Covid-19 News/Discussion

[ramssuperbowl99]

8 minutes ago, Danger said:

This I grant you is still relatively up in the air. I've seen a wide variety of estimates that say boosters will be needed as soon as 5 months, others saying only people at risk need them.

I would assume the 5 month estimate comes from roughly a 28 day half-life for antibodies, and a 5 half-life period for complete clearance. That's back of the napkin stuff, and would prevent people from ever really getting sick at all with it, instead of providing protection against serious disease.

It really comes down to our goal. And I wish there was more transparency on that.

[Danger]

1 minute ago, Deadpulse said:

unvaccinated its 1 in 8 of getting it and 1 in 63 of dying from it. 

You'd be correct. I strongly recommend anyone who wants the vaccine to get it, especially if you're an individual who's in a high risk category.

Also for what it's worth just looking at this delta spike peaks it seems to be a bit closer to 1/90, but over the entirety of the pandemic, yeah 1/63 is accurate.

[Danger]

2 minutes ago, ramssuperbowl99 said:

I would assume the 5 month estimate comes from roughly a 28 day half-life for antibodies, and a 5 half-life period for complete clearance. That's back of the napkin stuff, and would prevent people from ever really getting sick at all with it, instead of providing protection against serious disease.

It really comes down to our goal. And I wish there was more transparency on that.

Frankly, my expectation with this ever since they started discussing the variants back in like May is that it's basically just going to be like a worse Flu. There'll end up being a different shot annually because the thing will continuously change. 

[ramssuperbowl99]

9 minutes ago, Danger said:

Frankly, my expectation with this ever since they started discussing the variants back in like May is that it's basically just going to be like a worse Flu. There'll end up being a different shot annually because the thing will continuously change. 

I get that, but it should be coming centrally.

The original goal was herd immunity/70% national vaccination rate. Obviously, that's not happening. So what is the goal with a booster? We should start there, and design the rest of the plan with the goal in mind.

[Shanedorf]

1 hour ago, Danger said:

First this vaccine isn't a sterilizing vaccine like the ones we're traditionally used to for thinks like mumps, polio, or small pox. It inhibits the disease from damaging us and reproducing as much as it otherwise would. The CDC changed the definition of "Vaccination" very slightly to reflect this and you can see it via the waybackmachine. 

Before: Vaccination: The act of introducing a vaccine into the body to produce immunity to a specific disease.
After: Vaccination: The act of introducing a vaccine into the body to produce protection from a specific disease.

It's still an effective vaccine, but it still doesn't work as we have traditionally come to expect of vaccines.

Thanks for the info, greatly appreciated.

A part of that change from "immunity" to "protection" is due to COVID being a respiratory virus. So in order for a COVID vaccine to be sterilizing and prevent transmission - we have to develop an IgA response- because those are the antibodies that line our mouth/nose/airway/lungs.

The current vaccines create immunity via an IgG response in the bloodstream - so they don't attack until after the virus has penetrated/infected some cells.
Then the IgG antibody identifies the COVID virus and takes em out. I don't know much about vaccines/ mucosal ( IgA) immunity, I just know that's one of the big challenges with COVID vs other diseases.
 

1 hour ago, Danger said:

The other cause for concern is waning vaccine efficacy. This I grant you is still relatively up in the air. I've seen a wide variety of estimates that say boosters will be needed as soon as 5 months, others saying only people at risk need them. As well as studies from Israel that suggest it does fall off over time.

When you say waning efficacy, does that mean that the antibody concentration drops, or does that mean that antibody effectiveness drops ?

I haven't looked into any of that, so curious if you've come across anything

Edited September 28, 2021 by Shanedorf

[Deadpulse]

2 hours ago, ET80 said:

@Kirill - really good reading here. If you're interested in learning more, @Shanedorf and @ramssuperbowl99 are your best sources of information you'll find on this site.

and read my posts if you want to see thinly veiled insults peppered among stupidity busting repartee and links that still somehow goes over all my sparing partners' heads.  

[ET80]

7 hours ago, Deadpulse said:

and read my posts if you want to see thinly veiled insults peppered among stupidity busting repartee and links that still somehow goes over all my sparing partners' heads.  

...but that would involve actually READING your posts.

[ET80]

7 hours ago, Shanedorf said:

A part of that change from "immunity" to "protection" is due to COVID being a respiratory virus. So in order for a COVID vaccine to be sterilizing and prevent transmission - we have to develop an IgA response- because those are the antibodies that line our mouth/nose/airway/lungs

Sort of in line with this - isn't this why there's a discussion on an inhaler-based solution? I vaguely remember hearing something like this, a nose spray-type of vaccine or medicine would be the best option.

What say you?

[WizeGuy]

 

15 hours ago, Danger said:

Only a few more weeks until the seasonal spike starts to occur again. 

Tbh, here in upstate NY- the spike started in late July. We were down to .5% positivity rate at the end of June, then cases started increasing exponentially. I saw this playout before. Once cases start to climb rapidly- there's really no stopping it (outside of extreme mitigation efforts by the gov't)- not even seasonality can slow the beast at that point.

We went from 2% positive at the end of July to 4.5% positive at the end of August. We seemed destined to get curb stomped again. We were the most open we've ever been. Mask usage dropped to about 50% of our population wearing them. Bars are packed wall to wall. With Delta- that's all this virus needs when it already has a strong prevalence in the community. Another surge was destined, but then something strange happened...cases plateaued. Since the beginning of Sept. we've been stuck around 4% positive. Hospitalizations have plateaued as well. 

Vaccinations have really slowed the beast to the point it LOOKS like we may be turning it endemic in my area. we're closing in on 65% of the entire population fully vaxxed, and 75% of adults fully vaxxed (nearly 80% with one dose). The vaccines not only have kept people out of the hospital- but they mitigate transmission as well. As a community become more highly vaccinated- the steam slowly gets taken out of the beast.

As a healthcare worker who has worked a COVID ICU- I am so grateful for vaccines. As of now- they saved our *****. I can't say for sure what's going to happen this winter, but I assume we'll be over 70% of our total population fully vaxxed as we enter into the holiday season, which is when things turned really bad last year. That's going to do a lot to prevent hospitalizations and mitigate transmission. 

So, I guess what I'm saying is- the northeast is lucky to have higher vaxx rates than the rest of the country, and I think that will do a lot to diminish the burden this virus puts on a community. Of course, there are low vaxxed states in the north, too, and even highly vaxxed states have lowly vaxxed areas, so those communities will feel that burden again. Fingers crossed the vaccines hold the fort down for those highly vaxxed areas, though. 

[WizeGuy]

12 hours ago, ramssuperbowl99 said:

I would assume the 5 month estimate comes from roughly a 28 day half-life for antibodies, and a 5 half-life period for complete clearance. That's back of the napkin stuff, and would prevent people from ever really getting sick at all with it, instead of providing protection against serious disease.

It really comes down to our goal. And I wish there was more transparency on that.

Yup.

Do you want to reduce your chances of even getting infected? Then a booster around 6 months may be for you.

If you're content with the possibility of catching COVID rising, but even if you do get infected your chances of having a symptomatic case are reduced and if you do have symptoms they would likely range from the common cold to the flu. If you're content with that, then a booster may not be right for you.

I think that should be the messaging. Recommend for those at-risk, but offer it to the general public with a very clear explanation that these booster will really only provide that ultra protection against infection for the short term, and that the vaccines still seem very effective against symptomatic disease. 

I took the booster since I'm a healthcare worker around very sick patients and have a son who is yet to be vaccinated. If I didn't have those two variables at play- I'm not sure I would've got the booster shot since I'm a 33 year old with a healthy immune system, so I assume my memory cells are primed to curb stomp COVID quickly. 

Part of me would like more knowledge around long COVID as well, but that's going to take time, and what defines long COVID is also very murky. 

I see why people would rather take the booster over catching COVID, though catching COVID after two doses of the vaccine may provide you the best possible protection. Not that I recommend that!

 

Edited September 28, 2021 by WizeGuy

[Shanedorf]

3 hours ago, ET80 said:

Sort of in line with this - isn't this why there's a discussion on an inhaler-based solution? I vaguely remember hearing something like this, a nose spray-type of vaccine or medicine would be the best option.

What say you?

In theory that's a big winner and its been studied extensively in HIV- because preventing viral transmission at the mucosal level would be a godsend. But like most things in medicine, there are immense challenges that we have to learn how to overcome and that's been the case with COVID/ inhaled vaccines too.
The good news is that the initial studies showed that IF you dose the lungs with vaccine via an inhaler- you get an immune response in the mucosa AND in the bloodstream- so that's a huge winner if they can overcome the challenges

Danger mentioned earlier that COVID may become like the flu - where you get a shot each year to handle the new variants- but if they can develop the inhaler or nebulizer, that's even better than asking people to get a shot. The flip side is that they'd have to develop it as a single dose inhaler- otherwise people would be hitting the vaccine inhaler all day long while they watch the latest outbreak news. ( !)

The inhaler is also touted as a means of getting therapeutic drugs deep into the lungs as well- and those studies are ongoing across several therapeutics. Route of administration is super important and in some ways, that was the biggest challenge with Remdesivir - it had to be given IV and that's just not a great solution for dosing millions people

 

[ramssuperbowl99]

3 hours ago, ET80 said:

Sort of in line with this - isn't this why there's a discussion on an inhaler-based solution? I vaguely remember hearing something like this, a nose spray-type of vaccine or medicine would be the best option.

What say you?

https://www.science.org/doi/full/10.1126/scitranslmed.abh0755

Quote

Protection conferred by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines may be influenced by the route of immunization. As SARS-CoV-2 is a respiratory pathogen, vaccinating intranasally may provide enhanced protection within the respiratory tract. To investigate this possibility, van Doremalen et al. vaccinated hamsters and rhesus macaques intranasally with ChAdOx1 nCoV-19/AZD1222, an adenovirus-vectored vaccine in clinical use. In both models, intranasal vaccination reduced viral shedding after SARS-CoV-2 challenge relative to control animals. In hamsters, intranasal vaccination generated increased neutralizing antibody titers as compared to intramuscular vaccination, although both routes were effective at reducing viral loads. Together, these data support further investigation into intranasal vaccination with ChAdOx1 nCoV-19/AZD1222.

 

We're trying, with some good news so far.

 

Some more general context: inhalation exposure is really difficult to get right. First, we've got to make an aerosol version. That doesn't work for every drug, so sometimes it's just a no-go. But even if we cross that hurdle, think of all the differences between how people breathe - depth, how long they hold it, lung capacity differences, etc. That all impacts the dose. Of course, there's good news too: if you have an active site on the lungs and you breathe it right into the lungs, you don't have to deal with the stomach/intestines/liver all chewing up your drug or stopping it from getting absorbed before it does the thing we need it to do. 

So there are drugs that fit this perfectly, like an inhaler for asthma. It's safe with a huge window between the therapeutic dose and the toxic dose (About 10-fold per here:  https://pubmed.ncbi.nlm.nih.gov/12117040/ ), so we can make sure that with good breathing techniques everybody is getting the dose they need without putting sensitive people at risk. But it's a specific type of profile that's going to fit.

 

For this vaccine, it's a big salty brick of RNA, so logistically I'm not sure how you'd go about it without breaking the RNA strand up, but there are some really smart people at AZ who figured it out. Then it's a matter of making sure we get the dose right - with the Pfizer vaccine they tried 50/100/200 ug (IIRC), so we had about a 4-fold range on the dose for an injection, and there were more pronounced side effects in the 200 ug group than in the others. That makes me a smidge nervous in terms of the window, assuming we'd see a similarly tight window following nasal dosing, but even more generally, if the inhalation side effect reports were really bad for a small percentage, that might dissuade more people compared to the relative boost in convenience from the inhalation versus injection.

So I think I'm in "wait and see" mode personally, but the early signs are encouraging.

 

Edited September 28, 2021 by ramssuperbowl99

[Danger]

 

https://www.bbc.com/news/uk-wales-58680204

 

Call it anecdotal, but I think being skeptical moving forward, isn't unfounded. But that doesn't really show the efficacy all in all. This one better represents how things are going all in all.

~50% reduction in the elderly, about 72% reduction in younger individuals. With that in mind, it's not quite at the rates we are informed of in terms of reduction. So that makes me wonder, is it an isolated incident? Is it waning efficacy? Is it the delta variant specifically? I believe that something is going to break down in the next 3-4 months frankly.

[ramssuperbowl99]

9 minutes ago, Danger said:

~50% reduction in the elderly, about 72% reduction in younger individuals. With that in mind, it's not quite at the rates we are informed of in terms of reduction. So that makes me wonder, is it an isolated incident? Is it waning efficacy? Is it the delta variant specifically? I believe that something is going to break down in the next 3-4 months frankly.

This is interesting. To add a bit more:

https://ourworldindata.org/covid-vaccinations?country=GBR

 

Looks like it's more Pfizer than Moderna, but mostly the 2 dose versions where we'd expect better performance.

 

To me, this comes down to a snapshot in time. Here's the vaccination rates:

 

And here's the new cases:

 

 

The bulk of the vaccination occured a few months before the bulk of the infection, so we're seeing the antibody protection wane from those who have been vaccinated (with hopefully long term protection still, though definitely less of that than we all hoped based on hospitalizations), while people who have been already infected but survived will still have that protection.

 

I think the more data that comes out like this, the more we need to have the discussion in terms of optional boosters. @WizeGuyhit the nail on the head:

51 minutes ago, WizeGuy said:

I think that should be the messaging. Recommend for those at-risk, but offer it to the general public with a very clear explanation that these booster will really only provide that ultra protection against infection for the short term, and that the vaccines still seem very effective against symptomatic disease. 

 

[Danger]

4 minutes ago, ramssuperbowl99 said:

The bulk of the vaccination occured a few months before the bulk of the infection, so we're seeing the antibody protection wane from those who have been vaccinated (with hopefully long term protection still, though definitely less of that than we all hoped based on hospitalizations), while people who have been already infected but survived will still have that protection.

 

I think the more data that comes out like this, the more we need to have the discussion in terms of optional boosters. @WizeGuyhit the nail on the head:

55 minutes ago, WizeGuy said:

I think that should be the messaging. Recommend for those at-risk, but offer it to the general public with a very clear explanation that these booster will really only provide that ultra protection against infection for the short term, and that the vaccines still seem very effective against symptomatic disease. 

 

Agree for sure. This winter should really teach us a lot about how things are going to look long term.