Coronavirus

[JRP3]

I'm vaccinated. Personally I'm done with this thing

That was my thought until we started seeing all the breakthrough infections. Who knows what further mutations may bring if this thing doesn't get knocked down soon, which doesn't seem likely.

 

[madodel]

Video comparing Delta to Lambda.
Lambda has the same mutation they think makes Delta higher transmissible though they think Lambda has higher infectivity, and has some major changes to the spike that may make it less susceptible to current vaccines but the only one studied in South America against lambda is Sinovac's which is the major vaccine in in use there. But their study is showing still considerable neutralization with antibodies, with just some increased resistance to the mRNA vaccines. They also found much higher death rate with Lambda in Peru but they question if that might be more related to the healthcare system and environmental issues there then the actual lethality of the virus. So Lambda shouldn't be that much worse than Delta and they don't see it outcompeting Delta in the US.

N SARS-CoV-2 Lambda Variant: How Concerned Should We Be?

 

[AlanSubie4Life]

That was my thought until we started seeing all the breakthrough infections. Who knows what further mutations may bring if this thing doesn't get knocked down soon, which doesn't seem likely.

I can’t tell from your statement whether you think the breakthrough infections are a consequence of immune escape. Definitely future variants with immune escape are a concern…but Delta really isn’t one, very much at all (thankfully). It’s just really infectious!

I still don’t understand why people think there are more breakthrough infections due to Delta being a variant. I think evidence suggests the primary reason for reduced efficacy against infection is due to gradually waning antibody levels, which was always expected to first impact those who failed to mount a strong antibody response to the initial vaccinations. Those antibodies protect against infection but the T-cells and memory B-cells rally to maintain high efficacy against the actual disease of concern. As far as I know studies in Singapore have backed this up - there’s a correlation between antibody level and breakthrough probability.

There may be characteristics of delta like fast growth in the respiratory tract that require somewhat higher levels of antibodies to prevent infection, not sure.

But mostly the impression I get from the data so far (just my opinion) is that the expected waning of antibodies, particularly for people who are elderly and have been fully vaccinated for 8-9 months, is leading to more breakthroughs, but a minimal increase in severe disease. And it would have happened with other variants with minimal escape characteristics as well - albeit with MUCH reduced consequences for the “wildtype” or the alpha, which were less infectious.

If immune escape were the primary issue Moderna and Pfizer would be planning to boost with their candidates which provide better protection against variants with stronger immune escape characteristics. But they’re not, because the existing vaccines show strong efficacy against all existing variants. Including Lambda, Beta, etc

And of course as we know, except in those with weaker secondary immune systems or generally weaker systems, reducing antibody levels will not substantially impact the rate of severe disease.

Seems like the main reason for boosting is to reduce spread, which is important right now (but mostly because not everyone has gotten vaccinated - vaccinated people are clearly not driving the spread of the disease). It also helps reduce the occurrence rate of inconvenient and unpleasant infections. And, for the weaker individuals, it may well reduce incidence of severe disease (also desirable).

It would be more optimal to keep using doses to vaccinate the rest of the world, if the concern is variants. We’re obviously not going to do that though. Those doses are staying here and we’re all going to keep shooting them up.

Here is efficacy against Delta (San Diego is something like 60% vaccinated but no one actually seems to know the exact level - most new cases are in East County and South County):

 

[Dave EV]

But mostly the impression I get from the data so far (just my opinion) is that the expected waning of antibodies, particularly for people who are elderly and have been fully vaccinated for 8-9 months, is leading to more breakthroughs, but a minimal increase in severe disease. And it would have happened with other variants with minimal escape characteristics as well - albeit with MUCH reduced consequences for the “wildtype” or the alpha, which were less infectious.

If immune escape were the primary issue Moderna and Pfizer would be planning to boost with their candidates which provide better protection against variants with stronger immune escape characteristics. But they’re not, because the existing vaccines show strong efficacy against all existing variants. Including Lambda, Beta, etc

And of course as we know, except in those with weaker secondary immune systems or generally weaker systems, reducing antibody levels will not substantially impact the rate of severe disease.

Seems like the main reason for boosting is to reduce spread, which is important right now (but mostly because not everyone has gotten vaccinated - vaccinated people are clearly not driving the spread of the disease). It also helps reduce the occurrence rate of inconvenient and unpleasant infections. And, for the weaker individuals, it may well reduce incidence of severe disease (also desirable).

I think you're missing some key concepts here that you have acknowledged before, but just to clarify some key facts as I understand them in simplistic form:

• Antibodies are one of the body's immune response to actively attack a virus.
• Antibodies can take some amount time to build up
• Antibodies will naturally decline over a period of months regardless of the type of infection once the threat has passed (eg, no active COVID infection or after a vaccine) - as this happens, your body is building up T-cell and B-cells
• T-cells and B-cells are the body's long-term memory to viruses - after antibodies fade away, these cells are responsible for both quickly building antibodies as well as directly attacking the virus.

At the end of the day, for long-lasting immunity and resistance to a disease, you fully expect antibodies to fade away, but your body's T and B cells should still present a strong response to a virus.

Immunocompromised individuals need extra help building up enough long-term memory - as antibodies fade away, their T/B cells may not respond fast enough to fight off the virus.

In light of Delta, it appears that the body's antibodies and T/B cells are not quite fast enough to prevent infection in many people. But it is strong enough to prevent severe illness in nearly all. A booster appears to convince the body to build up an even stronger response to Delta which avoids any illness in most cases.

As an aside, I think there is still not enough data on the grey area between not-infected and severe-illness (hospitalized). With ~20% of infected, vaxxed individuals having symptoms lasting longer than 4-6 weeks, I am still personally concerned about getting covid and potentially suffering from long-lasting effects despite being vaxxed.

 

[JRP3]

But mostly the impression I get from the data so far (just my opinion) is that the expected waning of antibodies, particularly for people who are elderly and have been fully vaccinated for 8-9 months, is leading to more breakthroughs,

That's not what we are seeing locally

 

[AlanSubie4Life]

That's not what we are seeing locally

View attachment 696908

View attachment 696909

How can you tell from that? I can’t tell from that info what the vaccine efficacy is in each age group, because the information on the vaccination status of each infection (grouped by age) is not given.

It’s also low N so numerically it is hard to draw a conclusion, but from that graph there’s literally no information to be gathered on efficacy.

 

[AlanSubie4Life]

I think you're missing some key concepts here that you have acknowledged before, but just to clarify some key facts as I understand them in simplistic form:

Yes, I’m in agreement with all of that and thanks for adding the extra context.

That’s my point, anyway - it doesn’t seem clear to me that there has been any dropoff in efficacy beyond what might be expected from a virus which has a numbers advantage due to initial dose and replication rate. That’s not immune escape as I understand it (escape would be antibodies and T-cells and memory B-cells that cannot find appropriate places to bind and neutralize the virus and the body having to learn a new way to produce immunity).

I remain unconvinced that VE would be much different over the past month if delta didn’t exist. The case numbers of course would be VERY different, but that has nothing to do with efficacy - that’s related to the contagiousness of the virus (BOTH more vaccinated people and unvaccinated people will be exposed). I wouldn’t be surprised if VE is a LITTLE different because of how fast the virus replicates though - you might well need higher antibody levels to neutralize it effectively at the point of attack. And that’s what the data says (85-88% or so rather than low 90s), anyway, so not quibbling with that.

I’m just saying that all available evidence points to delta not having significant immune escape characteristics.

The Crotty link from a couple days ago I thought was pretty informative in this regard.

It does not mean that boosters won’t help, of course. They bring up the titer. As I understand it, the body naturally reduces antibody levels over time and relies on memory-B cells, otherwise our blood would be a sludge full of antibodies from all the infections we have seen.

For a fast replicating virus, antibody production may not ramp up fast enough in some people (even healthy people) to counter the infection (in addition the antibodies aren’t very numerous in the mucous membranes/nasal pharynx where they would be most effective - hence the inhaled vaccine development), and you could still have an unpleasant infection, long COVID, etc. One way to counter this aside from a booster is to wear a mask in high-risk environments, to keep the initial dose down, since that will right shift the exponential growth curve in time and give your body additional time to react and keep up (the B cells spew out massive amounts of neutralizing antibodies before the virus can make it to other places in the body). That is what I have read and heard from immunologists, anyway.

If you want to argue that we need higher antibody levels in the population to counter delta because of its higher contagiousness (because it’s a variant, but not because it’s an immune-escaping variant), just so we can do everything to bring the numbers down, I wouldn’t quibble with that. Maybe splitting hairs I guess, but I am just saying they are two separate issues with dramatically different impacts and strategies to counter them.

Specifically: What would counter delta better than boosters is everyone getting fully vaccinated one time. That wouldn’t be nearly as true if the variant had strong immune escape characteristics.

If you want to avoid future variants, the right strategy is probably to vaccinate everyone, too.

 

[dhanson865]

anybody have a serious answer of how you use .7 of one hospital bed? (I can make the short people jokes myself)

57.7 of 60 beds is some weird math to me.

 

[jerry33]

anybody have a serious answer of how you use .7 of one hospital bed? (I can make the short people jokes myself)

57.7 of 60 beds is some weird math to me.

Don't know for sure, but I'd guess bed occupancy is based in hours. That is a bed's occupancy is X hours, so 24 for a full day, and X/24 for a partial day.

 

[wdolson]

I'm vaccinated. Personally I'm done with this thing

The problem is that the virus may not be done with you.

Yes, I’m in agreement with all of that and thanks for adding the extra context.

That’s my point, anyway - it doesn’t seem clear to me that there has been any dropoff in efficacy beyond what might be expected from a virus which has a numbers advantage due to initial dose and replication rate. That’s not immune escape as I understand it (escape would be antibodies and T-cells and memory B-cells that cannot find appropriate places to bind and neutralize the virus and the body having to learn a new way to produce immunity).

I remain unconvinced that VE would be much different over the past month if delta didn’t exist. The case numbers of course would be VERY different, but that has nothing to do with efficacy - that’s related to the contagiousness of the virus (BOTH more vaccinated people and unvaccinated people will be exposed). I wouldn’t be surprised if VE is a LITTLE different because of how fast the virus replicates though - you might well need higher antibody levels to neutralize it effectively at the point of attack. And that’s what the data says (85-88% or so rather than low 90s), anyway, so not quibbling with that.

I’m just saying that all available evidence points to delta not having significant immune escape characteristics.

The Crotty link from a couple days ago I thought was pretty informative in this regard.

It does not mean that boosters won’t help, of course. They bring up the titer. As I understand it, the body naturally reduces antibody levels over time and relies on memory-B cells, otherwise our blood would be a sludge full of antibodies from all the infections we have seen.

For a fast replicating virus, antibody production may not ramp up fast enough in some people (even healthy people) to counter the infection (in addition the antibodies aren’t very numerous in the mucous membranes/nasal pharynx where they would be most effective - hence the inhaled vaccine development), and you could still have an unpleasant infection, long COVID, etc. One way to counter this aside from a booster is to wear a mask in high-risk environments, to keep the initial dose down, since that will right shift the exponential growth curve in time and give your body additional time to react and keep up (the B cells spew out massive amounts of neutralizing antibodies before the virus can make it to other places in the body). That is what I have read and heard from immunologists, anyway.

If you want to argue that we need higher antibody levels in the population to counter delta because of its higher contagiousness (because it’s a variant, but not because it’s an immune-escaping variant), just so we can do everything to bring the numbers down, I wouldn’t quibble with that. Maybe splitting hairs I guess, but I am just saying they are two separate issues with dramatically different impacts and strategies to counter them.

Specifically: What would counter delta better than boosters is everyone getting fully vaccinated one time. That wouldn’t be nearly as true if the variant had strong immune escape characteristics.

If you want to avoid future variants, the right strategy is probably to vaccinate everyone, too.

I recall reading that people develop antibodies in their mucus membranes after getting vaccinated. I can't remember if it was all vaccines or just the mRNA vaccines.

For whatever reason there is some indication that that breakthrough infections are becoming more common. It may be due to testing error, ie people are labeled as breakthrough infections if they test positive even if their viral load is low and they have few, if any symptoms. The vaccine is working if you test positive, but feel fine and are not contagious. It could be due to vaccine fade over time.

We do know that some people who are vaccinated get seriously ill and some die. Though vastly fewer than the unvaccinated. It's also abundantly clear that Delta is far more dangerous than previous strains. Houston reported yesterday that their ICU bed use now is higher than at the worst point in last year's outbreak and they aren't even close to cresting yet. This is happening despite some percentage of the population having immunity from either having had COVID or getting vaccinated. The pool of vulnerable people is much smaller than last year, yet the hospitals are filling up faster.

We're also running out of medical care workers. Some hospitals have enough ICU beds, but don't have the staff to support them so they are going unused. Staff attrition is high between dead hospital workers, those on long term disability from long COVID or COVID scars, and those who quit because of PTSD.

The effectiveness of the vaccines may have dropped, but even if they haven't, the best of them is around 90% effective. That leaves 1 in 10 vulnerable and gives a virus with a high R0 an opening to continue to live in the population and mutate. Even if we could get 100% of the population vaccinated, a high R0 virus vs a 90% effective vaccine, it will continue to exist in the population forever.

anybody have a serious answer of how you use .7 of one hospital bed? (I can make the short people jokes myself)

57.7 of 60 beds is some weird math to me.

I would assume it's a daily average derived from use over a longer period of time like a week. So a bed that was used 2 days out of 7 would be about .3 bed use.

 

[scottf200]

I think you're missing some key concepts here that you have acknowledged before, but just to clarify some key facts as I understand them in simplistic form:

• Antibodies are one of the body's immune response to actively attack a virus.
• Antibodies can take some amount time to build up
• Antibodies will naturally decline over a period of months regardless of the type of infection once the threat has passed (eg, no active COVID infection or after a vaccine) - as this happens, your body is building up T-cell and B-cells
• T-cells and B-cells are the body's long-term memory to viruses - after antibodies fade away, these cells are responsible for both quickly building antibodies as well as directly attacking the virus.

At the end of the day, for long-lasting immunity and resistance to a disease, you fully expect antibodies to fade away, but your body's T and B cells should still present a strong response to a virus.

Immunocompromised individuals need extra help building up enough long-term memory - as antibodies fade away, their T/B cells may not respond fast enough to fight off the virus.

In light of Delta, it appears that the body's antibodies and T/B cells are not quite fast enough to prevent infection in many people. But it is strong enough to prevent severe illness in nearly all. A booster appears to convince the body to build up an even stronger response to Delta which avoids any illness in most cases.

As an aside, I think there is still not enough data on the grey area between not-infected and severe-illness (hospitalized). With ~20% of infected, vaxxed individuals having symptoms lasting longer than 4-6 weeks, I am still personally concerned about getting covid and potentially suffering from long-lasting effects despite being vaxxed.

Related to your comments above. Found this after someone I know visited an infectious disease doctor (IDD) and had feedback regarding their antibody test (initially none at 3 wks and then some at 7 wks per my previous post ). The IDD mentioned there were other things in play that couldn't be tested.

Image below via this article: How Long Does COVID-19 Immunity Last? - GoodRx

 

[AlanSubie4Life]

It could be due to vaccine fade over time.

Most certainly there will be more breakthrough infections over time. If antibody titers go down over time, and they do, eventually people at the bottom of the distribution of titers will be more likely to get sick if exposed. It’s a certainty (but can be unrelated to immune escape). To some extent I do think this is happening now, but not sure how bad a problem it is except in the elderly/ill/compromised.

For whatever reason there is some indication that that breakthrough infections are becoming more common

They most certainly are! That would be expected for the number of infections we have now, even if the efficacy of the vaccine were completely unchanged. More infections means you will have more breakthroughs; there is no way around it - but that is not to say the rise in infections is due to breakthrough infections or lower efficacy, necessarily.

It may be due to testing error, ie people are labeled as breakthrough infections if they test positive even if their viral load is low and they have few, if any symptoms.

I know what you are saying and agree to an extent, but I would not call this a testing error. I agree: certainly this measure of efficacy is not what the vaccine trials were measuring. The goalposts have been moved, which might be a good thing, it may well be important to have very strong protection and a third dose might lead to very good longer-term immunity (no idea), though I think eventually waning will be a problem again.

The pool of vulnerable people is much smaller than last year, yet the hospitals are filling up faster.

Yeah but it’s a lot more contagious (high R0and high Rt) and this is how exponentials work with a high exponent! All you need to have is enough vulnerable people to get an Rt far enough above 1! And Rt is a lot higher in these areas than it was last time around. There are way too many vulnerable people still.

Even if we could get 100% of the population vaccinated, a high R0 virus vs a 90% effective vaccine, it will continue to exist in the population forever.

That would be an R0 of 10 to do that. Which delta is not. Delta is perhaps 5-7, higher than I ever thought it would be, but might be tractable. “5” is manageable. Note that Rt/Re is about 1.5 or lower right now, perhaps 2 in the worst locations (note these values take into account a standard assumption of generation time which is still the subject of some debate with delta, currently perhaps inconclusive). This is being accomplished by generally ripping through undervaccinated populations (30-40% rates in hard-hit age groups in hard-hit areas). So doubling vaccination rates there to 60-80% will mean no more spread (takes Rt to 0.7 or so). Technically that implies virus has R0 of 3.6 or so to get control at that level with a 90% effective vaccine, but this is all pretty squishy, due to natural immunity as well.

So I don’t even think we have to get to ridiculous levels of vaccination. I would settle for 80% in every age group and area (which is obviously difficult but not impossible with mandates). Though higher would be better. But at those levels hospital capacity would be a non-issue which is the main issue right now.

I recall reading that people develop antibodies in their mucus membranes after getting vaccinated

I don’t know the details on this but my understanding is that inhaled vaccines build mucosal immunity. I think you do have varying degrees of antibodies in the mucous membranes regardless. The article in the Atlantic from a few days ago (Masks and vaccines) covered the dynamics of this from an immunologist’s perspective.

I want to make it clear: I could be wrong about the escape characteristics of Delta beyond just waning. I just haven’t seen what I would need yet to change my mind. Observational studies could convince me eventually, but they are so hard to do. In the meantime, I am masking up and assuming I am not well protected. But in the back of my mind I still think I am (it’s only been 4 months since my second shot).

Remember: Moderna and Pfizer are both readying boosters, but are not concerned about vaccine escape at this time.

https://investors.modernatx.com/static-files/c43de312-8273-4394-9a58-a7fc7d5ed098

 

[JRP3]

How can you tell from that? I can’t tell from that info what the vaccine efficacy is in each age group, because the information on the vaccination status of each infection (grouped by age) is not given.

It’s also low N so numerically it is hard to draw a conclusion, but from that graph there’s literally no information to be gathered on efficacy.

True the numbers are small but if your premise was correct I'd expect to see higher percentages in the 60+ age range who got the vaccine first. Second graph shows percentage of infected with one or more vaccinations.

 

[AlanSubie4Life]

Second graph shows percentage of infected with one or more vaccinations.

I don’t believe it does. I believe it just shows the vaccinations (1 or more) in that age group as a % of all vaccinations. I have no idea what the white bar is, it's not labeled but looks the same as the other data.

There's no breakout by age & vaccination status. There is only a breakout by week with vaccination status.

So it is not possible to determine efficacy by age group AFAIK.

Obviously delta came in hard and heavy the last few weeks in Tompkins County, and affected a lot more vaccinated people than previously - but things have changed: in mid-May, the last time you could have sufficient infections to say one way or another, there were a lot fewer young people vaccinated (and also two weeks out from their second dose). And you can see that infections are now focused in that group 20-40 somewhat disproportionately - so you'd EXPECT to see more vaccinated cases (look at the vaccination rate for a county with ~100k residents!) - but again the numbers of cases here are so small overall they can be skewed by a single event or a few specific events with unusual vaccination profiles - there are going to be communities with 95% vaccination rates and others on the low side. If you're 95% vaccinated, most of the cases are going to be vaccinated individuals - especially with efficacy of "only" 85%.

Also, people are taking fewer precautions now than in May - that's going to reduce vaccine efficacy due to the change in viral dose vs. the trials!

Etc. Basically all the things Moderna mentions.

In any case there's definitely no way to determine the VE by age group here. The only thing I see is that the rates of cases in the old in the last 5 weeks are disproportionately high (but no idea of vaccination status!). However, the numbers are so low hard to say.

Again: Due to the strength of the assault of delta (again mentioned by Moderna), I wouldn't be surprised if efficacy against infection had dropped some, perhaps more than to the 85% or so that I think. But this is not the data we need to determine that. (And again, repeating, note this is not the same thing as immune escape.)

 

[Dave EV]

If you want to argue that we need higher antibody levels in the population to counter delta because of its higher contagiousness (because it’s a variant, but not because it’s an immune-escaping variant), just so we can do everything to bring the numbers down, I wouldn’t quibble with that. Maybe splitting hairs I guess, but I am just saying they are two separate issues with dramatically different impacts and strategies to counter them.

I don't think that anyone would argue that higher antibody / titers would help counter delta. In fact, that seems to be Moderna's argument for a booster in your subsequent post.

The question is how effective is this strategy? I suspect that for those who get the booster - quite effective. But just how many would get that booster? I suspect a fraction of those who have already received the vaccine, so overall, the effects would be quite limited.

As you said, the most effective strategy would be to get everyone vaccinated - but when that is not possible, what is next on the list?

We're currently stuck between a rock and a hard place right now with the number of people who refuse to get vaccinated. It seems that all we can do is to implement moderate social distancing measures and vaccinate all that are willing.

It's really too bad that the bulk of the anti-vax and anti-mask routine has turned political. Despite the fact that these same people are more than willing to wear a mask to hide their identity when they are performing illegal acts (see recent fights started by anti-vaxxers in Los Angeles this weekend).

 

[jerry33]

I don't think that anyone would argue that higher antibody / titers would help counter delta. In fact, that seems to be Moderna's argument for a booster in your subsequent post.

The question is how effective is this strategy? I suspect that for those who get the booster - quite effective. But just how many would get that booster? I suspect a fraction of those who have already received the vaccine, so overall, the effects would be quite limited.

As you said, the most effective strategy would be to get everyone vaccinated - but when that is not possible, what is next on the list?

We're currently stuck between a rock and a hard place right now with the number of people who refuse to get vaccinated. It seems that all we can do is to implement moderate social distancing measures and vaccinate all that are willing.

It's really too bad that the bulk of the anti-vax and anti-mask routine has turned political. Despite the fact that these same people are more than willing to wear a mask to hide their identity when they are performing illegal acts (see recent fights started by anti-vaxxers in Los Angeles this weekend).

I'd think it would be a large percentage of those already vaccinated just because there are so many who haven't been vaccinated that anyone who has been vaccinated will likely feel they need all the protection they can get.

 

[AlanSubie4Life]

Fortunately, it looks possible that we will see cases peak in the US this week. Now, kids returning to school could completely blow that up and lead to a secondary peak in a week or two…but hopefully we will see some overall declines this week (which will likely be composed of declines in some of the worst states with modest (or perhaps not so modest in some smaller population states) rise in some other states).

Haven’t seen hospitalizations peak yet but hopefully we’ll see that this week too. That seems more “certain” than a peak in cases - I think further case surges will likely he driven by children which won’t lead to enough hospitalizations to offset declines in other populations.

All massive guessing of course! I did expect a peak around now, or perhaps next week, so maybe it’s wishful thinking on my part. Rt is definitely dropping fast, which is good if it keeps up.

 

[ZeApelido]

Percentage of new cases that are ages under 17 spiking in California.

 

[dhanson865]

So my work (large corporation) now "requires vaccination to enter the office building". So I go to the corporate website page for covid response, it has my name, my bosses name, my employee number and asks with radio button Are you fully vaccinated. Then if you say yes it asks for a date of the last shot.

No request for a picture of the card, no other information requested, literally no proof given. I guess clicking yes and picking a date is enough for unvaccinated people to come into the office and infect people under the guise of being vaccinated.

Oh, I should mention masks are required in the office so there is that small provision, but that isn't much comfort if I'm face to face with a spreader pretending he's vaccinated.

 

[dhanson865]

Tennessee: More COVID-19 hospitalizations in August than any other month of pandemic

KNOXVILLE, Tenn. (WATE) – Tennessee Health Department Commissioner Dr. Lisa Piercey revealed Monday that the first half of August has seen more new COVID-19 hospitalizations in the state than…

www.wate.com

KNOXVILLE, Tenn. (WATE) – Tennessee Health Department Commissioner Dr. Lisa Piercey revealed Monday that the first half of August has seen more new COVID-19 hospitalizations in the state than any full month of the pandemic.

There have been 1,023 new hospitalizations in Tennessee in the first 15 days of August, more than any other full month of the pandemic. The next worst month for COVID-19 hospitalizations in the state was November, when new hospitalizations surpassed 900.