3 ms·

That's not what the Pfizer paper showed. There was a confidence interval from between 20-70% iirc for the first shot. Maybe if we're lucky it's on the higher en

That's not what the Pfizer paper showed. There was a confidence interval from between 20-70% iirc for the first shot. Maybe if we're lucky it's on the higher end, but I would stick to proven science if we're going to combat this thing effectively.

deleted 6y ago
[deleted]
mlyle 6y ago
Wargame the scenarios. You wouldn't want to give one dose on purpose, but reserving a whole bunch of doses to prevent some people from getting only 1 in a worst case scenario is silly. That 20-70% efficacy number includes the entire period between dose 1 and 2. It looks way better 10 days after dose 1, btw-- MLE around 80%. e.g. single dose -- 50% efficacy (to be pessimistic); double dose -- 95% efficacy. 10M doses "in flight" monthly. 100 deaths/million/month. Ignore all effects on transmission (to be more pessimistic). Scenario 1 (no logistics disruption, half held back): 5M dosed with 1 dose at day 0, 5M dosed with 2 doses at 1 month and 5M dosed with 1 dose at 1 month. 250 saved in first month, 725 saved in second month. Scenario 2 (no logistics disruption, 25% held back): 7.5M dosed with 1 dose at day 0, 7.5M dosed with 2 doses at 1 month and 2.5M dosed with 1 dose at 1 month. 375 saved in first month, 837 saved in second month. Scenario 3: (100% production disruption, half held back): 5M dosed with 1 dose at day 0; 5M dosed with 2 doses at 1 month. 250 saved in first month, 475 saved in second month. Scenario 4: (100% production disruption, 25% held back): 7.5M dosed with 1 dose at day 0; 2.5M dosed with 2 doses at 1 month; (5M late for dose 2); 375 saved in first month, 612 saved in second month. With a 25% reserve, you only get into the unexpected-only-1-dose regimen with a supply disruption of more than 50%... and even then it's still probably better than a 50% reserve.
- wwweston 6y ago
  This is a productive line of thinking.
- tehjoker 6y ago
  I wonder if hitting the delivery targets of 20M per month is going to be achieved. That's the first bottleneck before the vaccine supply.
  - mlyle 6y ago
    Right now, many jurisdictions are supply limited, and most look like they're ramping enough to be supply limited, though still a bit more slowly than I'd like. Lowering reserves would still increase administration rate immediately (though not proportionally). Actually, we might even enter phase 1B in some areas and have a mostly parallel administration system start to come up... It's unclear to me how much of the slowness so far in administration (13.5% of doses allotted are reported as administered so far)... is A) (fixed?) delays in reporting, B) (fixed?) delays in logistics getting doses to administration sites, C) limitations on rate of administration, D) holiday-related slowness. Only C really matters in the long term-- if it is ramping poorly compared to production than that's a problem. But I think it's premature to assume C is limiting when A, B, & D are surely large right now.
aquadrop 6y ago
Did you see that graph with amount of cases in control/vaccine groups? Where around day 10 vaccine group graph shows massive drop. It looks pretty convincing. And by now they have much more data, especially with lots of cases nowadays. That simple move can save thousands of live and I think worth considering, instead of just ignoring everything.
- tehjoker 6y ago
  I just reviewed it and somehow I missed that detail that the inflection point was way before the second vaccine on the first reading. Very interesting.
tehjoker 6y ago
Note reviewing the paper: 95% CI 29.5% to 68.4%, mean vaccine efficacy prediction 52% for 1st shot.
jpdus 6y ago
That is not correct (I think that number comes from the Oxford/AZ vaccine?). If you look at the cumulative incidence curves (for Moderna see [1] page 28), you can see that COVID-19 occurences drop approx. 14 days after the first dose with no measurable effect of the second dose after 28 days. This pattern is exactly the same for both vaccines. [1] https://www.fda.gov/media/144434/download https://www.fda.gov/media/144434/download PS: My parent comment was downvoted more often than any other HN comment I ever made, but nobody cared to elaborate why my line of thinking is unethical or why i am reading the data wrong. That's slightly disappointing.

deleted 6y ago

[deleted]

mlyle 6y ago

Wargame the scenarios. You wouldn't want to give one dose on purpose, but reserving a whole bunch of doses to prevent some people from getting only 1 in a worst case scenario is silly. That 20-70% efficacy number includes the entire period between dose 1 and 2. It looks way better 10 days after dose 1, btw-- MLE around 80%. e.g. single dose -- 50% efficacy (to be pessimistic); double dose -- 95% efficacy. 10M doses "in flight" monthly. 100 deaths/million/month. Ignore all effects on transmission (to be more pessimistic). Scenario 1 (no logistics disruption, half held back): 5M dosed with 1 dose at day 0, 5M dosed with 2 doses at 1 month and 5M dosed with 1 dose at 1 month. 250 saved in first month, 725 saved in second month. Scenario 2 (no logistics disruption, 25% held back): 7.5M dosed with 1 dose at day 0, 7.5M dosed with 2 doses at 1 month and 2.5M dosed with 1 dose at 1 month. 375 saved in first month, 837 saved in second month. Scenario 3: (100% production disruption, half held back): 5M dosed with 1 dose at day 0; 5M dosed with 2 doses at 1 month. 250 saved in first month, 475 saved in second month. Scenario 4: (100% production disruption, 25% held back): 7.5M dosed with 1 dose at day 0; 2.5M dosed with 2 doses at 1 month; (5M late for dose 2); 375 saved in first month, 612 saved in second month. With a 25% reserve, you only get into the unexpected-only-1-dose regimen with a supply disruption of more than 50%... and even then it's still probably better than a 50% reserve.

wwweston 6y ago
This is a productive line of thinking.
tehjoker 6y ago
I wonder if hitting the delivery targets of 20M per month is going to be achieved. That's the first bottleneck before the vaccine supply.
- mlyle 6y ago
  Right now, many jurisdictions are supply limited, and most look like they're ramping enough to be supply limited, though still a bit more slowly than I'd like. Lowering reserves would still increase administration rate immediately (though not proportionally). Actually, we might even enter phase 1B in some areas and have a mostly parallel administration system start to come up... It's unclear to me how much of the slowness so far in administration (13.5% of doses allotted are reported as administered so far)... is A) (fixed?) delays in reporting, B) (fixed?) delays in logistics getting doses to administration sites, C) limitations on rate of administration, D) holiday-related slowness. Only C really matters in the long term-- if it is ramping poorly compared to production than that's a problem. But I think it's premature to assume C is limiting when A, B, & D are surely large right now.

aquadrop 6y ago

Did you see that graph with amount of cases in control/vaccine groups? Where around day 10 vaccine group graph shows massive drop. It looks pretty convincing. And by now they have much more data, especially with lots of cases nowadays. That simple move can save thousands of live and I think worth considering, instead of just ignoring everything.

tehjoker 6y ago
I just reviewed it and somehow I missed that detail that the inflection point was way before the second vaccine on the first reading. Very interesting.

tehjoker 6y ago

Note reviewing the paper: 95% CI 29.5% to 68.4%, mean vaccine efficacy prediction 52% for 1st shot.

jpdus 6y ago

That is not correct (I think that number comes from the Oxford/AZ vaccine?). If you look at the cumulative incidence curves (for Moderna see [1] page 28), you can see that COVID-19 occurences drop approx. 14 days after the first dose with no measurable effect of the second dose after 28 days. This pattern is exactly the same for both vaccines. [1] https://www.fda.gov/media/144434/download https://www.fda.gov/media/144434/download PS: My parent comment was downvoted more often than any other HN comment I ever made, but nobody cared to elaborate why my line of thinking is unethical or why i am reading the data wrong. That's slightly disappointing.