This is another option for a reasonably priced, apparently legit KN95 mask for kids (and adults with smaller faces, too), although they currently show a 2-week lead time: https://bonafidemasks.com/powecom-kn95-sm-respirator-mask-10-masks-per-pack/ (This model is mentioned on Project N95's website but doesn't seem to be currently sold there.)
Are you aware of any guidelines about reuse of surgical/N95/KN95 masks? I've seen some guidelines published, but they all seem to be targeted at healthcare workers, not at the general public. I understand the CDC's official recommendation is "throw it away after wearing it once," but it seems like that's not necessarily a realistic recommendation for everyone when KN95/N95 masks can cost $1+ each and aren't always easy to find in stock, and might only be worn for a few minutes at a time.
I have heard that N95 masks are rated to maintain filtration up to when they have absorbed a 200mg load, and that this load is equivalent to wearing them in Shanghai for about 200 days. So I think based on that, we're pretty OK reusing them. Probably the straps on them will break before reaching that point.
Maybe it's best to have 2 of them at least, and let them each lie unused for about 24 hours at a time while the other is in use.
Im wondering about the naming scheme. Several friends have asked whether we had enough variants that didn’t become the dominant variant to go from delta all the way to omicron. Was there a rho and and epsilon and a nu etc before omicron was named?
Some Greek letters have been skipped in the progression. Notably, Xi (presumably because it is spelled too similarly to the name of Chinese leader Xi Xinping) and Nu (presumably because it sounds like "New," and is thus confusing when spoken aloud).
Not all variants escalate to becoming "variants of concern," so the public generally does not hear about them, but they do receive Greek letters. One example that I would bet most people haven't heard of is Iota, which was circulating in the US but never distinguished itself or competed well with Delta.
Ha, I just binged Succession myself. I wasn't sure I would like it at all, but it's quickly become one of my favorite current shows.
I'd love to know your thoughts on prospects for a pan-coronavirus vaccine. It's been getting a lot of buzz lately, as I'm sure you know. It seems like an important effort, less to avoid vaccine updates than to prepare for future zoonotic spillover events.
Personally, I'm not bothered by the thought of having to periodically get another COVID shot, nor is anyone in my family or social circles (at least, no one who didn't mind getting vaccinated in the first place). But I think vaccine hesitancy is going to be a big problem here. Short of mandates, which may or may not be upheld in the courts, I'm not sure what can be done about it. I also worry about the feasibility of rolling out updated vaccines to the entire world on a regular basis.
I've thought a lot about universal vaccines for influenza, because I got my degree in a department that was actively working on them. I think it would be great to have universal vaccines that stay stably protective.
On the other hand, I am not convinced they are actually possible for all viruses. Usually what is done is you try to pick a region that is well-conserved among known variants and target that as the antigenic site. That's an OK approach if the reason the region is conserved is actually a strong evolutionary pressure. Evolutionary pressures do not always have to be so strong for a site to be conserved. Sometimes just a small advantage can encourage maintenance.
But applying a vaccine to target a certain region changes things. That's a strong pressure to change. If the survival benefit of conserving the region targeted is less than the survival benefit of escaping the vaccine, "life finds a way."
There's a certain amount of luck we've had with paramyxovirus vaccines (eg MMR) where there is not substantial drift in the proteins targeted, and that makes them persistently effective against the viruses they target. Other viruses we haven't been so lucky with targeting in a way where the antigen site is so conserved.
I don't think we're necessarily going to be able to tell how well-conserved SARS-CoV-2 spike sites are until we are actively challenging the virus with drugs and vaccines that target those sites in real infections in real life. To make a stable, pan-corona vaccine, we have to pick sites that are really going to stay stable even under pressure. It would be interesting to see monoclonal antibody products deployed against these sites before vaccines are, to see if there is evolution to evade those.
Another problem that may arise in this is that there may be a reason the immune system doesn't already substantially target these sites. They may not be good sites for neutralizing the virus, or they may not be readily accessible to antibodies. That will also be hard to tell without experimentation in at least some kind of lab model.
On the other hand, maybe we'll find sites that it takes more time to evolve evasion from. Perhaps it'll be one shot every 5-10 years, like with tetanus, under such a circumstance.
Eventually though, I hope that whatever vaccine strategy ends up working long-term gets us to a place where we have such a strong immune foundation that this virus looks radically different and people's experiences of it are very mild without long term consequences. I don't know if that will happen, but if we can get to there we might be able to give only a few vaccines in childhood for this, and then everyone lives their lives and has minor illness from this from time to time. We are a long way off from even knowing if this can be made to happen, but it's the outcome I'm hoping for.
Since you referred to the home tests detecting the N protein of SARS-CoV-2, I thought I'd mention that over at Science-Based Medicine, someone mentioned that some of them instead detect the S protein, and that these are less able to detect omicron. I have no idea if that's true and they did not give a source.
Today you wrote, "If you throw enough of something sticky at a smooth surface, some of it is going to stick. Everyone has heard the cliche of throwing spaghetti at a wall to see what sticks. It is, quite literally, the entire mechanism of a booster dose in the prevention of symptomatic disease with the Omicron variant." While true, your going into more detail about antibodies here left out yet another whole level of complexity: cellular immunity. I have seen suggestions elsewhere that T-cell mediated immunity to omicron caused by (current) vaccines is not reduced to the same extent as antibody-mediated immunity. This was one paragraph in a Nature article in December, so I have no idea how valid it is (and I can't find the article now), but I thought I'd mention.
RE: home tests, yes, some do not target the N protein. That's why it's important to check what the test targets. N protein tests are ones I think are valid vs many variants, but one has to confirm if the test actually detects N or something else before that information matters. This is a manifestation of a wider principle where Omicron and other variants of concern often have lots of changes in specific parts of the spike protein but not a lot of changes in other parts of spike or in other proteins that the virus makes. So something that doesn't rely on those altered sites in spike will still be valid, while a test targeting highly varied regions of the spike protein will lose performance.
re:T cells, actually something similar is going on there as with the antigen tests, in that they target things that the "it" variant of the moment hasn't necessarily changed. T cells will target different antigens than antibodies go after, and so there is a slightly more diverse response. The reason I didn't mention them in my comments today is because T cells do not have a big impact on the prevention of disease. They are disease-limiting and can handle prevention of severe disease, but I do not believe they are effective at providing the type of immunity that everyone really wants--sterilizing immunity. At least they have not been important in this process so far. I don't think they're neutralizing virus or limiting it early enough in the disease process to prevent disease entirely.
They may be playing an important role in keeping people out of the hospital, though, which is very good.
This is another option for a reasonably priced, apparently legit KN95 mask for kids (and adults with smaller faces, too), although they currently show a 2-week lead time: https://bonafidemasks.com/powecom-kn95-sm-respirator-mask-10-masks-per-pack/ (This model is mentioned on Project N95's website but doesn't seem to be currently sold there.)
Are you aware of any guidelines about reuse of surgical/N95/KN95 masks? I've seen some guidelines published, but they all seem to be targeted at healthcare workers, not at the general public. I understand the CDC's official recommendation is "throw it away after wearing it once," but it seems like that's not necessarily a realistic recommendation for everyone when KN95/N95 masks can cost $1+ each and aren't always easy to find in stock, and might only be worn for a few minutes at a time.
I have heard that N95 masks are rated to maintain filtration up to when they have absorbed a 200mg load, and that this load is equivalent to wearing them in Shanghai for about 200 days. So I think based on that, we're pretty OK reusing them. Probably the straps on them will break before reaching that point.
Maybe it's best to have 2 of them at least, and let them each lie unused for about 24 hours at a time while the other is in use.
Im wondering about the naming scheme. Several friends have asked whether we had enough variants that didn’t become the dominant variant to go from delta all the way to omicron. Was there a rho and and epsilon and a nu etc before omicron was named?
CDC maintains the most transparent list of these, IMO (although the classification scheme was made my WHO, they don't have the complete list on their main tracking site). See here: https://www.cdc.gov/coronavirus/2019-ncov/variants/variant-classifications.html
Some Greek letters have been skipped in the progression. Notably, Xi (presumably because it is spelled too similarly to the name of Chinese leader Xi Xinping) and Nu (presumably because it sounds like "New," and is thus confusing when spoken aloud).
Not all variants escalate to becoming "variants of concern," so the public generally does not hear about them, but they do receive Greek letters. One example that I would bet most people haven't heard of is Iota, which was circulating in the US but never distinguished itself or competed well with Delta.
Ha, I just binged Succession myself. I wasn't sure I would like it at all, but it's quickly become one of my favorite current shows.
I'd love to know your thoughts on prospects for a pan-coronavirus vaccine. It's been getting a lot of buzz lately, as I'm sure you know. It seems like an important effort, less to avoid vaccine updates than to prepare for future zoonotic spillover events.
Personally, I'm not bothered by the thought of having to periodically get another COVID shot, nor is anyone in my family or social circles (at least, no one who didn't mind getting vaccinated in the first place). But I think vaccine hesitancy is going to be a big problem here. Short of mandates, which may or may not be upheld in the courts, I'm not sure what can be done about it. I also worry about the feasibility of rolling out updated vaccines to the entire world on a regular basis.
Speaking of long COVID, I thought you might be interested in this Mother Jones investigation (you may have seen it already): https://www.motherjones.com/politics/2022/01/desperate-patients-are-shelling-out-thousands-for-a-long-covid-cure-is-it-for-real/. An unfortunate, though predictable, consequence of so many people suffering with this poorly understood set of conditions is that it creates an audience highly susceptible to cranks and grifters.
I've thought a lot about universal vaccines for influenza, because I got my degree in a department that was actively working on them. I think it would be great to have universal vaccines that stay stably protective.
On the other hand, I am not convinced they are actually possible for all viruses. Usually what is done is you try to pick a region that is well-conserved among known variants and target that as the antigenic site. That's an OK approach if the reason the region is conserved is actually a strong evolutionary pressure. Evolutionary pressures do not always have to be so strong for a site to be conserved. Sometimes just a small advantage can encourage maintenance.
But applying a vaccine to target a certain region changes things. That's a strong pressure to change. If the survival benefit of conserving the region targeted is less than the survival benefit of escaping the vaccine, "life finds a way."
There's a certain amount of luck we've had with paramyxovirus vaccines (eg MMR) where there is not substantial drift in the proteins targeted, and that makes them persistently effective against the viruses they target. Other viruses we haven't been so lucky with targeting in a way where the antigen site is so conserved.
I don't think we're necessarily going to be able to tell how well-conserved SARS-CoV-2 spike sites are until we are actively challenging the virus with drugs and vaccines that target those sites in real infections in real life. To make a stable, pan-corona vaccine, we have to pick sites that are really going to stay stable even under pressure. It would be interesting to see monoclonal antibody products deployed against these sites before vaccines are, to see if there is evolution to evade those.
Another problem that may arise in this is that there may be a reason the immune system doesn't already substantially target these sites. They may not be good sites for neutralizing the virus, or they may not be readily accessible to antibodies. That will also be hard to tell without experimentation in at least some kind of lab model.
On the other hand, maybe we'll find sites that it takes more time to evolve evasion from. Perhaps it'll be one shot every 5-10 years, like with tetanus, under such a circumstance.
Eventually though, I hope that whatever vaccine strategy ends up working long-term gets us to a place where we have such a strong immune foundation that this virus looks radically different and people's experiences of it are very mild without long term consequences. I don't know if that will happen, but if we can get to there we might be able to give only a few vaccines in childhood for this, and then everyone lives their lives and has minor illness from this from time to time. We are a long way off from even knowing if this can be made to happen, but it's the outcome I'm hoping for.
Since you referred to the home tests detecting the N protein of SARS-CoV-2, I thought I'd mention that over at Science-Based Medicine, someone mentioned that some of them instead detect the S protein, and that these are less able to detect omicron. I have no idea if that's true and they did not give a source.
Today you wrote, "If you throw enough of something sticky at a smooth surface, some of it is going to stick. Everyone has heard the cliche of throwing spaghetti at a wall to see what sticks. It is, quite literally, the entire mechanism of a booster dose in the prevention of symptomatic disease with the Omicron variant." While true, your going into more detail about antibodies here left out yet another whole level of complexity: cellular immunity. I have seen suggestions elsewhere that T-cell mediated immunity to omicron caused by (current) vaccines is not reduced to the same extent as antibody-mediated immunity. This was one paragraph in a Nature article in December, so I have no idea how valid it is (and I can't find the article now), but I thought I'd mention.
RE: home tests, yes, some do not target the N protein. That's why it's important to check what the test targets. N protein tests are ones I think are valid vs many variants, but one has to confirm if the test actually detects N or something else before that information matters. This is a manifestation of a wider principle where Omicron and other variants of concern often have lots of changes in specific parts of the spike protein but not a lot of changes in other parts of spike or in other proteins that the virus makes. So something that doesn't rely on those altered sites in spike will still be valid, while a test targeting highly varied regions of the spike protein will lose performance.
re:T cells, actually something similar is going on there as with the antigen tests, in that they target things that the "it" variant of the moment hasn't necessarily changed. T cells will target different antigens than antibodies go after, and so there is a slightly more diverse response. The reason I didn't mention them in my comments today is because T cells do not have a big impact on the prevention of disease. They are disease-limiting and can handle prevention of severe disease, but I do not believe they are effective at providing the type of immunity that everyone really wants--sterilizing immunity. At least they have not been important in this process so far. I don't think they're neutralizing virus or limiting it early enough in the disease process to prevent disease entirely.
They may be playing an important role in keeping people out of the hospital, though, which is very good.