Coronavirus

[golfcart]

So if someone shoots a mass murderer that's a bad thing?

This is a horrible analogy. This person murdered nobody. This person spread misinformation on social media while most likely believing she was spreading the truth.

Your take also implies that the people listening to this person have no agency or ability to search out other views which is nonsense. The reality is that the people who followed this person most likely did so because she reinforced their existing beliefs. If those people choose to act on those beliefs and do something stupid it’s on them. She’s not their boss or general or parent forcing them to do things. She’s just another dumbass on the internet.

I hear conspiracy theories all the time. 9/11 was an inside job, cops are out murdering black people with impunity on a daily basis, national and state elections were stolen, the world will end in… if we don’t do …, vaccines have microchips in them… it’s all (most likely based on the evidence) nonsense, and some of those beliefs indirectly lead to bad consequences when enough people hold them, but it doesn’t make the people holding those beliefs the same as murderers who go out and shoot people or blow up people.

Like I said, we’re all adults and you can post what you like, but out of all the things on the internet it is beyond me why someone would choose to post that in this thread. It took actual effort to do that and it adds nothing to the forum. That's the last I'm gonna say about this, no need to keep beating a dead horse.

 

[PACEMD]

But if we do choose to beat a dead horse can we at least blame the horse? And make fun of them? Or is that reserved for Twitter?

By the way, did the horse die from covid?

 

[CatB]

This probably isn’t news to any of you, but in a desperate attempt to get us back on topic:

https://www.washingtonpost.com/health/2022/04/29/covid-deaths-unvaccinated-boosters/

I am hoping “Your local epidemiologist” will chime in on whether/if/how we can take better care of elderly. it sounds like even if vaxed and boosted and double boosted, those of us caring for an elderly parent need to mask, social distance, avoid public gatherings, etc. indefinitely. And that elderly may have to get boosted quarterly?

 

[Yaroslav Fadee]

Covid is still exist? Now I even miss this kind of problem: where i can spend 1000 Zelenskiy' grivnas

 

[PACEMD]

But if we do choose to beat a dead horse can we at least blame the horse? And make fun of them? Or is that reserved for Twitter?

By the way, did the horse die from covid?

Nothing? Look, I realize this is what kept Dostoevsky up at night and what ultimately drove the Brothers Karamazov over the edge, but give it a look-see, if you will.........

 

[NikolaACDC]

Moderna seeks to be 1st with COVID shots for littlest kids

"Moderna is seeking to be the first to offer COVID-19 vaccine for the youngest American children, as it asked the Food and Drug Administration Thursday to clear low-dose shots for babies, toddlers and preschoolers.
...
Moderna said two kid doses were about 40% to 50% effective at preventing symptomatic COVID-19, not a home run but for many parents, any protection would be better than none.
...
Moderna’s vaccine isn’t the only one in the race. Pfizer is soon expected to announce if three of its even smaller-dose shots work for the littlest kids, months after the disappointing discovery that two doses weren’t quite strong enough.
...
If FDA clears vaccinations for the littlest, next the Centers for Disease Control and Prevention would have to recommend who needs them -- all tots or just those at higher risk from COVID-19.
...
The FDA will face some complex questions.
In a study of 6,700 kids ages 6 months through 5 years, two Moderna shots — each a quarter of the regular dose — triggered high levels of virus-fighting antibodies, the same amount proven to protect young adults, Burton said. There were no serious side effects, and the shots triggered fewer high fevers than other routine vaccinations.
But depending on how researchers measured, the vaccine proved at best about 51% effective at preventing COVID-19 cases in babies and toddlers and about 37% effective in the 2- to 5-year-olds. Burton blamed the omicron variant’s ability to partially evade vaccine immunity, noting that unboosted adults showed similarly less effectiveness against milder omicron infections. While no children became severely ill during the study, he said high antibody levels are a proxy for protection against more serious illness — and the company will test a child booster dose.
“That’s not totally out of the realm of what we would have expected,” said Dr. Bill Muller of Northwestern University, who helped with Moderna’s child studies. “Down the road I would anticipate it’s going to be a three-shot series.”

 

[AlanSubie4Life]

This probably isn’t news to any of you, but in a desperate attempt to get us back on topic:

https://www.washingtonpost.com/health/2022/04/29/covid-deaths-unvaccinated-boosters/

I am hoping “Your local epidemiologist” will chime in on whether/if/how we can take better care of elderly. it sounds like even if vaxed and boosted and double boosted, those of us caring for an elderly parent need to mask, social distance, avoid public gatherings, etc. indefinitely. And that elderly may have to get boosted quarterly?

Yep, the boosted vaccines continue to work spectacularly. I don’t really understand the slow walking of Omicron-specific vaccines (assuming they work) until the fall, though. Makes no sense, but not a surprise at this point. Apparently they didn’t have enough people in the trial for an endpoint in a reasonable timeframe? Bizarre.

In any case, yes this virus is no joke even if vaccinated and boosted, and especially if immunocompromised. Vaccines work amazingly well, but second boosters look like a good option for those at high risk.

It seems critical to wear an N95 mask properly indoors for the foreseeable future for those who are at high risk. If you live with someone compromised, perhaps the best option is to make your exposure risk approximately zero outside the home (through consistent N95 use), so you can remain unmasked around the vulnerable (personal choice of course).

Have to get those therapeutics in use too. This article reflects a lot of deaths from a time when they were not as readily available. Have to keep working on that and get them to where they are needed with minimal friction.

I’ve been wearing my P100 at work (with surgical strapped on to make it slightly less selfish) again, since we seem to have the virus circulating again, with cases and close contacts (don’t want to bring the virus home to my wife, plus I like my lungs the way they are - bonus is my appearance seems to encourage others to mask up).

 

[AlanSubie4Life]

Pfizer is soon expected to announce if three of its even smaller-dose shots work for the littlest kids, months after the disappointing discovery that two doses weren’t quite strong enough

Yeah looks like the decision on this will not come earlier than June, which is pretty frustrating for parents I would imagine. Hopefully the three-dose data will look great, as some expect (though low-dose shots could be a problem for Pfizer). Moderna is 1/4 the dose, so 25ug I guess, which you would think would be enough, but children are not just small adults. However, the efficacy numbers are about in line with what we expect, very similar to the vaccine efficacy in adults (~50%).

Hopefully the affinity maturation will work well in children and the booster will be what takes us to the point of excellent efficacy. It’s what I expect, but hard to know. And hopefully they’ll actually start checking Omicron boosters on children now (they won’t I assume, for “safety”).

 

[AlanSubie4Life]

Yep, looks like people need to get vaccinated & boosted. BA.4 and BA.5 look like they will be next up, but hopefully due to broader immunity in the US than SA, we’ll see better results. We will see. In any case we’ll likely see a lull in BA.2.12.1 (which comes with its own issues) before any surge of these variants. Hopefully we can start from an even lower point, for this potential wave. An updated vaccine would be nice too.

https://twitter.com/x/status/1520114020400787456

 

[bkp_duke]

Current boosters are not worth much to people already vaccinated, except for someone with underling disease.

I won't be getting a booster until they change it to account for the new strains.

 

[AlanSubie4Life]

Current boosters are not worth much to people already vaccinated, except for someone with underling disease.

I won't be getting a booster until they change it to account for the new strains.

Citation needed, for sure. Even after removing immunocompromised, the data cited earlier in this thread indicate a benefit of a booster to everyone, even those previously infected.

You said “not much benefit” which allows some wiggle room. But seems that it is about 5x better (overall). That’s more than not much.

If you were talking about the second booster…I guess TBD until we see how the targeted boosters do in studies, but probably better than existing boosters. Closer call on that one, but even for the healthy elderly, it still probably makes sense to go ahead.

 

[bkp_duke]

Pfzier's COVID-19 mRNA Booster Effectiveness Shot May Drop 3 Months In

New research finds the efficacy of Pfizer’s COVID vaccine is initially powerful, but wanes significantly after three months. Experts say the vaccine still provides key protection against severe disease.

www.healthline.com

Durability of BNT162b2 vaccine against hospital and emergency department admissions due to the omicron and delta variants in a large health system in the USA: a test-negative case–control study

Three doses of BNT162b2 conferred high protection against hospital and emergency department admission due to both the delta and omicron variants in the first 3 months after vaccination. However, 3 months after receipt of a third dose, waning was apparent against SARS-CoV-2 outcomes due to the...

www.thelancet.com

Boosters should NOT be dropping off that quickly. In the vaccine world, this means effectiveness has dropped so much you need to re-formulate.

AGAIN: we are boosting with the original S-protein sequence to protect against something that has now accumulated 2.5+ years of mutations. We don't do that with influenza, we boost against the latest sequence each year (4 of them, actually - that's why it's called a quadravalent vaccine). There is no logical reason to think boosting with an OUT OF DATE sequence will confer good immunity against the most recent strains.

This is where natural immunity will actually be better than vaccine boosted immunity. Those that have been naturally infected will have antibodies to FAR more than just the S-protein, and will fight off disease faster due to the broader array of antibodies that respond.



BTW, your pic of your N100 cracks me up. If you are not changing clothes and essentially scrubbing down before you get home (and in your car), then that mask isn't doing too much for you, not when the CV is going to reside and survive on your clothes, etc. because it is a fully aerosolized virus with a long half-time on surfaces. In the hospital, we ONLY use N100 when we are in a disposable bunny suit. Otherwise, we are fully aware it's kinda pointless to go into an environment laden with viral particles and only protect one part of our body.


But you do you.

 

[bkp_duke]

What data are you using to make this determination?

See post right above you. Recent study published in Lancet showing large drop in effectiveness of 3rd shot after just 3 months.

Also, from a virology standpoint, it makes sense. It's like trying to vaccinate for H1N1 influenza with a vaccine built against H3N2. There is enough antigenic drift that sure, there is SOME immunity, but it's not what it should be.


Let me put it another way - - - if we didn't have already approved vaccines, the effectiveness we are seeing from the boosters against the current strains would probably be considered by an FDA board to be inadequate for an emergency approval.

That's my professional opinion as a medical scientist. The epidemiologists I talk with are all rumbling stuff similar, and don't understand why boosters are not already being reformulated (we could have conspiracy theories about this, but that's what they are asking).

 

[JRP3]

If you are not changing clothes and essentially scrubbing down before you get home (and in your car), then that mask isn't doing too much for you, not when the CV is going to reside and survive on your clothes, etc. because it is a fully aerosolized virus with a long half-time on surfaces.

But how likely is it to become re-aerosolized from the clothing in significant enough volume to cause infection?

 

[bkp_duke]

But how likely is it to become re-aerosolized from the clothing in significant enough volume to cause infection?

Very. It doesn't have to be re-aerosolized to infect. How many times do most people touch a surface and then eventually touch a mucous membrane (lips, nose, etc.).

There is a reason that during the height of the first two waves that hospital staff and their families accounted for 1 in 7 infections. These are the people trained how to best use PPE, and even then they were still getting infected and/or carrying it home to their loved ones.

At this point, the R value is so high on this virus that just about everyone in the USA has had it to some degree or another. It's endemic, and that's what we want.

Populations, however, like China that either haven't been fully vaccinated (many there just got one shot), or because the vaccine they use sucks, are in for some pain. And if you think Americans are anti-vax . . . . oh should you hear what I hear from colleagues in SE Asia and what they think will cure COVID. This is an article that is almost a year old, but the points (sadly) are still valid:

Anti-vaccine disinformation undermining Southeast Asia’s virus response

People in some of the region’s Covid-19 hotspots like Indonesia, the Philippines and Malaysia are being swayed by the anti-vax movement.

www.scmp.com

 

[Dave EV]

See post right above you. Recent study published in Lancet showing large drop in effectiveness of 3rd shot after just 3 months.

At this point in the game, I still think that only looking at hospitalization and deaths is only looking at a small part of the big picture, which is why I asked the question (for the record, deleted the post because I saw you had just posted, and wanted to read that before responding). My reasoning is that there appears to be a lot of long COVID sufferers out there, with estimates out in the rough ballpark of 20% (1 in 5).

There's also the significant unknown of long-term side effects - it's looking like the youth hepatitis cases are related to previous COVID infections, for example.

So my question would be - how does a booster change your risk of contracting long-term COVID complications and how does that compare to the risk of getting a booster? The FDA/CDC has already approved a fourth shot for 50+ year olds 6+ months out from their last shot - that's pretty significant.

Let me put it another way - - - if we didn't have already approved vaccines, the effectiveness we are seeing from the boosters against the current strains would probably be considered by an FDA board to be inadequate for an emergency approval.

That's my professional opinion as a medical scientist. The epidemiologists I talk with are all rumbling stuff similar, and don't understand why boosters are not already being reformulated (we could have conspiracy theories about this, but that's what they are asking).

Wasn't the talk when when Pfizer and Moderna approved that it was amazing at just how good they were and that really they were looking for ~50% efficacy against symptomatic infection as the baseline? After all, the one-doze J&J was approved and it was significantly less effective and it's effectiveness also quickly waned.

As far as reformulated COVID vaccines - didn't Pfizer or Moderna try one and it was not significantly better than the original formulation? I have to assume that they're working on updated ones.

Omicron-targeted vaccines do no better than original jabs in early tests

Experiments in animals show that boosters customized for the fast-spreading COVID variant offer little advantage over standard jabs.

www.nature.com

 

[AlanSubie4Life]

we are boosting with the original S-protein sequence to protect against something that has now accumulated 2.5+ years of mutations.

We all know this. You are an immunologist but seem to be disagreeing with Shane Crotty, Kristian Andersen, etc, though. All posted earlier here extensively.

Does affinity maturation not exist in your mind?

Looks like we’ll have to wait until June to see whether Mr. Armchair over here, or you, are correct about booster vaccines for under 5 group. Mr. Armchair thinks it will look pretty decent (80% or so) with the old spike, you don’t, because “kids are not small adults.”

And no one is suggesting we should not retarget - that’s been discussed for months here with tons of posts. I don’t understand the delay - Pfizer claimed 100 days. They’re still not ready.

The question is does the first booster provide benefits. And it clearly does.

But you do you.

BTW, your pic of your N100 cracks me up.

You’ve had COVID, I haven’t. I’ll stick with my best practices. I still don’t know a single person, or have heard of any case, who has been demonstrated to be infected while wearing an N95. The P100 is just for extra assurance. Some day maybe I’ll find out with more certainty if it works (known exposure).

There is a reason that during the height of the first two waves that hospital staff and their families accounted for 1 in 7 infections.

You keep on dragging this one out. I don’t think it means what you think it means! (It’s much more likely for medical workers to be exposed because they tend to hang out with other medical workers…think about it!) It doesn’t mean they got infected while wearing PPE. If you can point to a study that proves that they did (and excludes the use of surgical masks of course)…that would be interesting. It would have to specifically separate and carefully study source of infections, etc. It is a study that could be done.

 

[AlanSubie4Life]

didn't Pfizer or Moderna try one and it was not significantly better than the original formulation? I have to assume that they're working on updated ones.

My understanding is the studies are still ongoing and the data have not been released.

The monkey models showed issues with the Omicron booster, but when using it as a first booster. Not the same situation, exactly. You wouldn’t necessarily expect to see much benefit when comparing differences when using it as the first booster, due to affinity maturation smoothing out the differences. For the second booster maybe you’d expect the same, but we simply haven’t seen any results yet. There is speculation that Omicron is less immunogenic (smoother spike?) which could be a reason, too.

 

[AlanSubie4Life]

At this point, the R value is so high on this virus that just about everyone in the USA has had it to some degree or another. It's endemic, and that's what we want.

The highest Rt we’ve seen so far has been about 3.5. That’s for Omicron - about the same as the initial Rt in a completely naive population in NY. And Omicron had a lot of immune escape.

It’s just not as contagious as you make it out to be (that is not to say it is not very contagious!), especially in a largely vaccinated population.

We have had plenty of close contacts in our entirely vaccinated and boosted population at work and the secondary attack rate is extremely low (I have not heard of a case of secondary transmission yet, though they may have happened…but they disclose every positive test to my knowledge, and the last 20-person close contact event had no ongoing transmission (it is possible it was not disclosed to them of course)). In any case it is not running wild, and informal polling indicates most people have NOT had diagnosed COVID at the office, so we’re apparently relying on boosters.

And…no…it’s not endemic yet. Getting close maybe, but doesn’t seem that way quite yet. A little lively on the infection numbers still. Maybe after the next couple waves?

 

[bkp_duke]

At this point in the game, I still think that only looking at hospitalization and deaths is only looking at a small part of the big picture, which is why I asked the question (for the record, deleted the post because I saw you had just posted, and wanted to read that before responding). My reasoning is that there appears to be a lot of long COVID sufferers out there, with estimates out in the rough ballpark of 20% (1 in 5).

There's also the significant unknown of long-term side effects - it's looking like the youth hepatitis cases are related to previous COVID infections, for example.

So my question would be - how does a booster change your risk of contracting long-term COVID complications and how does that compare to the risk of getting a booster? The FDA/CDC has already approved a fourth shot for 50+ year olds 6+ months out from their last shot - that's pretty significant.


Wasn't the talk when when Pfizer and Moderna approved that it was amazing at just how good they were and that really they were looking for ~50% efficacy against symptomatic infection as the baseline? After all, the one-doze J&J was approved and it was significantly less effective and it's effectiveness also quickly waned.

As far as reformulated COVID vaccines - didn't Pfizer or Moderna try one and it was not significantly better than the original formulation? I have to assume that they're working on updated ones.

Omicron-targeted vaccines do no better than original jabs in early tests

Experiments in animals show that boosters customized for the fast-spreading COVID variant offer little advantage over standard jabs.

www.nature.com

EXCELLENT questions - no one has this data that I'm aware of (how does a booster reduce long-COVID from the newer strains), but we do know that early on the 2 dose series greatly reduced this AGAINST THE ORIGINAL viral strain, that that part is the key to understanding here. Long-COVID is less prevalent in Delta, Omicron, and subsequent variants. There is rock-solid data that shows it has moved from a deep lung virus (think pneumonia) to more upper-respiratory, that the hospitalization and death rates have (expectedly) dropped along with that. This is simply part of the march from a pandemic to an endemic strain. I'm not saying were "there" yet, but we are certainly much better than we were compared to the first 2-3 waves.

So, with the latest strains being less and less deadly, the bar for vaccine efficacy goes up (as it does with all vaccines - there is literally a calculation for this, called NNT). So both vaccine effectiveness needs to go up along with side effects to go down. Side effects are already very low in the mRNA vaccines, so that's a great start there, but effectiveness dropping is the wrong direction when the death rate with each subsequent variant is lower. You have to "treat" more and more people to save one life or prevent one hospitalization (NNT = number needed to treat). This is the exact reason why a vaccine for the common cold has been so difficult - it needs to be DAMN GOOD because rarely anyone dies from the common cold. We are not at common cold, but we are marching along that spectrum (and it is a spectrum).

This is why the "sell" for additional boosters becomes much more difficult - those boosters are savings fewer and fewer lives with each round (both round of the vaccine, and round of the virus). Diminishing returns.


The above is also why a vaccine has not been approved for very young children. Death in this group is very rare. When you account for prevalence, it's lower than seasonal influenza. A good argument could be made for immunodeficient children getting vaccinated, but not the full population. Antibody studies have shown that most kids in the USA now have antibodies after the Delta and Omicron waves. And coincidently, we didn't see a raft of new infections in this group when mask mandates in schools were lifted, indicating that most of these kids were probably already exposed and/or fought off the infection with a minimum of sympoms.