Coronavirus

[EVCollies]

My wife had to do a TEE (TransEsophageal Echocardiogram) on an intubated COVID patient yesterday. Even though she is fully vaccinated she still triple masks. Again she says the patients in the ICU now are very sick and most will probably die. She doesn't have the statistics on them since she only reads the charts on those she has to do consults or procedures on. But it's getting grim again. Though still not many COVID cases in the hospital, just sicker people.

Same here, no decrease in hospitalizations, just steady increase of higher intensity illness.

got it, smallest needle I've encountered since I was kid.

Seems like TN is opened up quite broadly, I filled out a super long form, made an appointment, brought an essential worker document with me and some one with 0 special classifications of any kind got the vaccine while I was there, no prior appointment.

Vaccinations clinics are not enforcers, they rely on personal responsibility to define if they are eligible. Our system struggled with how to define who is eligible. We found no reliable method and chose personal responsibility.

I've been Pfizerized. Second shot is done with no side effects at all. I wish they'd made this vac card wallet size.

After the J&J, my friend posted she was Johnson'd last weekend.

For sure, but as they say, there are a few factors that make that result make sense:

1) Getting good antibody titers in plasma has been tough since natural infection leads to a sub-optimal response. And the timing has to be right.
2) Early use is key. (FDA has adjusted their guidance.) After damage to the body and the systems has occurred, which takes some time, it's probably of limited utility. (The virus multiplies quickly in the nose which is why presymptomatic/asymptomatic spread is such an issue, but it takes a good long time to damage the rest of the body.)
3) Fully vaccinated sera is way, way more neutralizing than natural infection. The really high titers probably make timing of collection less of an issue.

I guess we'll see. I assume someone will try this soon - I don't know whether it requires FDA approval to explore, especially if you take it from previously infected vaccinated folks.

Maybe horse serum?

 

[dhanson865]

Vaccinations clinics are not enforcers, they rely on personal responsibility to define if they are eligible. Our system struggled with how to define who is eligible. We found no reliable method and chose personal responsibility.

It wasn't that they didn't enforce it, it was that they specifically told her she didn't need to wait. See below for a timeline and further clarification.


When I made the appointment my county was on phase 2 of vaccinations which is filled with various classes of essential workers.

Things looked like this

I specifically went in as part of Phase 2 because I was too young to get in by age.

but when I got there the woman behind the table told my friend there she didn't need to wait for April 5th because it had opened up already

It still says this for the county in question

my friend told her she was waiting for april 5th and was just there waiting for me to finish but the woman taking the forms handed her a blank form and said it didn't matter what classification she was in, that they were giving shots to anybody. No reason to wait until April 5th like the website said.

So the person in question was under 45 but was given the vaccine right then and there because there is no shortage of supply apparently. This was around noon with a steady stream of people coming through before and after us. They weren't just giving it to her because it would go bad otherwise.

 

[scottf200]

1) Good past few days.
My remaining unvaccinated sibling did the J&J on Fri.
Our kid 2 received their 1st Pfizer Fri. (Kid 1 had their 1st already).
My wife and I were able to book both doses Sat at a near Walgreens for this coming week. 2nd does is scheduled 28 days later so we are assuming we are getting Moderna.

2) By chance, I was just listening to a short clip from Maddows show about monoclonal treatment and that it is available and 'free' for at risk patients. Just something to keep in the back of your mind for any friends/family/etc.

https://twitter.com/x/status/1375590724700360705

 

[KG M3]

My wife and I were able to book both doses Sat at a near Walgreens for this coming week. 2nd does is scheduled 28 days later so we are assuming we are getting Moderna.

Got our second dose yesterday at Walgreens. Their system automatically sets the second dose 28 days later. If you get J&J, they cancel the appointment. If you get Pfizer (we did) you can reschedule the second dose (starting on day 20) for 21 or more days after the first. We spent way too much time on their system figuring this out. . .

 

[Yuri_G]

Got our second dose yesterday at Walgreens. Their system automatically sets the second dose 28 days later. If you get J&J, they cancel the appointment. If you get Pfizer (we did) you can reschedule the second dose (starting on day 20) for 21 or more days after the first. We spent way too much time on their system figuring this out. . .

You can also schedule a second shot only with CVS if for some reason you can't get the second shot at the same provider that gave you the first. I was impressed with their setup. Fill all of your info out online, then in and out of the store in 20-30 minutes.

 

[rxlawdude]

You can also schedule a second shot only with CVS if for some reason you can't get the second shot at the same provider that gave you the first. I was impressed with their setup. Fill all of your info out online, then in and out of the store in 20-30 minutes.

Good point. While it is preferable to go to the same vaccination center used on the first dose (of the two-dose vaccines), the record card anticipates the second dose may be given by another provider.

The problem is, which vaccine was used for dose 1, and which vaccine does CVS offer? If you got Moderna for the first dose, the data supports getting the same for the second, and similarly for the Pfizer vaccine doses.

In theory, there shouldn't be much difference between the mRNA vaccines that crossing over could result in insufficient immune response, there are insufficient data to support this at this time.

 

[Yuri_G]

Good point. While it is preferable to go to the same vaccination center used on the first dose (of the two-dose vaccines), the record card anticipates the second dose may be given by another provider.

The problem is, which vaccine was used for dose 1, and which vaccine does CVS offer? If you got Moderna for the first dose, the data supports getting the same for the second, and similarly for the Pfizer vaccine doses.

In theory, there shouldn't be much difference between the mRNA vaccines that crossing over could result in insufficient immune response, there are insufficient data to support this at this time.

They have the option to choose which shot you received for the first dose when signing up.

 

[bkp_duke]

Good point. While it is preferable to go to the same vaccination center used on the first dose (of the two-dose vaccines), the record card anticipates the second dose may be given by another provider.

The problem is, which vaccine was used for dose 1, and which vaccine does CVS offer? If you got Moderna for the first dose, the data supports getting the same for the second, and similarly for the Pfizer vaccine doses.

In theory, there shouldn't be much difference between the mRNA vaccines that crossing over could result in insufficient immune response, there are insufficient data to support this at this time.

Actually, latest data indicates that you might (big if since it is prelim data) have better protection against the new variants if the second dose is not the same as the first.

In a related note, CDC has also issued guidance that if you had a reaction to the first Pfizer dose, they recommend you get J&J for the second dose (vs. no vaccine).

 

[rxlawdude]

Actually, latest data indicates that you might (big if since it is prelim data) have better protection against the new variants if the second dose is not the same as the first.

In a related note, CDC has also issued guidance that if you had a reaction to the first Pfizer dose, they recommend you get J&J for the second dose (vs. no vaccine).

The operative word is "might. That same word was used re chloroquine in the early days.

The recommendation for J&J after a severe reaction to the first mRNA vaccine makes sense because of very different mechanisms to generate immune responses; but a wholesale "use whatever for your second dose" is not supportable until further evidence is available. Obviously, the numbers of persons that do take the other mRNA vaccine is small, making any early findings more anecdotal than good science. Can We Mix and Match COVID-19 Vaccines? Experts Say Not Yet

 

[bkp_duke]

The operative word is "might. That same word was used re chloroquine in the early days.

The recommendation for J&J after a severe reaction to the first mRNA vaccine makes sense because of very different mechanisms to generate immune responses; but a wholesale "use whatever for your second dose" is not supportable until further evidence is available. Obviously, the numbers of persons that do take the other mRNA vaccine is small, making any early findings more anecdotal than good science. Can We Mix and Match COVID-19 Vaccines? Experts Say Not Yet

No, this is not like chloroquine recommendations, which was "based" upon very VERY iffy pseudo-science. Here is why. The moderna and pfizer vaccines do not encode proteins with the same structure, or even have exactly the same mRNA sequence (both have proprietary insertions to increase their immunogenicity). We do know, for fact, from the antibody studies conducted in the past 3 months that the antibodies produced by the different vaccines produce different epitope-specific antibody sub-types, and it is very likely (would bet my Ph.D. on it) why the Pfizer vaccine has been shown to have more neutralizing antibodies to some of the new variants than the Moderna vaccine.

Using a second dose from a different vaccine (with a proven good track record) would prime your immune system to have a wider repertoire of antibodies saved up under their respective memory B cells, and thereby prime any subsequent reaction to neutralize a SARS-CoV-2 with a greater array of neutralizing antibodies.

For the lay person, it's like shooting a target with a shotgun vs. a rifle. Assuming what one wants to do is hit the target as much as possible, not just one time.

 

[EVCollies]

You can also schedule a second shot only with CVS if for some reason you can't get the second shot at the same provider that gave you the first. I was impressed with their setup. Fill all of your info out online, then in and out of the store in 20-30 minutes.

Agree, very impressed with CVS. My SO was given a left over Pfizer dose at a mass vaccine clinic I was volunteering. Three weeks later that clinic was canceled leaving her a "vaccine orphan". The CVS website opens up slots at 4AM Mountain time every day and she was able to get a dose just a few days late. Both my daughter, a food service worker, and sister in law were able to secure Pfizer doses by booking very early in the morning on CVS. No luck on King Soopers or Albertsons, all of their slots required the second dose to be scheduled which was impossible as they don't schedule more than 28 days out...

 

[TespaceX]

No, this is not like chloroquine recommendations, which was "based" upon very VERY iffy pseudo-science. Here is why. The moderna and pfizer vaccines do not encode proteins with the same structure, or even have exactly the same mRNA sequence (both have proprietary insertions to increase their immunogenicity). We do know, for fact, from the antibody studies conducted in the past 3 months that the antibodies produced by the different vaccines produce different epitope-specific antibody sub-types, and it is very likely (would bet my Ph.D. on it) why the Pfizer vaccine has been shown to have more neutralizing antibodies to some of the new variants than the Moderna vaccine.

Using a second dose from a different vaccine (with a proven good track record) would prime your immune system to have a wider repertoire of antibodies saved up under their respective memory B cells, and thereby prime any subsequent reaction to neutralize a SARS-CoV-2 with a greater array of neutralizing antibodies.

For the lay person, it's like shooting a target with a shotgun vs. a rifle. Assuming what one wants to do is hit the target as much as possible, not just one time.

By that logic, when vaccine supplies outnumber demand, should people who got J&J get Pfizer or Moderna?
CDC suggests people who had a reaction to Pfizer/Moderna get J&J, but how about the reverse (for broader protection)?

 

[bkp_duke]

By that logic, when vaccine supplies outnumber demand, should people who got J&J get Pfizer or Moderna?
CDC suggests people who had a reaction to Pfizer/Moderna get J&J, but how about the reverse (for broader protection)?

Assuming all vaccines have "equal efficacy" then yes, you would want a second, different vaccine. But because the mRNA vaccines are so much better than all the others in terms of efficacy, my unofficial recommendation would be to pair those two if all possible. The J&J does have a "close third" status of efficacy, so it could be grouped in with Moderna and Pfizer.

I will state, straight up, this needs more research, and this is my own professional opinion based on theory and the limited antibody data we have to date. It's something we should tease out more to know exactly. But in the past, these kinds of "what if" questions about vaccines are luxuries we have not had the opportunity to explore with other viruses.

 

[dhanson865]

Day 4 since injection and my arm is still sore. Getting better every day but I skipped my normal weight lifting Friday because of it. Going to try a light workout tonight and see how it goes.

 

[jerry33]

Day 4 since injection and my arm is still sore. Getting better every day but I skipped my normal weight lifting Friday because of it. Going to try a light workout tonight and see how it goes.

This happened to me, it took a few weeks to go away, but it only hurt when I touched it. The second one hurt without touching for a couple of days but had no pain at all after a few days. Neither caused pain when rowing (50-60 minutes per session). (Moderna). Two shots, two arms.

 

[JRP3]

I had two days of noticeable but not terribly distracting pain and so far another two days of pain if I press on the area. First shot. A friend said his pain was bad enough that he had to take naproxin to dull it enough so he could sleep.

 

[uujjj2]

Mr. Uujjj finally got the 1st shot. Pfizer. The injection site was sore for a day.

So the news is that 1 shot of Pfizer/Moderna is actually slightly better than 1 shot of J&J. I wonder if, at some point, people who got J&J will be offered a second shot or a single shot of Pfizer/Moderna as a booster.

 

[TespaceX]

So the news is that 1 shot of Pfizer/Moderna is actually slightly better than 1 shot of J&J.

Some important notes about that CDC vaccine news:

Among the 3,950 participants in the study...
The majority of the participants were female, white and had no chronic medical conditions, according to the CDC.

The study had limitations, the CDC said, adding that delays in shipments (of tests) could reduce the sensitivity of virus detection of Covid-19 tests.

They basically tested a small population of likely the healthiest people eligible for a vaccine.
White, likely higher income, female, no health condition. I highly doubt those results would apply to the general population.

 

[TespaceX]

On the topic of Moderna versus Pfizer, a recent study among pregnant women showed those receiving Moderna had higher S- and RBD-specific IgA response. The study mentioned one possibility for this could be the longer delay until the 2nd shot.
DEFINE_ME

 

[Jeff N]

No, this is not like chloroquine recommendations, which was "based" upon very VERY iffy pseudo-science.

The idea that (hydro)chloroquine would inhibit SARS-Cov-2 infection was initially based on real science. Lab tests showed it could actually work based on Vero (Green Monkey Kidney) cells. Unfortunately, the virus infects lung cells using a path not inhibited by Chloroquine.

Chloroquine does not inhibit infection of human lung cells with SARS-CoV-2 - Nature

Expression of TMPRSS2—a protease that activates SARS-CoV-2 for entry into cells—renders SARS-CoV-2 insensitive to chloroquine.

www.nature.com

Do you have a good handy reference to the differences between the Pfizer and Moderna genetic or protein sequence?