Our regulatory state is failing us, antibodies edition

It might be the next best thing to a coronavirus vaccine.

Scientists have devised a way to use the antibody-rich blood plasma of COVID-19 survivors for an upper-arm injection that they say could inoculate people against the virus for months.

Using technology that’s been proven effective in preventing other diseases such as hepatitis A, the injections would be administered to high-risk healthcare workers, nursing home patients, or even at public drive-through sites — potentially protecting millions of lives, the doctors and other experts say.

The two scientists who spearheaded the proposal — an 83-year-old shingles researcher and his counterpart, an HIV gene therapy expert — have garnered widespread support from leading blood and immunology specialists, including those at the center of the nation’s COVID-19 plasma research.

But the idea exists only on paper. Federal officials have twice rejected requests to discuss the proposal, and pharmaceutical companies — even acknowledging the likely efficacy of the plan — have declined to design or manufacture the shots, according to a Times investigation. The lack of interest in launching development of immunity shots comes amid heightened scrutiny of the federal government’s sluggish pandemic response.

Here is more from the LA Times, substantive throughout, via Anecdotal.

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This is supposed to be last ditch stuff for people who are likely to die without it. This is due to the risk of spreading other pathogens. When this treatment moves to the first or second ditch it means you've got your ditches in the wrong order.

I used this method on the troops in Valley Forge and it worked great!

You were willing to inoculate soldiers against smallpox, a procedure with around a 1% death rate to prevent the 20-35% mortality rate an uncontrolled outbreak could cause. I'm sure those currently charged with the safety of the people of the United States would do no less and do whatever it takes to preserve their lives. Unless I'm wrong about that. And I think I am.

When the owner recognizes that rubbing their noses in it will not cause any change in behavior.

If I have helped you marshal your aggressive feelings and let the hate flow through you, then my work here is done. Go forth and do what is necessary to stop the virus.

My fortune is to live in a place where the virus has been stopped. The point was that telling Americans how to stop the virus only seems to cause aggressive feeling and letting hate flow, without doing anything necessary to stop the virus. It is a waste of time, much like how there are simply puppies incapable of being house trained.

It is a pipedream to believe that you can stop the virus.

We had the virus, we eliminated it. Clearly pipedreams come true 4 times out of 5 in Australia. (Sorry Victoria.)

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In this thread prior_approval makes a point so irrelevant it convinces an Australian he means the exact opposite. Oh well.

Has Germany stopped the virus? Well, no. Of course it hasn’t. In fact it has more new cases in each 24-48 hour period than Taiwan has had in total since the beginning of the crisis

That’s how a country like Taiwan ends up with 7 deaths total.

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"Federal officials have twice rejected requests to discuss the proposal..."

Yeah, well, why bother? Just trouble.

They have confused Trump et al as big government central planner tax and spend leftist ....

Trump promotes free market high monopoly profit capitalism with government paying whatever price is needed to inflate the company share price and reward Trump's family, friends and supporters.

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What are the reports on Russian vaccine in USA? Do you even discuss that it already passed trials on people? Do people in the West believe it to be a hoax? Are there talks to buy a vaccine from the accursed Russians, when we test it some more?

Russian vaccine, even if we totally believe the claim, has only passes 1st stage of trials, I.e. proven it is safe. It has still to pass 2nd stage, i.e. prove that it actually works.

True. But I was actually more interested in how it is being reported. In Russian official news it is being reported almost daily and the general idea is (as should be expected): "we are doing great in this field, quite soon we will have a working vaccine". But in the same news I have yet to hear anything about other countries' vaccines. That is why I am asking how Russian work in this field is being reported in USA. Do we have some sort of news barrier, or is it transparent?

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From what I know, Chineese have done most work for their vaccines. But it is not being reported in Russia. Is that reported in USA?

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I going to go out on a limb and say that article only offered half of the story. For example, is this similar to Immunoglobulin therapy? From what I understand that’s a fairly serious thing.

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This is pure desperation in a nation that is clearly unable to use the resources of the finest research and health care system in the world to achieve the results of Greece or Poland in controlling a novel pandemic.

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Shattock said the study was important and indicated that neutralising antibodies rapidly wane. “This certainly suggests that we cannot be confident natural infection will be protective for a significant proportion of individuals, nor certain of the duration of any protection.”

He added: “We would however expect that re-infection would be less severe for any individual as they will still retain immune memory allowing them to more rapidly respond. Nevertheless they could still be a source of onward transmission.

“It does indicate that vaccines need to do better than natural infection, providing consistent responses in the majority of individuals and sustained levels of protective antibodies. Ultimately this may require the use of annual boosting immunisations, particularly for the most vulnerable. This could be delivered alongside annual influenza immunisations.” www.theguardian.com/world/2020/jul/12/immunity-to-covid-19-could-be-lost-in-months-uk-study-suggests

Not so simple.

See Serum-IgG responses to SARS-CoV-2 after mild and severe COVID-19 infection and analysis of IgG non-responders
https://www.medrxiv.org/content/10.1101/2020.07.11.20151324v1

"Time to seroconversion was significantly shorter (median 11 vs. 22 days, P=0.04) in patients with severe compared to mild symptoms. Of the three patients without detectable IgG-responses after >90 days, all had detectable virus-neutralizing antibodies and in two, spike-protein receptor binding domain-specific IgG was detected with an in-house assay."

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Technological stagnation.
Institutional sclerosis.
Cultural revolution.
Geopolitical decline.

Not to mention it's difficult to patent medical inventions like this involving human cells, too many hot buttons. Thus: " have declined to design or manufacture the shots, according to a Times investigation". Same happened with penicillin (nobody owned a patent, no incentive to make it), finally solved with state intervention to mass produce it.

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Trump is an amazing President isn't he?

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Advocates for the immunity shots say "businesses are reluctant to invest in a product that could soon be replaced by a vaccine"

Sounds like it is the libertarian free market that is failing us, yet Marginal Revolution chooses not to frame it that way for some reason.

They simply don't mention free market failures while attempting to make the world a much better place by relentlessly pointing out that our regulatory state is failing us.

They also don't mention that a major reason our regulatory state is failing us is the ceaseless work done by those that have worked so hard to drown it in a bathtub.

+1

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The regulatory state seems to be thriving in spite of those efforts.

Case in point, the Atlantic Coast Pipeline, cancelled this month, after a 7 year effort to build it, and about 8 billion dollars, due to regulatory uncertainty.

And people wonder why companies are reluctant to make investments in infrastructure.

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In this thread:

Prior_approval believes a government with an annual budget of $4.45 Trillion dollars is small enough to drown in a bathtub

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I'm guessing there's a part of this story we're not getting.

Unfortunately it looks like TC's using some weak journalism to try to further his narrative.

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“It’s not shortages of any one thing. It’s now spot shortages of all of them,” said Scott Becker, chief executive of the Association of Public Health Laboratories. “Clinical labs need more swabs, chemical reagents, viral transport media, test kits, machines to process the tests, staffing to run the machines.”

Compounding the problem are logistical delays: collecting and transporting the rising number of samples and returning the results to people and health agencies so they can start contact tracing — a process that involves seeking out the web of people who came into contact with someone who is infected."

"This week, eight organizations representing those working in U.S. labs sent a letter to Vice President Pence pleading for help with test supplies.

One of those groups, the American Association for Clinical Chemistry, said it raised those same concerns last month in a call with Giroir, who said he had designated an official in each state to oversee the test supply chain and promised to give the organizations a list of those officials so they could direct pleas for help to them.

But the group never received that list and has not heard back from the administration.

“Instead, we’re all still competing against each other like the Hunger Games for critical supplies,” said David Grenache, president-elect of the association and chief scientific officer of a lab in New Mexico."

"Seattle, for instance, partnered with the University of Washington and has been able to maintain free, unrestricted testing with one- to two-day turnaround times.

Others are advocating for faster approval of rapid-result tests by the Food and Drug Administration, even if they are not as sensitive as nasal swabs. A group from the University of Colorado at Boulder and Harvard University recently released research, not yet peer-reviewed, finding that test frequency and turnaround time is more important than accuracy when it comes to broad disease surveillance.

“We’re really only going to get effective when we get into two-, one- or even half-day turnaround,” lead author Daniel Larremore said. But, he said, “The United States is not at the point with our testing where we can do any real surveillance and screening.”

Contrary to prior's characteristically fraudulent spin, that article is quite positive. The only supposedly bad examples that it can find:
• The mayor of Atlanta's test was taking several days to come back, so she took a second test and got the result within hours. By the way, she irresponsibly attended a funeral and thereby infected her whole family (getting her husband quite ill); this is presented as a failing of the system.
• A rural clinic in Arizona has experienced fluctuation in its testing numbers. Last week it received thousands of test kits. This is presented as a bad thing.

That's the worst the media could find about the state of testing in the US.

This is what struck me from that article, even though it was not quoted for whatever reason.

The nation’s largest commercial lab companies said increased demand has lengthened turnaround time for results. Quest Diagnostics said results across the country are taking three to five days on average; LabCorp said it is taking four to six days.

But because testing is being conducted by a mix of commercial, public and hospital labs, the average waiting time is not known with precision state by state.

“Some labs have indicated that their turnaround time could be as long as 10 days,” said Jason Mahon, a spokesman for the Florida Division of Emergency Management. Statewide, more than 11 percent of tests in Florida are coming back positive, but in hard-hit Miami-Dade County, it’s 1 in 3.

What’s still missing and urgently needed is a federally coordinated plan “assessing our testing capacity and identifying bottlenecks, forecasting what our future testing needs would be,” said Jennifer Nuzzo, a senior scholar at Johns Hopkins University’s Center for Health Security. Without that, Nuzzo said, the U.S. response remains “a kind of janky flotilla, that, you know, is put together with gum and duct tape.”

Finding 'janky' in an article is a pearl of high price, even when among swine.

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Why don't other countries take the lead in this and other good measures repressed by US regulation?

Your question is a very good one. We don't know what is going on in other countries. Although there are reports that in a few countries "they" are using new and old ideas to prevent Covid-19, it's almost impossible to verify how reliable and effective they are. Even within the U.S., I have the impression that the conflicting interests and values of politicians, bureaucrats, experts, scientists, and private companies' owners and managers make verification impossible. Most mass and social media reports cannot be trusted.

As I said in previous comments, Tyler and Alex so far have failed as intermediaries/filters of knowledge. I'm not surprised they have failed because of those conflicting interests and values. Every day we get reports with "good" news but many more reports with arguments to doubt on the competence and honesty of those involved in producing and intermediating knowledge. Indeed, it's quite difficult to build a system with incentives good enough to trust it. I hope Tyler and Alex address this issue rather than pretending to be "reliable" intermediaries of others' ideas on Covid-19. By training, they are supposed to be "experts" in designing those incentives.

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They are simply spiting their face by cutting off their nose, and sticking to their socialized medicine model instead of following America's lead in handling the current pandemic.

They aren't even counting on the free market to save them, but doing silly things like running clinical trials that demonstrate the life saving effectiveness of a common generic steriod. A therapy which will not bring any shareholder value to anyone, and actually cost taxpayer money to discover, as the RECOVERY Trial is funded by the NHS - https://www.recoverytrial.net/

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"Our regulatory state is failing us"

Maybe people get the state they deserve. Since I'm not God I can't tell what they deserve so the point is mere speculation.

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As everyone's favorite constitutional scholar points out, the threat of a Trump second term isn't that he will become a dictator, rather Trump's incompetence will turn Americans against democracy: "If Donald Trump is a danger to democracy, it is not because he will overthrow the Constitution. It is because his contempt for American values and institutions, and his ineptitude as a leader, may persuade Americans, by his example if nothing else, that democracy just does not work." https://www.nytimes.com/2020/07/13/opinion/trump-second-term.html

Now we should have a better understanding as to why Cowen's friend Peter Thiel supports Trump: it's Trump's incompetence, stupid! It's not that Thiel wants to drown "government" in the bathtub; it's our form of government that he is after.

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Of course, Thiel is not alone. Efforts to gerrymander voting districts, to suppress the vote, and to pack the courts with judges who render unpopular decisions, all contribute to Americans' loss of confidence in democracy.

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The libertarian turn against democracy is ancient, but not without fundamental contradictions.

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Finally, Republicans have become remarkably hostile toward voting. Bent on sculpting an electorate (through gerrymandering, permanent loss of voting rights for ex-felons, opposition to voting by mail and other voter-suppression techniques) that is whiter and more conservative than the country, they no longer evidence faith in democratic self-government. So long as they are unwilling to fully embrace the core of democracy — voting — they place themselves outside the bounds of acceptable American political debate.

Understanding the mysterious group of Never Trumpers

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oh...

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Looks promising (and yes, it does make me want to pull my hair out), but the question is why Bill Gates, foundations, and other countries aren’t pursuing this despite regulatory hurdles in the U.S.

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James Hamblin, who is a physician, lecturer at the Yale School of Public Health, and contributing writer at The Atlantic, has written the best articles about the coronavirus for someone like myself. He writes about a very complicated subject with clarity that anyone (even I) can understand. Articles at The Atlantic on the coronavirus are available without a subscription. Here is the link to his latest and what I consider his best: https://www.theatlantic.com/health/archive/2020/07/herd-immunity-coronavirus/614035/

Butterflies, chaos, and heterogeneity, that should interest everybody.

Heterogeneity is not just a four-bit word for economists, it's a term of art for folks who study chaos: "the complexities of real life create what (chaos) modelers refer to as heterogeneity". Reading the linked article gave me a much better understanding of why what happened in New York City didn't happen everywhere: it's the chaos, stupid!

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This is not, actually, the elephant in the room.

Have you been to see the elphant?

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I would generally agree the federal government is standing in the way of solutions like these.

But, and I know many of them, the people over at the FDA are not idiots. Their inability to evaluate solutions like these is a simple fact that one agency, designed to operate in a conservative manner, cannot process the thousands of solutions being created and tested daily. I'd wish the general tone of articles and posts like these were less, FDA / CDC are incompetent, they are not, and more, the organizations lack the ability to centrally plan this system because central planning is impossible for such a system to move quickly.

As far as antibodies go, there are a number of wrinkles that need to be addressed. Antibodies decay. They don't work with every patient, different people develop different antibodies. It's not an easy fix.

Perhaps, it's hard to tell.

But I think there is a kind of infantile plea that the CDC/FDA stand athwart their own Executive Branch, and override the Congress, to solve everything. I say "plea" and not "argument" because it's not really an argument that the CDC/FDA have the independence and power to actually do that.

So what is the plea for? Perhaps to redirect the conversation, and nothing more.

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In the mean time, it probably won’t hurt anything if people take matters into their own hands by increasing the frequency with which they use mouthwash.
https://academic.oup.com/function/article/1/1/zqaa002/5836301

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"Our regulatory state is failing us" is now the code phrase Alex and Tyler us for "government central planners are failing to spend hundreds or trillions of dollars to fix what the private for profit sector won't fix".

In other words, "how to be a radical leftist while talking like the intellectual right".

Note, the US has humongous amounts of vacant land on which to build cheap housing, especially in the heartland where Trump supporters live, but the intellectual right focuses only on the leftist dense urban areas where the rich live and claim the left is blocking the construction of tenement slums aka favelas by requiring they be paid millions for the property the commie leftists bought and paid for for only hundreds of thousands.

The solution for "housing shortages" is crushing the "failed regulatory state" by government spending billions on infrastructure in the Midwest building more Purdue's, IU's, more UI Urbana, fiber optic to every lot , along with roads, sidewalks, water and sewer, great public schools around them, and subsidizing all the professors and lab staff and maintenance workers.

These future cities in the conservative heartland would attract the intellectual right devoted to stopping deadly disease, the intellectual right devoted to ensuring everyone is as healthy as possible, the intellectual right who wants every consumer to earn a high level of consumption spending to greatly increase their cost of living to match the income the intellectual right aspires to.

If Tyller and Alex can embrace leftist political economics using the rhetoric of the intellectual right on deadly airborne disease, why not for health care, education, housing, economic equality, government spending?

Annd Trump and McConnell have proved since 2017 that conservatives are all in on massive increases to government spending even when the economy is the greatest every in the entire history of the universe, and then willing to dwarf the government spending increase in a time of conservative fear of the unknown triggering an economic downturn by the paradox of thrift.

The conservative governing thrift in the face of economic contraction is yet to kick in in the conservative heartland which has been in relative decline compared to the leftist cities which force high cost of living to drive economic growth.

The paradox of using "thrift" to get businesses and workers to move from California to places run by intellectual right principles is costs rise rapidly and these places turn into leftist fronts that destroy the thrift, and drive out the ideology of the intellectual right.

Eg, Austin reminds me of 60s big government taxing and spending to grow the population and economy.

And Austin is a center of fighting deadly airborne disease by decades of massive government spending that Obama wanted to be bigger. But Trump has directed a lot of his massive government spending increases to leftist east coast centers for fighting deadly airborne disease created over centuries by government spending, but especially by Bush and Obama this century.

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