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Effectiveness of a Third Dose of mRNA Vaccines ...

"Summary
  • What is already known about this topic?
COVID-19 mRNA vaccine effectiveness (VE) in preventing COVID-19 might decline because of waning of vaccine-induced immunity or variant immune evasion.
  • What is added by this report?
VE was significantly higher among patients who received their second mRNA COVID-19 vaccine dose <180 days before medical encounters compared with those vaccinated ≥180 days earlier.
During both Delta- and Omicron-predominant periods, receipt of a third vaccine dose was highly effective at preventing COVID-19–associated emergency department and urgent care encounters (94% and 82%, respectively) and preventing COVID-19–associated hospitalizations (94% and 90%, respectively).
  • What are the implications for public health practice?
All unvaccinated persons should start vaccination as soon as possible. All adults who have received mRNA vaccines during their primary COVID-19 vaccination series should receive a third dose when eligible, and eligible persons should stay up to date with COVID-19 vaccinations.
 
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Thanks for the info on fluvoxamine. That was a relatively late discovery, and while I definitely knew already it was very helpful as a treatment, I was not aware that it actually reduced risk of hospitalization (looks like odds ratio of 0.5-0.9 or so) and death, which is great. On that one I was definitely wrong; I had not read the study. Good to know. My knowledge was old and those comments were based on my recollection of dexamethasone treatment.

Anyway: It seems that fluvoxamine would definitely be advised over HCQ, Ivermectin, Vitamin C. Which was my point! Unfortunately, I suspect people are not seeking it out urgently for early treatment due to the deafening arguments over Ivermectin and the other treatments which have been shown to have no statistically significant benefit, unlike fluvoxamine, which is well known in the medical profession to be an effective treatment.
...

The NIH's take on fluvoxamine, also referencing the TOGETHER study:

Fluvoxamine | COVID-19 Treatment Guidelines

"Recommendation
There is insufficient evidence for the COVID-19 Treatment Guidelines Panel (the Panel) to recommend either for or against the use of fluvoxamine for the treatment of COVID-19."
 
COVID-19 antibody drugs from Regeneron and Eli Lilly should no longer be used because they don’t work against the omicron variant that now accounts for nearly all U.S. infections, U.S. health regulators said Monday.

 
"“It makes no difference whether you get infected-and-then-vaccinated, or if you get vaccinated-and-then-a-breakthrough infection,” said co-senior author Fikadu Tafesse, Ph.D., assistant professor of molecular microbiology and immunology in the OHSU School of Medicine. “In either case, you will get a really, really robust immune response – amazingly high.”

It’s interesting that they found this because prior studies seemed to suggest a slight advantage of infection then vaccination (with obvious huge downside risk). But, the differences were quite small in prior studies and there were substantial improvements with either ordering.

Link to paper - it’s notable that they seem to be comparing against just two doses of vaccine, in general, as far as I can tell. Notable because I think (guessing!) the degree of super-immunity would be much less remarkable (though still present) when compared to boosted responses, which operates in a similar (though not identical) fashion.

For that group, previous research reveals a much more variable level of immune response than vaccination, Messer said.

Yes. One of the primary disadvantages of infection-acquired immunity.

Vaccination makes it much more likely to be assured of a good immune response.”
Yes.

I will stick with my own chosen path to natural super-immunity, through vaccination alone, even if I do not have nucleocapsid antibodies. Ready (and likely nearly eligible on a time basis at 4.5 months out) for my fourth dose! Want it to be Omicron specific, but it seems like that may be a pipe dream with how things work around here.
 
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Assuming one was boosted already, would one
1) get a fourth booster,
2) get infected for natural immunity, or
3) signup for one of the Omicron-specific booster studies
 
This article from last week is pretty much what I expected but it’s good to get confirmation….
TL;DR Reporter’s senior mom gets Covid, doctors refuse to prescribe anything without in-person appointment which can’t be scheduled in a timely manner, pharmacies with supplies hard to find.
Non-paywalled version: When My Mom Got Covid, I Went Searching for Pfizer’s Pills - TechiLive.in

These types of things (pill and monoclonal) worry me about traveling (IL->FL) in March with my immunocompromised wife (4th shot/booster last week) and we won't go unless her antibodies test comes back OK mid-Feb.
 
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Assuming one was boosted already, would one
1) get a fourth booster,
2) get infected for natural immunity, or
3) signup for one of the Omicron-specific booster studies
That Dr. Paul Offit. He seems fine, but perhaps he has not been following the news if he thinks that preventing serious illness is the only goal here. I don’t think a situation where nearly half the infections are vaccinated people (note they do make up a substantial majority of the population) occurring in an 8-week time period is ideal for economic function. It’s not good to have a situation where everyone can get sick at once, and severe disease prevention is not the only objective.

I thought we figured this out with boosters. Assuming the Omicron-specific version shows very high efficacy with a single dose, it cannot come soon enough, and it's unfortunate that Pfizer thinks they will be not be able to roll it out by the end of March due to FDA data requirements. There is still a huge portion of the population who could benefit and it will be much more likely to be beneficial against new variants, which are more likely to be similar to Omicron at this point (though not guaranteed).

Study structure:

The study will evaluate up to 1,420 participants across the three cohorts:

  • Cohort #1 (n = 615): Received two doses of the current Pfizer-BioNTech COVID-19 vaccine 90-180 days prior to enrollment; in the study, participants will receive one or two doses of the Omicron-based vaccine
  • Cohort #2 (n = 600): Received three doses of the current Pfizer-BioNTech COVID-19 vaccine 90-180 days prior to enrollment; in the study, participants will receive one dose of the current Pfizer-BioNTech COVID-19 vaccine or the Omicron-based vaccine
  • Cohort #3 (n=205): Vaccine-naïve participants will receive three doses of the Omicron-based vaccine

It sounds like if you were in cohort #2 you could not be guaranteed of the Omicron-based vaccine, so it's not ideal if you want that one.
 
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Wrong. And plenty of other examples if you Google it.

Isolated cases not a widespread issue.. Overall, the health system has held up pretty good and as vaccination numbers increase as also cases of natural immunity due to infection, severity of cases will keep dropping. At this point, this should be treated like the flu.
 
COVID-19 Omicron Variant: Implications of the Current Surge, Isolation Policies and the Efficacy of Vaccines and Medications

"COVID-19 Omicron Variant: Implications of the Current Surge, Isolation Policies and the Efficacy of Vaccines and Medications" by Drs. Eric Topol, Scripps Research Institute, La Jolla, CA and Bob Wachter, UCSF, San Francisco, CA.

It's an hour long. He talks about how he doesn't understand "speed the spread" which will cultivate more variants. He's also into the rapid tests saying while they aren't perfect they are important to determining when to stop quarantine. Stay in quarantine until 2 days past negative. He also talks about a 10 fold drop in viral load with Paxlovid as being a replacement for MCA and the standard treatment once supply issues are worked out. He also talks about schools and vaccines in children and how safe they are. Vaccines are the way to make schools safe. And a lot more.
 
Standard procedure for transplants is to be up on all vaccinations. This idiot won't do it and his family is crying about it.

 
Standard procedure for transplants is to be up on all vaccinations. This idiot won't do it and his family is crying about it.


This is correct. He's playing a political game.

Post-transplant, he MUST go on immuno-suppressive medications . . . for the rest of his life. It is STANDARD OF CARE to require all vaccinations be up to date to be on the transplant list, and even things you are supposed to get later in life (shingles, etc.) are sometimes given early.
 
Standard procedure for transplants is to be up on all vaccinations. This idiot won't do it and his family is crying about it.

And it's the Brigham. I'd take any and all vaccinations or anything else they required to get a transplant or anything else cardiac related there. As soon as this story came on the news yesterday about him being refused a heart transplant, before they even said why, my wife said "he's not vaccinated". These people are nuts.

Edit To clarify: The Brigham is Harvard Medical School's hospital. My wife once had a patient who visited Boston and had chest pain or something and was taken to the Brigham. She insisted they call her cardiologist (my wife) to arrange transport to my wife's hospital. My wife talked her out of that explaining to her she was in one of the best hospital's in the world for her care. The Brigham is almost always in the Top 10 for hospitals in the US especially for cardiology.
 
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Standard procedure for transplants is to be up on all vaccinations. This idiot won't do it and his family is crying about it.

I want to know why the father of the transplant candidate has a trach.
 
The data in San Diego is continuing to track at a similar ratio as it did a few weeks ago. We'll see how the deaths/hospitalizations panned out in the Omicron surge in a few weeks (basically have to ignore what you see in the gray area, though it does give a hint of what we'll see - but look at these plots from a three weeks ago to see how drawing conclusions from that gray area works over time - to me it seems like there's a bit of a delay on the vaccinated death/hospitalizations being reported so that gray area seems to look a bit better than it actually pans out).

But it sure would be nice if people got their boosters! They're incredibly effective against Omicron & Delta, thankfully. Note that these plots are NOT age standardized, so the data looks worse than it does in some municipalities that do this age adjustment (vaccinated group is older and more vulnerable so is expected to have worse outcomes):

Screen Shot 2022-01-26 at 11.40.33 AM.png
Screen Shot 2022-01-26 at 11.40.41 AM.png
Screen Shot 2022-01-26 at 11.40.51 AM.png


Look at those boosters and think of how the vaccinated/unvaccinated case/hospitalization split would look if everyone were boosted....

Screen Shot 2022-01-26 at 11.40.08 AM.png
 
Look at those boosters and think of how the vaccinated/unvaccinated case/hospitalization split would look if everyone were boosted....
Yeah, according to the COVID-19 Vaccine Dashboard (ArcGIS Dashboards) in San Diego 90% of people have had at least one dose, 80% are fully vaccinated and 50% of eligible people are boosted.

If everyone eligible were fully vaccinated / boosted, total hospitalizations would probably be cut in half, at least, and deaths nearly eliminated. Cases would be reduced probably be reduced by 30%, too - maybe more since more more you're vaccinated, the less likely you are to spread COVID.
 
Yeah, according to the COVID-19 Vaccine Dashboard (ArcGIS Dashboards) in San Diego 90% of people have had at least one dose, 80% are fully vaccinated and 50% of eligible people are boosted.
Likely the first dose numbers are high due to incorrect counting of second doses, no idea how much.

The 80% number doesn't align with their own spreadsheets, and I'm not sure why - totally different numerator (actual number may be 74%?).


As a border county, in general I worry about how many of the US citizens & others coming from Mexico to get vaccinated end up getting lumped in San Diego numbers.

Screen Shot 2022-01-27 at 1.43.47 PM.png



In any case, from the charts above, if everyone (including currently unvaccinated) were boosted (had gotten shots promptly), or recently fully vaccinated, I think the numbers would be even better than you suggest. I think cases might be at 30% of current levels without even accounting for reduced spread.

In any case, things would be way way better! Kind of changing the subject, but somewhat related: I'm not sure I fully comprehend why Denmark has it so bad, though. I thought they had good vaccination rates? (Haven't looked it up.)
 
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This individual needs to learn to refrain from making such comments regarding anything COVID-19.


He will not be silenced! FREEDUM!!!!

Dunning-Kruger, interesting example:


I’m not sure why he finds this odd. It’s only been a year, and I imagine things got a bit chaotic and backed up with a global pandemic and all. The obvious question is: how long is the delay, usually? I would guess at least 6-9 months. Why he is not asking that question? Seems pretty silly.

Maybe he should say: “Seems odd that Tesla still hasn’t released the 2022 Cybertruck?” (Normally you'd expect to see that in 2021.) Seems more relevant to his billions and might stop the bleeding there.
 
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This probably won't put this to rest, but very good article here that summarizes a new finding.

Basically it doesn't matter if you had COVID and then got vaccinated, or vice versa, but "Super Immunity" is determined by having had both (not just one):
 
This probably won't put this to rest, but very good article here that summarizes a new finding.

Basically it doesn't matter if you had COVID and then got vaccinated, or vice versa, but "Super Immunity" is determined by having had both (not just one):

Cannot read it…but:

I wonder how big the advantage really is over vaccination, especially vaccination/boosting with an updated (or different) spike. Obviously nucleocapsid antigens & antibodies are a big difference here, but people with infection-acquired immunity plus vaccination will in most cases have been exposed to more diversity of spike (B.1.1.7, Delta, etc. in addition to emulated wild type ) than those who have just been boosted, in addition to the nucleocapsid. Their other advantage is the delay between vaccination and infection or vice-versa (though less of a difference when comparing to boosted people), which we know matters for durability of immunity.

I’m not sure if there are other reasons why there would be anything special about infection-acquired immunity.

I’ll still take my super immunity (and natural!) through controlled vaccination (four doses if necessary) over infection any day. And seems likely the difference is not large, but too soon to say at the moment I think. No data.
 
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