Coronavirus

[Krugerrand]

Mom had her Pfizer booster on Wednesday. She had a more significant reaction than after her first two (1 virtually no reaction, 2 was red, swollen, painful at injection site); 3 whole arm down into her hand was red, swollen and painful. By Friday it felt significantly better.

She’s only one and we’ll see if a trend develops, but the booster may cause the most severity of (consistent?) side effects.

Adding: her long term facility (over 180 residents) still has had ZERO residents contract COVID. I just got an email that they are now mandating all healthcare providers, volunteers, staff be fully vaccinated or they will be put on leave with no pay.

 

[jerry33]

Whatever happened to achieving herd immunity ?

This one appears to be fairly simple. The vaccine take up is too low to achieve herd immunity, and "natural" herd immunity is a bit too ineffective (see Sweden's results).

 

[dhanson865]

Is the booster for this age group not needed or is it not useful ?

This is the one I was commenting on earlier. They should have recommended booster shots even if that would make a significant difference in immunity against symptomatic disease - not just base the decision on hospitalization.

Whatever happened to achieving herd immunity ?

Reaching ‘Herd Immunity’ Is Unlikely in the U.S., Experts Now Believe (Published 2021)

Widely circulating coronavirus variants and persistent hesitancy about vaccines will keep the goal out of reach. The virus is here to stay, but vaccinating the most vulnerable may be enough to restore normalcy.

www.nytimes.com

Now, more than half of adults in the United States have been inoculated with at least one dose of a vaccine. But daily vaccination rates are slipping, and there is widespread consensus among scientists and public health experts that the herd immunity threshold is not attainable — at least not in the foreseeable future, and perhaps not ever.

 

[Krugerrand]

Big gap between Pfizer, Moderna vaccines seen for preventing COVID hospitalizations

Moderna's COVID-19 vaccine does a significantly better job of preventing COVID-19 hospitalizations compared with Pfizer's shot.

www.latimes.com

Considering the horrific side effects I had and it taking a whole month to regain full stamina and energy levels that biscuit Moderna vaccine better have made me invincible!!!

 

[bkp_duke]

And is part of the equation the time between shots? Pfizer being only 3 weeks. So today, if a 14 year old girl is going to get the vaccine - obviously Pfizer - should she get the second in 3 weeks or wait until 4 weeks after?

I doubt it. Once the B cells are formed and producing antibodies, that's kinda the end of the train ride.

 

[bkp_duke]

I’m confused a bit. I just don’t understand exactly how this works.

My simplistic understanding is that since this is about hospitalization, it suggests an insufficient cell-mediated immune response generated by the first two doses of the vaccine.

At the same time, soon after two doses, the humoral response (antibody levels) was similar.

What specifically about the long delay before the third dose allows for a better cell-mediated response, bringing it on par with Moderna? And why is it sufficient to have a larger dose (Moderna) and get a good response after two doses?

What’s going on here that results in a highly protective immune response for Moderna? What specifically about the dose does this? - it doesn’t seem like more spike would necessarily do it.

My understanding is that this has little to do with serum antibody levels - those will always wane. Protection against severe disease has more to do with how well the body can rally T cells and the memory B cells, doesn’t it?

You allude to memory B cells above. Do you mean that the new dose will result in very high antibody levels (resulting in only a temporary boost in efficacy), or are you saying that somehow that cell-mediated response will be in better shape after the boost?

If it’s just the amount of mRNA that determines protection, that doesn’t make much sense - after the third dose it would be 90ug for Pfizer, compared to 200ug for Moderna (unless there are differing efficiencies in how well the cells take up and produce spike).

Based on your response I think this all must come down to the delay (affinity maturation) and not the dose, but I don’t really understand it.

No, you can't really make definitive assumptions about "cell mediated" responses between the two vaccines. Why? Because we haven't seen hard data about what exactly the Th-1 and Th-2 cell populations look like after COVID vaccination or natural immunity. These require far more complex assays to obtain (FACS-sorted cell assays, taken at EXACT time points in an immune response - and then you need multiple patients for the proper statistics, etc.). FACS sorting is nothing like a PCR or other "simple" assay. It's complicated research-grade work that is slow and requires some pretty sophisticated and expensive equipment.


If I were taking this to Vegas, I would bet that why Moderna is more effective is due to higher dosing. In theory, more mRNA = more cells transfected = more spike proteins formed = greater immune response = more prolonged antibody production = (possibly) more memory B cells (which are formed from the circulating pool of antibody-producing B cells). The population of memory B cells formed is complexly interdependent upon not just the initial B-cells that produce antibodies, but also how long the antigen sticks around and is presented to the B-cells, in the process that forms the memory B-cells, as well as what kind of T cells form, how long they stick around, what cytokines are present, etc.

Basically - higher dose = good for immune response (long and short), but the major downside is possible larger side-effects. We have enough reports out there that we are pretty confident that on that second Moderna shot, we're seeing on average a stronger side effect profile than we do with Pfizer. The benefit of this may be that the immune response appears to be lasting longer.

 

[AlanSubie4Life]

Whatever happened to achieving herd immunity ?

Practically speaking, assuming the FDA sticks to the basic recommendation of VRBPAC (and in fact the FDA is who recommended the exact phrasing of the recommendations), the booster will be available to anyone who wants it. It’s just not going to be recommended or ”approved” for those lower ages (except for the huge number of exceptions - so there is not an actual significant safety risk, with myocarditis in young males being the primary risk - which is far outweighed by the risk of COVID in the case of those with comorbidities or those with high occupational exposure risk).

No, you can't really make definitive assumptions about "cell mediated" responses between the two vaccines

I’m still not sure I completely believe the 77% number efficacy against hospitalization from the CDC study - it’s not consistent with a lot of other studies. But just assuming it is correct: I’ve read that prevention of hospitalization is mostly determined by the cell-mediated response (just listened to Prof. Shane Crotty mostly).

So that is why if this data were true it seems like the cell-mediated response for Pfizer is lacking. Would that not be the implication?

In theory, more mRNA = more cells transfected = more spike proteins formed = greater immune response = more prolonged antibody production = (possibly) more memory B cells (which are formed from the circulating pool of antibody-producing B cells).

Sure. So it seems like a larger dose could elicit a longer and stronger response as the mRNA gradually dissipates over a longer period.
However: then why would three doses of Pfizer be enough? It’s still less exposure and transcription than a single Moderna dose (assuming equal potency per mcg of course - which is just an assumption here).
That’s really the core point of my confusion.

It seems like maybe after a long delay the immune system is more organized and primed, so that delayed small dose may have a disproportionately strong and solidifying immune response…and maybe that’s all it is?

 

[bkp_duke]

Sure. So it seems like a larger dose could elicit a longer and stronger response as the mRNA gradually dissipates over a longer period.
However: then why would three doses of Pfizer be enough? It’s still less exposure and transcription than a single Moderna dose (assuming equal potency per mcg of course - which is just an assumption here).
That’s really the core point of my confusion.

It seems like maybe after a long delay the immune system is more organized and primed, so that delayed small dose may have a disproportionately strong and solidifying immune response…and maybe that’s all it is?

It doesn't work that way. It's the entire point of boosters. The 2nd immune response (the boost) is triggering expansion and reproduction of the memory cells.

Think of it this way: give 60 mg of Pfizer in one dose, or 30+30? The second is exponentially better.

Third dose will provide a boost similar to the 2nd dose, expanding the pool of memory B cells to produce B cells and antibodies, and when they go back to a "just memory B cell" pool, they will have a few more, better trained members of memory cells.


There are limits to this, however, with markedly diminishing returns as you keep going.

 

[AlanSubie4Life]

It doesn't work that way. It's the entire point of boosters. The 2nd immune response (the boost) is triggering expansion and reproduction of the memory cells.

Think of it this way: give 60 mg of Pfizer in one dose, or 30+30? The second is exponentially better.

Third dose will provide a boost similar to the 2nd dose, expanding the pool of memory B cells to produce B cells and antibodies, and when they go back to a "just memory B cell" pool, they will have a few more, better trained members of memory cells.


There are limits to this, however, with markedly diminishing returns as you keep going.

Sure. I get that there is a much bigger response to the second. But there was also a MUCH bigger response to Moderna’s second. So unless the exponential benefit/factor is even larger with such a long delay (from what I have heard, it is, to some extent), then Moderna still seems like it would come out ahead when compared to boosted (3x) Pfizer.

Anyway, I guess I understand these basic concepts, but still can’t get all the data to seem completely self-consistent.

In the end, it seems odd to me that Pfizer efficacy against hospitalization has dropped so much - in that single study. I just don’t understand why it would be that different - especially given the similar initial antibody titers (a proxy for strength of the immune response?).

 

[bkp_duke]

Antibody titers are only ONE marker of a robust immune response. Not the only (some would argue not the best marker), but they are the easiest marker to measure.

They also, generally, have a ceiling on production.

 

[cwerdna]

More people died in Alabama during 2020 than were born as Covid-19 deaths continue rising in the US | CNN

Alabama had more people die last year during the onset of the Covid-19 pandemic than births, a top health official said, as the US continues to grapple with rising coronavirus cases and deaths.

www.cnn.com

Alabama recorded more deaths than births in 2020, marking a first in state history

Alabama, which has been hit hard by the coronavirus pandemic, saw more deaths than births in 2020, marking the first time that the state’s population has shrunk.”Here in Alabama we…

thehill.com

CBS Texas - Breaking Local News, First Alert Weather & I-Team Investigations

Latest breaking news from CBS11 KTVT-TV | KTXA-TV.

dfw.cbslocal.com

 

[AlanSubie4Life]

Antibody titers are only ONE marker of a robust immune response. Not the only (some would argue not the best marker), but they are the easiest marker to measure.

They also, generally, have a ceiling on production.

Yes, though it sounded like titers after the third shot were 10x the peak prior level, so we had not reached that ceiling after dose two, I guess.

I'm content with accepting that there is some other marker of immune response that we're not seeing measured, and Moderna would look better on that measurement, possibly, if this hospitalization risk is real.

If the hospitalization risk increase is not real and there's just more breakthroughs for Pfizer, then I guess I'd expect that to happen with Moderna eventually, maybe in a few months.

I guess the CDC study only studied hospitalized patients, both those with COVID and those without COVID. I suppose if you're only looking at people who get hospitalized (even if they didn't get hospitalized for COVID), maybe it makes sense that the Moderna would give more of the "baseline" efficacy while Pfizer might drop off. It doesn't necessarily seem like a representative population, since the people who did not get COVID were hospitalized. Hard for me to even comprehend how that might work - are people who are hospitalized more likely to have lower efficacy for their vaccination, or higher breakthrough rates - I would guess yes, but it's hard to guess how big a factor it would be.

Worth noting also that the study group for Pfizer had 43% of the people in the South, while the Moderna group had 26% from the South. Overall, these groups are not similar, so I'm not sure what to make of these results.

 

[wdolson]

person I know that got Covid.

She got Pfizer in April/May (2 shots), got covid in Sept, died in Sept (within the last 12-24 hours).

would she have lived if she got Moderna instead, or if she got a booster of Pfizer (3rd shot), maybe, but she got what she got and that was the result.

Only the 2nd person I know that got covid and it was a breakthrough infection that ultimately was fatal.

I'm sorry to hear that. I'm curious, did she have any underlying conditions or was she generally healthy?

I would expect a booster would have helped.

 

[JRP3]

At least 7 anti vax radio hosts have died from covid. Conspiracy types think they were killed for telling the "truth".

 

[scottf200]

source: ft.com/covid19

It's nice they've managed to smooth out some of FLs data too. Still pretty horrendous in several states and countries.

 

[dhanson865]

I'm sorry to hear that. I'm curious, did she have any underlying conditions or was she generally healthy?

I would expect a booster would have helped.

She was 70, not the perfect picture of health but other than age I wouldn't have listed her has having any obvious comorbidities. She was a smoker. So two comorbidities (age and smoking).

She wasn't antimask but would forget to wear it at times. Entirely possible that if she wore the mask every time she went out she wouldn't have caught it.

 

[madodel]

At least 7 anti vax radio hosts have died from covid. Conspiracy types think they were killed for telling the "truth".

They died because they denied reality. Some media personalities may lie to people but they don't stop doing what protects themselves. These folks ignored that reality.

 

[bhzmark]

Rough situation there. I REALLY don't want the courts or gov involved in who takes or doesn't take a vaccine, as that sets a nasty precedent and puts us on a slippery slope for courts/gov to dictate other healthcare choices. As long as I can protect myself and my family (by being vaccinated), I don't care that much if someone else is not vaccinated. The VAST majority of those dying in hospitals right now of COVID (99%) are unvaccinated. For better or for worse, they made that choice and are living with the consequences.

Like that pediatrician, I would not want to get involved.

Why should the judge side with the stupid mother who was anti-vax? Then the government would be “involved in who takes or doesn’t take” the vax by interfering with the father’s right to provide medical care for his minor daughter. Here the pt was a minor, the parents were in a deadlock, the pediatrician wouldn’t break the tie, so the judge did. Going the other way would still be government interference — just supporting a stupid decision.

 

[madodel]

Masks Protect Schoolkids from COVID despite What Antiscience Politicians Claim

 

[eevee-fan]

Yahoo! Voices: A Texas restaurant owner threw out a family wearing masks who were trying to protect their immunocompromised son.

A Texas restaurant owner threw out a family wearing masks who were trying to protect their immunocompromised son

A masked family at a restaurant was told "this is political and I need you to take your mask off" by their waitress at the behest of a bar owner.

www.yahoo.com

Pu lic health needs to issue a big fine on that restaurant and the family should sue. The restaurant owner is obviously a moron..