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CR: COVID-19 --Political Talk


Mrs Whiggins

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31 minutes ago, Snake Diggity said:

That chart to me says one dose is effective after 14 days.  Am I reading it wrong?

Looks like separation around day 12, with increasing effectiveness to day 21 and beyond. 

Unfortunately neither company did a single dose arm in their trial.  That being said there is some data from the MRNA study that suggests ~80% effectiveness with one dose, and real world data coming out of Israel and UK suggest a range of effectiveness after PFE first dose.  The UK data is notable since they took the public health approach of extending the dosing interval to get more first dose shots in arms. Which is what the doctor appears to be suggesting here. It was hashed out here earlier, but the models suggest that the optimized approach is to get as many first doses in arms and circle back with second doses as supply constraints are addressed.  The problem that Bean rightly points out, is that such an approach requires a coherent public health policy and consistent messaging.  Not things we really excel at on this side of the pond.  That, and the approach is not without it's own set of unknowns and risks (variant breakout). 

 

Two things that I think we should have been more open to to stretch first wave of vaccine administration:

1. Extended dosing interval while supply chain caught up.

2. Single dose administration for people with prior confirmed COVID infection.     

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The numbers I recall much of that debate hinging on were related to the notion that a first dose was 50% effective, and a second dose bumped this another 40%.  In that world, a 2nd dose isn't all that much less effective than a new 1st dose.

BUT, I don't know if that claim was true.  The Pfizer chart seems to indicate a 1st dose is better than 50% effective, if I'm reading it right.  I'd like to see the Moderna version, given that I received Moderna dose 1 about 10 days ago.  #selfish

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41 minutes ago, jimmyjazz said:

BUT, I don't know if that claim was true.  The Pfizer chart seems to indicate a 1st dose is better than 50% effective, if I'm reading it right.  I'd like to see the Moderna version, given that I received Moderna dose 1 about 10 days ago.  #selfish

From their filing:

Screenshot-2021-03-18-125341.jpg

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1 hour ago, 4th&Five said:

 

We should put out a call for all people of all ages in red states.  If they want the vaccine, give em 2-3 weeks.  If they don't, their vaccines get shipped overseas.  Or something, I don't know, but fuck the people who don't want a vaccine because they are morons.

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31 minutes ago, Anastasis said:

From their filing:

Screenshot-2021-03-18-125341.jpg

Yeah, that's the kind of detail that is important.  "We're reasonably confident through 28 days; after that, who knows?"

OK, maybe that's not a strict interpretation, but it's probably not all that far off, and it's exactly the kind of technical subtlety that gets left out when the rumor game starts.

Thanks!

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17 minutes ago, Biff Tannen said:

So I'm fully vaccinated.  Technically will be fully effective in 12 days, but whatever.  I've been wearing a mask in indoor public spaces for over a year.  It's normal now.  I have no problem doing it for another few months until we get enough people vaccinated.  What is really the problem?  Why are people such fucking babies?  "Oh noes!  I can't take another minute of this horrid piece of cloth over my nose and mouth!  FREEDOM!!!!"

We are the dumbest fucking species.

I think you answered your own question(s)

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43 minutes ago, Biff Tannen said:

So I'm fully vaccinated.  Technically will be fully effective in 12 days, but whatever.  I've been wearing a mask in indoor public spaces for over a year.  It's normal now.  I have no problem doing it for another few months until we get enough people vaccinated.  What is really the problem?  Why are people such fucking babies?  "Oh noes!  I can't take another minute of this horrid piece of cloth over my nose and mouth!  FREEDOM!!!!"

We are the dumbest fucking species.

unless you want to pin your vaccination record to your chest, wear a fucking mask, because we are part of a society. 

so fucking maddening.

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2 hours ago, jimmyjazz said:

Yeah, that's the kind of detail that is important.  "We're reasonably confident through 28 days; after that, who knows?"

OK, maybe that's not a strict interpretation, but it's probably not all that far off, and it's exactly the kind of technical subtlety that gets left out when the rumor game starts.

Thanks!

I agree that it is an important caveat. We don't know anything about durability at this point, whether we are talking 1 dose or 2. But honestly, that particular phrase reads to me as the kind of very careful hedged language used in a regulatory filing. There is no reason that protection would poof and disappear at 28 days, but you still got to hedge how you frame the results. The bigger problem with that analysis set imo is the small number of events, thus the wide confidence intervals, and the selected nature of the set.  But those are very very promising data, and seem to be translating to real world as well. 

 

You should feel pretty fucking good about things after two weeks, imo. Your antibodies are in the meat of the levels expected after COVID infection.  Still be vigilant of course, but things are definitely going in the right direction.

mrnavaxresponse.jpg

 

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48 minutes ago, Anastasis said:

You should feel pretty fucking good about things after two weeks, imo. Your antibodies are in the meat of the levels expected after COVID infection.  Still be vigilant of course, but things are definitely going in the right direction.

. . . particularly since I have to take my son to Dallas for a college soccer showcase at the end of March.  We originally had to book 5 nights, which gave me great uneasiness, because it was peak post-spring-break super-spreader timeframe.  Fortunately, we'll be able to go up and back for the only 2 matches he can make.  Staying at a Dallas hotel at the end of March did not make me feel good at all.

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8 hours ago, Beantown Express 2.0 said:

Just saw a doctor on Fox News, Dr. Makary, who was saying people should hold off on their second dose of the vaccines until 12 weeks not the 4 weeks that Pfizer and Moderna are doing.  Any idea where this is coming from?  Legit reasoning or is this guy wrong?  I find it very concerning when the American population is already dumb and we start giving different view points on vaccines that will totally confuse them.  I just wonder if its like putting a doctor on national TV and he starts promoting good heart health can be achieved by never exercising and eating fast food as much as you can.  I would think putting out wrong information can be pretty dangerous to idiots.  

I was going to bring up important limitations to consider when making such a consequential public health policy. But then I found this letter from John FR Robertson (who I've admired from my days working in hormonal therapies of breast cancer) and his colleagues in Lancet.

CORRESPONDENCE| VOLUME 397, ISSUE 10277, P879-880, MARCH 06, 2021

Delayed second dose of the BNT162b2 vaccine: innovation or misguided conjecture?

John F R Robertson

Herb F Sewell

Marcia Stewart

Published:February 19, 2021 DOI:https://doi.org/10.1016/S0140-6736(21)00455-4

We strongly support vaccination against COVID-19 with the Pfizer-BioNTech COVID-19 mRNA vaccine BNT162b2 when adhering to the 3-week dosing schedule that was found highly effective in the phase 3 randomised clinical trial—regarded as the gold standard. However we do not support the second dose being delayed to 12 weeks, as implemented by UK Chief Medical Officers.

The latter followed recommendations by the Joint Committee on Vaccination and Immunisation (JCVI), based on unplanned, retrospective analysis and unwarranted assumptions.

The UK is currently the only country to have adopted a maximal 12 weeks delay. How science-led is the UK strategy? Is it innovative and world-leading, or scientifically fallacious, resulting in an unproven dosing schedule introduced without fully informed patient consent? What are the potential risks, for individuals and the population?

The idea of protecting more of the population by delaying the second dose is predicated on a joint statement by the JCVI and Public Health England (PHE) that a first dose provides 89–90% efficacy (protection). This is contrary to the clinical data or efficacy generated from real-life clinical observational data from Israel. 

How did the JCVI arrive at their estimate of 89%?

The JCVI performed an unplanned, retrospective analysis of the randomised clinical trial data. They compared COVID-19 cases in the vaccine group versus the control group from a 6-day window (15–21 days), selected retrospectively after examining the data. The resulting 89% efficacy (95% CI 52–97) was based only on roughly 20 events. Retrospective analyses in therapeutic trials can be hypothesis-generating but should not be used to treat individuals. The JCVI then made a major assumption that the 89% effectiveness persists from day 21 to day 85 in the absence of the second dose, for which no empirical evidence was adduced. In a further major, incorrect assumption, the JCVI stated “There is currently no strong evidence to expect that the immune response from the Pfizer-BioNTech and AstraZeneca vaccines differ substantially from each other”. No scientific data on mRNA vaccines exists to support this assumption. The available quality peer-reviewed, published immunology data would refute the assumptions documented by the JCVI and PHE. mRNA vaccines had never been used therapeutically in humans. The JCVI assumption that mRNA vaccines (BNT162b2 and Moderna's mRNA-1273 SARS-CoV-2 vaccine) would behave similarly to the AZD1222 viral vector DNA vaccine developed by the University of Oxford and AstraZeneca is not supported by published evidence. Phase 1/2 trial data of AZD1222 show a substantial specific anti-virus spike protein T-cell responses at day 7, which peaks at day 14.8This response is not seen with BNT162b2. Furthermore, there are marked quantitative differences in the production and duration of neutralising antibodies (NAbs). The mRNA vaccines show marked falls in NAb titres (compared with the DNA vaccine) in the period before the scheduled second dose (day 22 and day 29 for BNT162b211, and mRNA-1273, respectively), something we have specifically highlighted as occurring in all age groups.

Inevitably, NAb titres will continue to fall during days 21–85, leading to very reduced immunity and increased risk to individuals of infection, especially in frail older people.

An efficacy of 52·4% was reported out to day 22 for BNT162b2,13 and efficacy of 50–60% has been reported in observational cohort studies from Israel covering the same period.

UK's delayed second dose strategy for BNT162b2 is, in our view, a misguided conjecture. It will yield some protection for the individual after a first dose: how much, and for how long, is unknown and without patient consent.

The population risk is that the UK's delayed second dose could strongly favour the emergence of consequential SARS-CoV-2 variants resulting from sub-optimal or partial immunity. The Government's Scientific Advisory Group for Emergencies has also documented concern about emergence of variants as a result of the delayed second dose.

Sub-optimal vaccination will create selective pressure facilitating the emergence of vaccine-resistant variants, which could result in a persisting pandemic. New vaccines, covering such variants, can be made but will require time for testing, mass production, and distribution.

We have no concerns regarding the second dose of AZD1222 at 12 weeks, as this is supported by evidence. However, if escape variants arise due to sub-optimal dosing with BNT162b2, they will likely be resistant to other vaccines that target the same viral spike protein.

In conclusion, we would strongly recommend that the UK Government reverts to the two doses in a 3-week schedule (94% efficacy) for BNT162b2; or, as recently supported by WHO and the US Centers for Disease Control and Prevention, adopt no more than a 6-week delay to the second dose “in exceptional circumstances”.

 

BTW, I am getting my 2nd dose of Pfizer vaccine this Saturday and will continue to wear masks except my family or small groups of people who've been vaccinated. I hope that will change by this summer, but I'm just not as confident in the public overall as I am in the scientific community.

Edited by PsychMike
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Take Jen from Iowa, one of 19 participants in Luntz's focus group, which was sponsored by the de Beaumont Foundation, a nonpartisan group with a public health focus.
She and her husband both recently had the virus, and he spent three weeks in an intensive care unit. "For us personally, I don't know, I really am highly doubtful we'll ever get vaccinated for this, even though it almost killed him,"

In fact, the NPR/PBS Newshour/Marist poll last week found 47% of Trump voters said they would turn down a vaccine. By way of comparison, among Biden voters, only 10% said they wouldn't get vaccinated.
 

tenor.gif
 

Edited by Ted Lange
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Covered in the Tucker thread, but as John Oliver noted, everyone has been asking those questions and they have all been easily answered for anyone who wishes to know the answers. Also, no one is saying to not ask questions. So, 100% bullshit.

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1 hour ago, Ted Lange said:

 

Take Jen from Iowa, one of 19 participants in Luntz's focus group, which was sponsored by the de Beaumont Foundation, a nonpartisan group with a public health focus.
She and her husband both recently had the virus, and he spent three weeks in an intensive care unit. "For us personally, I don't know, I really am highly doubtful we'll ever get vaccinated for this, even though it almost killed him,"

In fact, the NPR/PBS Newshour/Marist poll last week found 47% of Trump voters said they would turn down a vaccine. By way of comparison, among Biden voters, only 10% said they wouldn't get vaccinated.

Fuck Frank Luntz. Not related to this topic. Just in general. He’s one of the reasons the Republicans are so good at messaging. And deception. 

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I think it's possible we will reach "near" herd immunity by early May.  I'm fudging the definition, but let's assume that (a) one dose is very effective and (b) 3X reported cases actually occurred.  Some of those who didn't experience symptoms will get vaccinated, so that overlap isn't all that helpful, but let's say there are 90M Americans who already "somewhat immune" beyond the vaccine.  Add them to the current vaccinated (1D) crowd, and add in another 100M to get 1 dose, we're getting in the 70% range.  

Of course, some of those doses are #2, so whatever.  Regardless, I think things will start looking relatively rosy before summer.  I will bet a sweet US dollar on it.

Edited by jimmyjazz
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53 minutes ago, Sawbonz said:

 

Quote

State Sen. Regina Bayer, a Republican, closed by wishing her colleagues a happy Easter.

"And remember what grandma says: Take your vitamins – zinc, D3, magnesium and vitamin C — and then you'll be back here healthy," Bayer said.

 

Regina Bayer looks exactly like you'd think she'd look: broken foot, missing teeth etc...
 

https://www.facebook.com/ReginaBayerForIdaho/videos/2443463495961688

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17 minutes ago, jimmyjazz said:

I think it's possible we will reach "near" herd immunity by early May.  I'm fudging the definition, but let's assume that (a) one dose is very effective and (b) 3X reported cases actually occurred.  Some of those who didn't experience symptoms will get vaccinated, so that overlap isn't all that helpful, but let's say there are 90M Americans who already "somewhat immune" beyond the vaccine.  Add them to the current vaccinated (1D) crowd, and add in another 100M to get 1 dose, we're getting in the 70% range.  

Of course, some of those doses are #2, so whatever.  Regardless, I think things will start looking relatively rosy before summer.  I will bet a sweet US dollar on it.

I haven’t checked in the last month but CDC website has consistently estimated actual cases as 6 per 1 confirmed positive from last summer to now. Their methodology is similar to what they use to estimate flu cases. 
 

Even a more conservative estimate such as yours plus continuing the current vaccination pace gets us to herd immunity by the start of summer. Assuming that the j&j vaccine is available on a walk-in basis to anyone who wants it at that point, I’m getting rid of my mask. 

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On 3/18/2021 at 12:38 PM, Biff Tannen said:

So I'm fully vaccinated.  Technically will be fully effective in 12 days, but whatever.  I've been wearing a mask in indoor public spaces for over a year.  It's normal now.  I have no problem doing it for another few months until we get enough people vaccinated.  What is really the problem?  Why are people such fucking babies?  "Oh noes!  I can't take another minute of this horrid piece of cloth over my nose and mouth!  FREEDOM!!!!"

We are the dumbest fucking species.

Seems Texas is doing better at getting it earlier(?).  Here in Oregon we are still at if you are not in a risk group and of certain age you are not getting it for the most part.  

Moderna apparently did a “pop up” all ages thing  at a small town near here but by the time I saw it on Reddit, it was booked up.  I also signed up for the “notify me as soon as I can have an appointment” app run by the county in conjunction with the big hospital here.  But I am pretty sure we won’t be getting it until May at best.

Edited by MC Fresh Breath
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10 minutes ago, MC Fresh Breath said:

Seems Texas is doing better at getting it earlier(?).  Here in Oregon we are still at if you are not in a risk group and of certain age you are not getting it for the most part.  

Moderna apparently did a “pop up” all ages thing  at a small town near here but by the time I saw it on Reddit, it was booked up.  I also signed up for the “notify me as soon as I can have an appointment” app run by the county in conjunction with the big hospital here.  But I am pretty sure we won’t be getting it until May at best.

i'm not at risk or of a certain age, and i got my first shot, and will be getting my second wednesday. 

our governor made it thunderdome, so i'm treating it as such.

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15 minutes ago, mdmost said:

And my wife and I didn't do that and we probably should have like you said due to Abbott. My hope is Texas moves to 40+ soon. 

As jimmyjazz stated, Bryan, is an option perhaps. They've been getting 5000 doses in the allotments so my spouse is going there too. He said when he signed up Friday there were loads of appointment times.

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17 hours ago, jimmyjazz said:

I think it's possible we will reach "near" herd immunity by early May.  I'm fudging the definition, but let's assume that (a) one dose is very effective and (b) 3X reported cases actually occurred.  Some of those who didn't experience symptoms will get vaccinated, so that overlap isn't all that helpful, but let's say there are 90M Americans who already "somewhat immune" beyond the vaccine.  Add them to the current vaccinated (1D) crowd, and add in another 100M to get 1 dose, we're getting in the 70% range.  

Of course, some of those doses are #2, so whatever.  Regardless, I think things will start looking relatively rosy before summer.  I will bet a sweet US dollar on it.

Been saying this for months now.  People are being way too Debbie Downer.  Just do the math.  We'll still have some churn of like 10K cases a day nationwide but it's essential gone at that point.

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https://www.nytimes.com/2021/03/19/briefing/atlanta-shootings-ncaa-mens-division-teen-vogue.html?smid=url-share

Britain’s ‘One-Jab’ Strategy

Britain’s “one-jab” strategy is working, offering lessons for the world.

The global leaders in Covid-19 vaccination rates are Israel and the United Arab Emirates. After them come a handful of countries that have each given between 30 and 45 shots for every 100 residents, including the United States, Britain, Bahrain, Chile and Serbia.

Image

Credit...By The New York Times | Sources: Local governments via Our World in Data

But these handful of countries have followed two different strategies. The U.S. and most others have tried to make sure that anybody who gets a first vaccine shot gets the second shot within a few weeks (except in the case of the Johnson & Johnson vaccine, which requires only one shot). Britain has instead maximized the number of people who receive one “jab,” as the British call it — and has delayed the second jab, often for about three months.

Kate Bingham, a venture capitalist who led the committee that advised the British government on vaccination, has described the strategy this way: “I think it’s the right public health response, which is to show that you try and vaccinate as many people as possible, as soon as possible. Better to protect everybody a bit rather than to vaccinate fewer people to give them an extra 10 percent protection.”

So far, the data suggest that Britain’s approach is working — because even a single shot provides strong protection against the virus.

Dig deeper into the moment.

Special offer: Subscribe for $1 a week.

A delay seems OK

As Dr. Robert Wachter of the University of California, San Francisco, has written, “According to most vaccine experts, delaying shot #2 by a few months is unlikely to materially diminish the ultimate effectiveness of two shots.”

In Britain, the daily number of new Covid cases has fallen by more than 90 percent since peaking in early January. The decline is larger than in virtually any other country. (In the U.S., new cases have fallen 79 percent since January.) Given that the contagious B.1.1.7 variant was first discovered in Britain and is now the country’s dominant virus form, “Britain’s free-fall in cases is all the more impressive,” Wachter told me. “Clearly their vaccination strategy has been highly effective.”

British deaths have also plummeted in recent weeks:

Britain’s approach not only brings immediate benefits, in terms of lives saved; it also reduces the chances of future outbreaks: The fewer people who have Covid, the fewer who can infect somebody else. That’s especially important when more contagious variants are circulating. Worldwide, the number of confirmed new cases has risen 21 percent over the past month.

It is probably too late for the U.S. to change policy and adopt the British approach. Doing so would create widespread confusion and frustration. Still, there are lessons from Britain:

Speeding up a vaccination program brings enormous benefits. The U.S. has recently been giving about 2.5 million shots a day, up from about 800,000 in mid-January. But the federal government will soon be receiving closer to four million shots a day from the vaccine makers. A big question is whether the Biden administration and state governments will be able to continue increasing the pace at which people are getting shots in their arms.

For countries where vaccine programs have only just begun, as in much of South America, Africa and Asia, the British approach may be worth mimicking.

Finally, keep in mind that one of Britain’s main vaccines has been AstraZeneca’s — the same one that some other European countries have stopped using this week, out of concern over blood clots. But there is no sign of an increase in clots in Britain. “If the choice is potentially being exposed to Covid-19, or getting the vaccine & being protected, choose the vaccine,” Devi Sridhar, a professor of public health at the University of Edinburgh, wrote yesterday.

All of this comes with the usual caveat: If the data changes, the lessons should change, too. Based on the current evidence, though, Britain appears to have landed on the most effective vaccination strategy — which is yet another sign of how powerful the vaccines are.

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