Coronavirus

[MXLRplus]

California appears to be dead last in the % of allocated vaccine doses distributed among the 50 states. 4.7 million doses available, 1.8 million deployed. The US is 39.8 M / 19.1 M ratio.

The "cellphone tracking" is probably useless in CA. An employee's spouse tested positive, and nobody, not even that employee, received the alert. I sent everyone to the 1 hr C19 test site (LabCorp), and everyone was negative. HOWEVER, I did not allow the affected employee to return to work at this time.

The drive-thru 1hr testing is booked online, immediate slots are available, and gives results in 30 minutes. In Riverside County California there is surplus testing capacity.

 

[TEG]

The drive-thru 1hr testing is booked online, immediate slots are available, and gives results in 30 minutes. In Riverside County California there is surplus testing capacity.

How much is it there? My daughter did one near San Francisco and it was $140...

 

[MXLRplus]

How much is it there? My daughter did one near San Francisco and it was $140...

$150 each. Owww... But the 2-3 day tests at Walgreens or CVS are free with our insurance. We will follow up with that next week.

 

[mekberg]

Tested positive yesterday (Friday).

Wednesday evening I had a low grade headache which disappeared by Thursday morning. Headache came back Thursday afternoon along with a fever of 100.6.

Today (Saturday) my throat is a painful mess.

I expect things will get worse before they get better.

Overall I’m frustrated because we made our best effort at being safe: masking everywhere, no indoor dining, frequent hand washing, no gatherings.

 

[jerry33]

Overall I’m frustrated because we made our best effort at being safe: masking everywhere, no indoor dining, frequent hand washing, no gatherings.

Sorry to hear that. I have a vaccination scheduled for Tuesday, but no such luck for Denise. They way they are handling it (for this waiting list, there are several) is using Eventbright. They send an email when some vaccine arrives and then you try to beat others for the appointment. Once you get the ability to actually get a "ticket", it only lets you select one (so we can't both go at the same time). On other lists we're in the 80,000s (about 150,000 have signed up in our county--1M residents).

 

[bkp_duke]

Not really true. The answer is we don't know the efficacy after one dose in either case. And it's really best to wait on any exposure until 10+ days after the second dose, since the immune response and preparation will be at least 10x stronger after that second dose (from what I've read - you would know that much better than me, since you are an immunologist, of course).

The high uncertainty numbers, after eliminating the initial 10/12/14-day period from the observation interval, are about 92% efficacy for both vaccines.

The Moderna results over the entire interval between first and second dose are ALWAYS going to be skewed to look better, because there is a longer delay between first and second dose, so there is a longer period after immune response kicks in relative to the entire period (time for more cases in the placebo group). Also the N is very small in both cases, so the uncertainty is high (and Moderna may have ALSO gotten a little lucky in those first 10 days or so after vaccination in their trial) - but mostly it is the first factor:

https://twitter.com/michaelmina_lab/status/1340087821768536067?s=20

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This is a cherry-picked argument. The fact of the matter is that like Pfizer, Moderna picked their centers for vaccine Phase 3 in areas with HIGH incidence of COVID-19 (it's just how you run these kinds of studies).

Both vaccines work by the SAME mechanism, and both trigger an immune response in the same timeline. We KNOW that the Ab response to Moderna's vaccine produces a robust antibody response BY day 14 (see image below). That doesn't just appear from zero on Day 13 and is there by Day 14. It also does so at 50% of the full dose being given now.

Safety, tolerability, and immunogenicity of a recombinant adenovirus type-5 vectored COVID-19 vaccine: a dose-escalation, open-label, non-randomised, first-in-human trial

Pfizer showed data at Day 8 that showed no antibody response, so all we know is that patients getting that vaccine start ramping up their Ab response between days 8 and 21.
COVID-19 vaccine BNT162b1 elicits human antibody and T H 1 T cell responses | Nature

In a nutshell, you CANNOT dismiss that there is a statistically lower incidence of COVID-19 early on in the Moderna group vs. the Pfizer group. That's not supported by the fact that both Phase 3 groups were in population centers with significant COVID-19 incidence.

How can I explain this difference? While both are mRNA vaccines, we know that the carrier fluids are vastly different between the two. Moderna's is far more stable than Pfizer's, as is evidenced by the storage conditions that do not require deep freezing. I would surmise that with the Moderna vaccine, a quicker immune response is triggered because either 1) more mRNA gets into the cells (supported by the fact that both low and mid-dose trials also showed robust immune responses) or 2) less mRNA is lost to degradation because the storage requirements.

Regardless, if it were up to me, I would split the doses we have and give EVERYONE a 1/2 dose immediately, before we tried to get people to the 2nd dose. This would give 4X the doses we have now with 80%+ efficacy throughout the population, instead of 95% at a vastly smaller number receiving 2 doses.

 

[TheTalkingMule]

I'm sure this has been asked and discussed, but with vaccination ramping, it wouldn't hurt to bump.

For those of us fairly sure we've had covid19 at some point over the pandemic, is there logic in getting an antibody test and then skipping vaccination? Other than the "just to be sure" argument, it seems to me the goal of building antibodies will have already been achieved, no?

 

[JRP3]

no?

People who had it and were infected again might suggest getting the vaccine.

 

[TEG]

Tested positive yesterday (Friday).
Wednesday evening I had a low grade headache which disappeared by Thursday morning. Headache came back Thursday afternoon along with a fever of 100.6.
Today (Saturday) my throat is a painful mess.
I expect things will get worse before they get better.
Overall I’m frustrated because we made our best effort at being safe: masking everywhere, no indoor dining, frequent hand washing, no gatherings.

Sorry to hear that !

‘Headache, dizziness before fever and cough may signal COVID-19’

I had a bad headache yesterday and some dizziness, but it cleared up and I feel fine today. Hopefully it isn't COVID related.

New “NeuroCOVID” Classification System Uses MRI to Categorize Patients

https://www.researchgate.net/public...teristics_in_COVID-19_pandemic-a_survey_study

If Your Headache Feels Worse When Bending Over, It May Be COVID

(Sorry that some of the above links are from questionable sites with lots of random ads... It seems maybe they copied content from some more authoritative sites, but I didn't find the original source material...)

 

[bkp_duke]

I'm sure this has been asked and discussed, but with vaccination ramping, it wouldn't hurt to bump.

For those of us fairly sure we've had covid19 at some point over the pandemic, is there logic in getting an antibody test and then skipping vaccination? Other than the "just to be sure" argument, it seems to me the goal of building antibodies will have already been achieved, no?

Get the vaccine. All research to date shows that the vaccine induces a far better immune response than having had COVID-19. Far less likely to get the vaccine, and then get COVID-19, than to have COVID-19 twice.

And if you think you "had" it more than 6 months ago, but don't have proof (PCR, antibody, or antigen test from that time-frame), your Antibody test now will probably be negative anyway (COVID-19 antibodies wane relatively quickly).

 

[AlanSubie4Life]

We KNOW that the Ab response to Moderna's vaccine produces a robust antibody response BY day 14 (see image below).

Pfizer showed data at Day 8 that showed no antibody response, so all we know is that patients getting that vaccine start ramping up their Ab response between days 8 and 21.

Of course. Antibody response takes some time and is somewhat gradual. It’s not non existent on day 12 and there on day 14.

It would be interesting to know when antibodies show for Pfizer, but their results suggest it must be after day 8 and before around day 14.

And obviously the plots only pick up illnesses when symptoms arise, so protection may arise even earlier than shown by the timing of the divergence of the placebo and vaccinated groups. Maybe as early as day 8-10.

In a nutshell, you CANNOT dismiss that there is a statistically lower incidence of COVID-19 early on in the Moderna group vs. the Pfizer group. That's not supported by the fact that both Phase 3 groups were in population centers with significant COVID-19 incidence.

Again, the key issue is that if we assume antibody responses between day 8 and day 14 or so for both vaccines (I see nothing contradicting this and I think it is what would be expected from immunology?), then the 52% and 82% comparison compares:

8-14 days unprotected out of 21 days. (Result 52% VE)
8-14 days unprotected out of 28 days (Result 82% VE)

That 21/28 day difference is key to me. You can just look at the plots and see how big a difference in cases in the placebo group that causes. Anyway, If you pick 8 days and assume 100% effective, you’d expect (very roughly, and this is not exactly how VE is calculated - I’m just trying to show the point with minimal complication):
13/21 = 62%
20/28 = 71%

Given the low N, you can see the results could easily result in 52%/82%.

Is it possible that Moderna produces a response a couple days earlier, or maybe a stronger response? Sure. Just saying that the extra week to the second dose is a major factor here.

AND: if you arbitrarily pick from day 14 for both, to day 21/28, you get 92% VE for both.

Just imagine what Pfizer’s results would have shown if they had waited an extra week for the second dose! Would have been considerably better VE, almost certainly (just look at the plots), though we’d have to actually run that experiment to say for SURE.

 

[bkp_duke]

Again, the key issue is that if we assume antibody responses between day 8 and day 14 or so for both vaccines (I see nothing contradicting this and I think it is what would be expected from immunology?)

You CANNOT make this assumption. It is patently false, with no data to support it. With vaccines for other viruses, we see marked differences in antibody response profiles by manufacturer formulation.

Just because the Pfizer and Moderna vaccines are both mRNA based does not mean they are comparable. In fact, their storage requirements show they are vastly different.

 

[bkp_duke]

Just imagine what Pfizer’s results would have shown if they had waited an extra week for the second dose! Would have been considerably better VE, almost certainly (just look at the plots), though we’d have to actually run that experiment to say for SURE.

No no no. Another false assumption. Antibody response curves do not work that way. The levels at 28 days might be a few small percent higher than at 21 days, but that is it. Until a second challenge, antibody responses are logarithmic.

 

[AlanSubie4Life]

You CANNOT make this assumption. It is patently false, with no data to support it

The main data I see is the clear efficacy in Pfizer vaccine after day 12/14. What else would explain that?

Again, summary: my point is that if you measure after day 14, you get 92% VE in both cases. That’s all I am really arguing. I’m not suggesting the antibody response is identical for both vaccines!

 

[bkp_duke]

The main data I see is the clear efficacy in Pfizer vaccine after day 12/14. What else would explain that?

Again, summary: my point if that if you measure after day 14, you get 92% VE in both cases. That’s all I am really arguing. I’m not suggesting the antibody response is identical for both vaccines!

No data scientist would ever agree that cutting off the first 14 days is a valid assumption. Ever.

 

[AlanSubie4Life]

No no no. Another false assumption. Antibody response curves do not work that way. The levels at 28 days might be a few small percent higher than at 21 days, but that is it. Until a second challenge, antibody responses are logarithmic.

I think you are misunderstanding what I am saying. I am assuming when I make this statement that antibody levels are identical at day 21 and day 28. You’d see much better efficacy for Pfizer in this case because you’d have 14/28 days “protected” rather than 7/21. (Or whatever - as discussed these are very rough numbers since we don’t know when the antibodies show up exactly). Tons more cases will show in the placebo group during this fourth week.

The red line shows what happened in the placebo. We can’t say what would have happened to the blue line, but my guess is it would have been pretty similar without a second dose between days 21 and 28. This would result in a much better calculation for VE ( in the 70s) over days 0 to 28 for Pfizer, though still not as good as the Moderna 82%, I believe:

 

[AlanSubie4Life]

No data scientist would ever agree that cutting off the first 14 days is a valid assumption. Ever.

I’m not cutting it off. What happened there happened there! Maybe Moderna offered protection a little earlier! (As I said!) I am just comparing what happens after day 14. Is there something wrong with doing that?

Personally, looking at both of these curves, if I got either vaccine, I would assume no protection before day 14 (out of an abundance of caution). That’s really my point.

And the (really, really low N) data between day 14 and day 21/28 shows similar efficacy for the two vaccines.

 

[bkp_duke]

And I am saying that based upon the LACK of Ab data before day 8, and the lower infection rate in the Moderna group that a valid argument can me made that the Moderna vaccine is more effective early on. By all valid scientific methodology that cannot just be tossed aside based upon on a whim.

 

[AlanSubie4Life]

a valid argument can be made that the Moderna vaccine is more effective early on

I would definitely agree that it’s possible that Moderna provides better protection between day 7 and day 14. After that, and before the second dose, there doesn’t appear to be much difference, though the statistical power is pretty low for both.

My original point was just that the 52%/82% numbers are misleading. Especially for someone who is cognizant of the time it takes to develop an antibody defense and is going to be hunkering down ANYWAY for 14 days after their initial shot.

I don’t think I would recommend to anyone that with Moderna you can just wait only 7 days, but wait for 14 days for Pfizer. I’d wait 14 days for both (MAYBE could cut that to 12 due to exposure to onset delay in these plots).

For both vaccines, efficacy appears to be close to zero for days 0 to 7 (not quite zero but close). As expected.

Personally, I’ll be waiting until 10 days after my *second* shot to relax my protections and stop wearing my P100 full-face (will go to N95).

 

[AlanSubie4Life]

Overall I’m frustrated because we made our best effort at being safe: masking everywhere, no indoor dining, frequent hand washing, no gatherings.

Sorry to hear that. I hope you have a mild case, no one else gets it, and that ends the chain of transmission.

Obligatory questions: sounds like you are WFH? And did you wear N95 mask (or KN-95/KF-94) and if not, what did you wear?

Any idea of where you got it?

Really trying to understand how the defenses are breached.