Coronavirus

[AlanSubie4Life]

https://twitter.com/shamezladhani/status/1361636096585654273?s=21


Seems about right; at these levels we would see a LOT of stories about reinfections, even though they are not really an issue (wrt herd immunity) if there is no underlying immune escape by the virus (note of course that this study likely does not have B.1.351 playing any significant role - B.1.1.7 does not show evidence of immune escape).

Not sure if it’s a coincidence that the efficacy of prior infection is similar to the efficacy of the first vaccine dose (within the wide confidence intervals). Probably not. This is probably on average an older cohort than the vaccine trial so making these comparisons is probably not that meaningful in any case.

 

[AlanSubie4Life]

Interesting blurb on B.1.1.7. (Tweet has nice GIFs.) One interesting implication is that some of the increase in transmissibility may be from a reduction in serial interval (time between transmissions) rather than a change in R0, which make it not quite as fearsome (in terms of changing the herd immunity threshold). These two factors both impact the final exponential growth rate, but fast transmission doesn’t affect the herd immunity threshold. It also implies that the NPIs we are all used to using may continue to be nearly as effective. In reality, B.1.1.7 is probably also more transmissible, but the exact degree matters for pandemic trajectory.

https://twitter.com/viruswhisperer/status/1360991304134631427?s=21

 

[chronoreverse]

Slightly not on topic but XKCD is great as usual:

 

[renim]

2 studies from Australia

Innate cell profiles during the acute and convalescent phase of SARS-CoV-2 infection in children | Nature Communications
compares the response of Children infected VS Children exposed (but negative on PCR testing) ie how children fight of COVID19 without being infected.

Immune responses to SARS-CoV-2 in three children of parents with symptomatic COVID-19 | Nature Communications
further detail within a single family unit.
"Our combined salivary and serological findings show that, despite having no virological evidence of infection, all three children developed antibody responses against various SARS-CoV-2 epitopes. Of the three children, C3, who remained asymptomatic throughout, demonstrated the most robust antibody response. We also observed that symptom resolution in A2, C1, and C2 coincided with a spike in salivary anti-S1 IgA, but not IgG. SARS-CoV-2 likely infects the salivary glands and is detectable in saliva22. Our data, therefore, provide evidence that control of SARS-CoV-2 at the site of infection may be mediated by a mucosal IgA antibody response."

 

[Jeff N]

Another study showing concern about the potential for vaccine escape with the B.1.351 variant from South Africa, this time from Pfizer regarding their mRNA vaccine.

“A laboratory study suggests that the South African variant of the coronavirus may reduce antibody protection from the Pfizer Inc/BioNTech SE vaccine by two-thirds, and it is not clear if the shot will be effective against the mutation, the companies said on Wednesday.

The study found the vaccine was still able to neutralize the virus and there is not yet evidence from trials in people that the variant reduces vaccine protection, the companies said.”

Pfizer says South African variant could significantly reduce vaccine protection

 

[TEG]

Hopefully they are working on a new vaccine variation to better protect against that mutation.

 

[Jeff N]

Hopefully they are working on a new vaccine variation to better protect against that mutation.

Yep, both Pfizer/BioNTech and Moderna have said they are working on updated vaccines that will also include mRNA for spike protein based on the B.1.351 variant.

 

[TEG]

Yep, both Pfizer/BioNTech and Moderna have said they are working on updated vaccines that will also include mRNA for spike protein based on the B.1.351 variant.

Any thoughts on timeframe to availability?

 

[alloverx]

2 studies from Australia
Immune responses to SARS-CoV-2 in three children of parents with symptomatic COVID-19 | Nature Communications
further detail within a single family unit.

I recall a video about this family and I think I posted a link to it last year. Very interesting.

 

[wycolo]

Just got Pfizer#2 today, LOL. [returns to hibernation]
--

 

[AlanSubie4Life]

Another study showing concern about the potential for vaccine escape with the B.1.351 variant from South Africa, this time from Pfizer regarding their mRNA vaccine.

“A laboratory study suggests that the South African variant of the coronavirus may reduce antibody protection from the Pfizer Inc/BioNTech SE vaccine by two-thirds, and it is not clear if the shot will be effective against the mutation, the companies said on Wednesday.

The study found the vaccine was still able to neutralize the virus and there is not yet evidence from trials in people that the variant reduces vaccine protection, the companies said.”

Pfizer says South African variant could significantly reduce vaccine protection

Weirdly inconsistent numbers and I am too lazy to look up the paper:

“The study by Pfizer and scientists from the University of Texas Medical Branch (UTMB), which has not yet been peer-reviewed, showed a less than two-fold reduction in antibody titer levels,”

In any case it’s a way better result than we have had before. It is either just 50% less (2x less) or 33% (3x less) than the prior result of about 6x (average) as I recall.

But it doesn’t really mean anything concrete, because this virus didn’t have all the mutations, and it also wasn’t the real virus (lentivirus). It may well be correlated with actual in vivo results but it’s hard to say.

So hopefully we’ll have clinical data soon.

All of these numbers, including the 6x less effective number, should be plenty to keep this vaccine effective, with efficacy nearly unchanged - if the neutralizing activity in these tests translates into actual clinical efficacy. (Because it starts with such sky-high antibody levels.)

 

[bkp_duke]

Any thoughts on timeframe to availability?

Completely depends upon the FDA. "Swapping out" the mRNA for a new strand is relatively simple. That's the beauty of this technology.

What I don't know, is how well incorporating multiple mRNA strands into a single vaccine dose works with this technology. Most certainly there is a minimum threshold of mRNA that you need per variant to induce an adequate immune response, but it's not clear to me what that is (probably 25% or so of the regular dose, giving the ability to incorporate possibly 3 variant strands into one dose - assuming some excess for losses, etc. - but that's a complete guess on my part). Might also be better to go with a booster shot, composed entirely of just the new strand.

This is what clinical trials are designed to tease out.

 

[TEG]

From the time they come up with a new tested/approved strand, I don't know how long it takes to put that into the production pipeline and get it through all the logistics into people's arms. Is it just a matter of dropping a new "template" into the production machinery and within days(?) or weeks(?) the vaccinations centers would have the updated batches? For instance, I have no idea how much "lag" exists in the mass scale replication equipment. I also have no idea how many different production factories would need to get updated.

 

[bkp_duke]

From the time they come up with a new tested/approved strand, I don't know how long it takes to put that into the production pipeline and get it through all the logistics into people's arms. Is it just a matter of dropping a new "template" into the production machinery and within days(?) or weeks(?) the vaccinations centers would have the updated batches? For instance, I have no idea how much "lag" exists in the mass scale replication equipment. I also have no idea how many different production factories would need to get updated.

The government approval would be a far longer process than the logistics.

 

[madodel]

NEPA health networks reschedule COVID-19 vaccines due to shortages

So remember when everyone was saying just give all the first vaccine doses to as many people as possible and worry about the second dose later. Well in Pennsylvania some of the providers screwed up and gave doses that were supposed to be allotted for the second dose as a first dose. Now the state is scrambling to get people rescheduled.

 

[bkp_duke]

NEPA health networks reschedule COVID-19 vaccines due to shortages

So remember when everyone was saying just give all the first vaccine doses to as many people as possible and worry about the second dose later. Well in Pennsylvania some of the providers screwed up and gave doses that were supposed to be allotted for the second dose as a first dose. Now the state is scrambling to get people rescheduled.

It's fine. It's not like the immune cells that cause the 2nd dose disappear.

If it were up to me, I would vaccinate the entire country with a first dose ASAP, as there is a good bit of protection from that (at least with Moderna and Pfizer).

The ONLY reason that providers are anal retentive about the dosing interval (28 days for Moderna, 21 days for Pfizer) is that those are the intervals used in the trials, so there is no data for other intervals, although from a "how the immune system works" perspective, it should be fine even if they are spaced months apart.

 

[ZeApelido]

Alright I've gone 23.5 hours since my 2nd shot. Can I take Ibuprofen now?

 

[bkp_duke]

Alright I've gone 23.5 hours since my 2nd shot. Can I take Ibuprofen now?

If you need it, take it. Don't make yourself miserable over this.

 

[ZeApelido]

If you need it, take it. Don't make yourself miserable over this.

Thanks.

My wife is gonna be thrilled when I tell her I get my advice from a doctor on an internet forum.

 

[bkp_duke]

Looks like I've still got my mojo - I called this weeks ago:

New Data Boost Calls for Single COVID-19 Vaccine Dose
"A single dose of the Pfizer/BioNTech vaccine offers 92.6% efficacy in new calculations based on data submitted to the US Food and Drug Administration (FDA), researchers report."

"Together with previous findings that a single Moderna vaccine dose provides 92.1% efficacy against SARS-CoV-2 infection, investigators propose it is time to defer the second dose to extend protection to more people through single-dose mRNA vaccinations."

Original Source:
https://www.nejm.org/doi/full/10.1056/NEJMc2036242

Yes, if you read the full Medscape article, there is still argument about 1 vs. 2 doses. But if you are looking to stamp out a pandemic, this should not even be a discussion - get as much vaccine first dose into the arms of the public as possible. Deal with 2nd shots later.

It would save lives, and the economy would recover faster.