfish.com/mailman/listinfo/friam_redfish.com
archives back to 2003: http://friam.471366.n2.nabble.com/
FRIAM-COMIC http://friam-comic.blogspot.com/ by Dr. Strangelove

Edward Angel

Re: Papers on asymptomatic transmission and serology

In reply to this post by thompnickson2

Here’s part of my friend's email. I think the differences between the US and NZ are clear. As a contrast to the example I pointed out, the SF schools closed with no preparation for online learning. After two weeks they are starting it using the pads they own, Comcast hot spots and training for teachers.

_____

I’m writing with a short update on life in New Zealand in the time of this apocalypse.

People are concerned here, just like everywhere else in the world. However, the response is somewhat different and speaks to life and attitudes in Aotearoa New Zealand.

At this point, we have 62 cases, no deaths, and it is not clear whether we yet have community transmission. So far, there have been no “lockdowns” but everyone is being asked to do their part and follow a few new rules to be sensible.

Gatherings over 100 are prohibited. Borders have been closed. When we go to a restaurant or bar, we need to sign in and provide our email and mobile number so that they could do contact tracing if necessary. Schools are still open, but with different programmes focused on health, emotional support, and two government provided meals. Supermarkets have reduced hours, so that they have time to restock the shelves, but there is plenty of food to go around since we produce significant amounts of most foods here in NZ.

Politicians of all stripes have come together to do their best to support the response.

This week at the University, we will be working, in person for as long as the rules allow it, to transition to online delivery of courses to our students. Emails from our administration make clear that it is not enough merely to post things online and run the class as best we can. The goal is to truly create a quality learning experience for students of all backgrounds, parts of which could create a better platform for future course delivery.

Here is a paragraph from an email we received from our Dean:

‘Being able to deliver online is not enough. We need to make the online experience engaging and inclusive, not just send out lecture captures. The week’s hiatus will give you the opportunity to redesign and adapt components of your courses and assessments to this new delivery mode. I urge you to use next week to prepare. While I understand that preparing so quickly for online may result in compromises about what you deliver, this work could also potentially lead to innovations that will enhance your teaching long term.”

In short, the Kiwi response is less of panic and more of teamwork, kindness and opportunity. This, it seems, captures the essence of NZ generally that I’ve noticed in my 9 months here.

_______________________

Ed Angel

Founding Director, Art, Research, Technology and Science Laboratory (ARTS Lab)
Professor Emeritus of Computer Science, University of New Mexico

1017 Sierra Pinon

Santa Fe, NM 87501
505-984-0136 (home) [hidden email]

505-453-4944 (cell) http://www.cs.unm.edu/~angel

On Mar 23, 2020, at 10:29 AM, <[hidden email]> <[hidden email]> wrote:

Ed,

How do you read this? It sort of seems like, even with all that sane preparation, they ended up in the same stupid stew we are in. No?   I guess, we’ll see. The needed to put all the returnees on islands and send people out to the islands to live with and take care of them until the damn thing had worked its way through that island. Tuberculosis colonies.

I tell you one thing; I aint ever going on any damned cruise again. That’s one lesson I’ve learned. That’s one phase that’s changed.

Oh. Wait a minute! Hang on! I’ve never been on a cruise.

Nick

Nicholas Thompson
Emeritus Professor of Ethology and Psychology
Clark University
[hidden email]
https://wordpress.clarku.edu/nthompson/

From: Friam <[hidden email]> On Behalf Of Edward Angel
Sent: Monday, March 23, 2020 8:48 AM
To: The Friday Morning Applied Complexity Coffee Group <[hidden email]>
Subject: Re: [FRIAM] Papers on asymptomatic transmission and serology

This weekend I received an email from a good friend in NZ. Unlike the U.S, NZ spent the last two months preparing for what is happening now. For example, the schools spent a lot of time preparing teachers to be able to teach effectively on line.

Ed
_______________________

Ed Angel
Founding Director, Art, Research, Technology and Science Laboratory (ARTS Lab)
Professor Emeritus of Computer Science, University of New Mexico

1017 Sierra Pinon
Santa Fe, NM 87501
505-984-0136 (home)                         [hidden email]
505-453-4944 (cell)                                        http://www.cs.unm.edu/~angel

On Mar 23, 2020, at 8:36 AM, Barry MacKichan <[hidden email]> wrote:

The case count in New Zealand is at least 100. The early cases were from travelers who had been in Italy and Iran. Then the word went out that citizens needed to come back to NZ, and some cases were among this counter-diaspora. Then a group from a cruise ship went on a tour through Te Papa, a national museum in Wellington and infected a number of others on the tour. As of this weekend, they were at threat level 2 (I don’t know precisely what that meant) and with clear community transmission, they upped it to level 3 which means ‘You have two days to get ready for total lockdown’. After two days, they will go to level 4 — total lockdown. The schools are closed, university students have been sent home and classes are canceled for four weeks. When they resume they will be online.
—Barry
On 21 Mar 2020, at 13:09, Steven A Smith wrote:
How, by the way, is NZ doing with this themselves? I always think of
them as a sort of safe-haven being as relatively isolated as they are
yet with an anglophone first-world embedding.

- Steve
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gepr

Re: Papers on asymptomatic transmission and serology

In reply to this post by cody dooderson

Maybe helpful?

The convalescent sera option for containing COVID-19
https://www.jci.org/articles/view/138003

On 3/23/20 9:15 AM, cody dooderson wrote:
> @Steve Smith <mailto:[hidden email]>. You mentioned that someone who has become resistant to a virus may be able to donate their blood to someone struggling with symptoms. does that actually work?

--
☣ uǝlƃ

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uǝʃƃ ⊥ glen

Barry MacKichan

Re: Papers on asymptomatic transmission and serology

In reply to this post by cody dooderson

See on the Johns Hopkins site:

https://www.globalhealthnow.org/2020-03/covid-19s-stop-gap-solution-until-vaccines-and-antivirals-are-ready

On 23 Mar 2020, at 12:15, cody dooderson wrote:

@Steve Smith <[hidden email]>. You mentioned that someone who has become
resistant to a virus may be able to donate their blood to someone
struggling with symptoms. does that actually work?

Cody Smith

Steve Smith

Re: Papers on asymptomatic transmission and serology

Thanks for the two references:

Glen>	The convalescent sera option for containing COVID-19
	https://www.jci.org/articles/view/138003

Barry>  https://www.globalhealthnow.org/2020-03/covid-19s-stop-gap-solution-until-vaccines-and-antivirals-are-ready

This is particularly promising, especially the point in the second one that 60ktonne of plasma having been shipped to Italy from China...   

While there *may* be some unintended/unexpected consequences in this strategy, it is very promising that we *already* have a plasma donation network in place.  

Millennial Spring-Break Scofflaws should be kept (encouraged to stay?) on the beach until they recover and show positive for enough antibodies to donate plasma, then return home to live with their grandparents since their parents are mad at them for their choices and their dorms are closed.  They can infuse their grandparents first, then one at a time, all of the other old folks in their nursing/assisted-living/retirement facility/neighborhood.

I didn't see what dosage of plasma is considered remedial or prophylactic.  Is it one-to-one?  A pint per patient?   I think plasma donors can give a pint weekly or more often?

I'm expecting to see want ads on Craigslist "Seeking Antibody Positive Plasma Donor, will pay cash"

@Steve Smith [hidden email]. You mentioned that someone who has become
resistant to a virus may be able to donate their blood to someone
struggling with symptoms. does that actually work?

Cody Smith
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thompnickson2

Re: Papers on asymptomatic transmission and serology

Well, I gather it’s a little more complicated than siphoning somebody’s gas tank. For one, the serum has to be typed and screened for toxins, right?

Nicholas Thompson

Emeritus Professor of Ethology and Psychology

Clark University

[hidden email]

https://wordpress.clarku.edu/nthompson/

From: Friam <[hidden email]> On Behalf Of Steven A Smith
Sent: Monday, March 23, 2020 7:16 PM
To: [hidden email]
Subject: Re: [FRIAM] Papers on asymptomatic transmission and serology

Thanks for the two references:

Glen>   The convalescent sera option for containing COVID-19

        https://www.jci.org/articles/view/138003

Barry>  https://www.globalhealthnow.org/2020-03/covid-19s-stop-gap-solution-until-vaccines-and-antivirals-are-ready

This is particularly promising, especially the point in the second one that 60ktonne of plasma having been shipped to Italy from China...

While there *may* be some unintended/unexpected consequences in this strategy, it is very promising that we *already* have a plasma donation network in place.

Millennial Spring-Break Scofflaws should be kept (encouraged to stay?) on the beach until they recover and show positive for enough antibodies to donate plasma, then return home to live with their grandparents since their parents are mad at them for their choices and their dorms are closed.  They can infuse their grandparents first, then one at a time, all of the other old folks in their nursing/assisted-living/retirement facility/neighborhood.

I didn't see what dosage of plasma is considered remedial or prophylactic.  Is it one-to-one?  A pint per patient?   I think plasma donors can give a pint weekly or more often?

I'm expecting to see want ads on Craigslist "Seeking Antibody Positive Plasma Donor, will pay cash"

@Steve Smith [hidden email]. You mentioned that someone who has become
resistant to a virus may be able to donate their blood to someone
struggling with symptoms. does that actually work?

Cody Smith
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gepr

Re: Papers on asymptomatic transmission and serology

In reply to this post by Steve Smith

From the 1st link:
> Producing highly purified preparations containing a high titer of neutralizing antibodies against SARS2-CoV-2 is preferable to convalescent sera given that these are safer and have higher activity. Unfortunately, such preparations will not be available for many months, whereas locally produced convalescent sera could be available much sooner.
>
> [...] At this time, we do not know what an effective neutralizing titer would be in a susceptible individual given passive antibody therapy for prophylaxis, and determining this parameter would be part of the study design. Similarly, we do not know what doses would be effective therapeutically. We do know that when convalescent serum was used to prevent measles or mumps the amounts used were in the order of 10–40 cc (10, 11). In contrast, when convalescent serum was used to treat severe disease in soldiers with 1918 influenza, the amounts given were in the hundreds of milliliters (34). These older studies claimed efficacy even though convalescent serum was given without any knowledge of neutralizing titers. Those experiences suggest that even small amounts of antibody may prevent and/or treat infection. Hence, we can anticipate that effective prophylactic doses would be much smaller than therapeutic doses. This makes sense, since the infecting inoculum is likely to be much smaller than the viral burden during severe disease.

On 3/23/20 6:15 PM, Steven A Smith wrote:
> Glen> The convalescent sera option for containing COVID-19
> https://www.jci.org/articles/view/138003
>
> Barry> https://www.globalhealthnow.org/2020-03/covid-19s-stop-gap-solution-until-vaccines-and-antivirals-are-ready
> [...]
> I didn't see what dosage of plasma is considered remedial or prophylactic. Is it one-to-one? A pint per patient? I think plasma donors can give a pint weekly or more often?

--
☣ uǝlƃ
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uǝʃƃ ⊥ glen

Steve Smith

Re: Papers on asymptomatic transmission and serology

Good find, thanks!

"you can see a lot just by looking" - yogi berra

> From the 1st link:
>> Producing highly purified preparations containing a high titer of neutralizing antibodies against SARS2-CoV-2 is preferable to convalescent sera given that these are safer and have higher activity. Unfortunately, such preparations will not be available for many months, whereas locally produced convalescent sera could be available much sooner.
>>
>> [...] At this time, we do not know what an effective neutralizing titer would be in a susceptible individual given passive antibody therapy for prophylaxis, and determining this parameter would be part of the study design. Similarly, we do not know what doses would be effective therapeutically. We do know that when convalescent serum was used to prevent measles or mumps the amounts used were in the order of 10–40 cc (10, 11). In contrast, when convalescent serum was used to treat severe disease in soldiers with 1918 influenza, the amounts given were in the hundreds of milliliters (34). These older studies claimed efficacy even though convalescent serum was given without any knowledge of neutralizing titers. Those experiences suggest that even small amounts of antibody may prevent and/or treat infection. Hence, we can anticipate that effective prophylactic doses would be much smaller than therapeutic doses. This makes sense, since the infecting inoculum is likely to be much smaller than the viral burden during severe disease.
>
>
> On 3/23/20 6:15 PM, Steven A Smith wrote:
>> Glen> The convalescent sera option for containing COVID-19
>> https://www.jci.org/articles/view/138003
>>
>> Barry> https://www.globalhealthnow.org/2020-03/covid-19s-stop-gap-solution-until-vaccines-and-antivirals-are-ready
>> [...]
>> I didn't see what dosage of plasma is considered remedial or prophylactic. Is it one-to-one? A pint per patient? I think plasma donors can give a pint weekly or more often?