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Native Answers Coronavirus Related Basic Science Questions
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Pfizer Briefing for FDA Meeting on Thursday. A few salient points.
- Youth, HIV+, pregnant women(dropped from trial if became pregnant) data are non-existent or lack robustness due to lack of numbers and follow-up period for those limited #’s isn’t complete.
- Fatigue, muscle pain, chills, and fever are definitely potential side effects. The majority of the data is centered on the 18-55 yr old population but looks good with lesser numbers for the older groups.
- Figure 2 showing cumulative incidence of disease is powerful and indicates that protection kicks in on day 10 post initial injection.
- Pfizer, in this briefing, was very careful to state that they don’t know long term protection and kept their claims at the length of the follow-up period of 2 months. This is potentially concerning to me, but I understand they are only presenting what they can definitively show. The negative is that we can’t even repeat a guess/calculation on the durable immunity aspect of the vaccine from this briefing. I would add that you aren’t seeing incidence pop up in the vaccinated control group through the 2 month follow up at all, suggesting to me that protection isn’t waning at all at that point.
For those that want a detailed vaccine discussion.
https://www.nature.com/articles/d41586-020-01221-y
https://www.nature.com/articles/d41586-020-01221-y
Q: What are the differences between Pfizer and Moderna vaccines?
A: The Pfizer/BioNTech and Moderna COVID-19 vaccines are similar in composition, effectiveness, and safety. The differences between the two vaccines for storage and handling (-70 vs -20 C), time between shots (3 vs 4 weeks), and amount per shot (30 vs 100 micrograms of mRNA) are minimal and do not change vaccine effectiveness.
Q: Is the London Covid strain more dangerous and will it stop the vaccine from working?
A: Small genetic changes have been noted in SARS-CoV-2 throughout the course of the pandemic. Anytime a “new strain” appears scientists have to carefully examine and determine if the strain is more dangerous, or the most likely result, a strain was part of a superspreader event, and has become commonly seen due to predominance in an area. There have literally been thousands of mutations that have been identified in SARS-CoV-2 and these small changes are often “silent” and do nothing to change the virus. These small changes, even if they were to occur in the Spike protein are not going to stop the effectiveness of either vaccine, as they are both causing our bodies to make many antibodies to lots of different regions (epitopes) of the spike protein.
A: The Pfizer/BioNTech and Moderna COVID-19 vaccines are similar in composition, effectiveness, and safety. The differences between the two vaccines for storage and handling (-70 vs -20 C), time between shots (3 vs 4 weeks), and amount per shot (30 vs 100 micrograms of mRNA) are minimal and do not change vaccine effectiveness.
Q: Is the London Covid strain more dangerous and will it stop the vaccine from working?
A: Small genetic changes have been noted in SARS-CoV-2 throughout the course of the pandemic. Anytime a “new strain” appears scientists have to carefully examine and determine if the strain is more dangerous, or the most likely result, a strain was part of a superspreader event, and has become commonly seen due to predominance in an area. There have literally been thousands of mutations that have been identified in SARS-CoV-2 and these small changes are often “silent” and do nothing to change the virus. These small changes, even if they were to occur in the Spike protein are not going to stop the effectiveness of either vaccine, as they are both causing our bodies to make many antibodies to lots of different regions (epitopes) of the spike protein.
There are some Illinois specifics in this FAQ and some areas that aren't of interest to all, but there is a lot of good basic simplified information provided in this FAQ.
Another fun fact about this FAQ is that I was the leader of team who wrote portions of this.
dph.illinois.gov
Another fun fact about this FAQ is that I was the leader of team who wrote portions of this.
Vaccine Information
A safe and effective COVID-19 vaccine is a critical component of the U.S. strategy to reduce COVID-19-related illnesses, hospitalizations, and deaths. Easy access to COVID-19 vaccines is equally important. The Centers for Disease Control and Prevention (CDC) is working with public health...
1) My understanding is there vaccine won't necessarily prevent infection, but should prevent severe cases. Is that correct?
2) if correct.... suppose a vaccinated person contracts a mild case, then they're still capable of passing it on to others, right?
I can see how these are confusing. Many answers in science aren't 100% and then we are only really able to comment on what the data actually shows. The vaccine trials looked at symptomatic covid and severe covid as endpoints of their study. So both vaccines had protection against symptomatic covid and that is where the 94-95% comes from. There weren't enough people that got severe covid for Pfizer to say with statistical significance that severe covid was prevented, while there were enough cases for the moderna vaccine. (This is all due to the number of people within the placebo group that got severe covid, and likely has nothing to do with the actual vaccines. Other than they both are likely going to achieve that with time. I say all of that, to state the vaccine trials did not really look at asymptotic cases. (moderna a bit at 2nd shot, but wasn't really part of the study design - and again, was promising, but not high enough numbers to make claims). All this is why we don't have statements on asymptomatic infection in the vaccinated population. To me it stands to reason, and makes sense that there could be some underlying infection going on, however, it is going to be at a much reduced rate, No data on transmission, but likewise, the reasonable assumption is that it is going to be limited as well. So while technically, and given the number of people and their varied immune responses, there is going to be some mild, underlying cases of covid still passed around in the vaccinated population, they are going to have reduced transmission, decreased disease severity, and are going to be extreme outliers, (not frequent at all) and with the total numbers of illness inevitably dropping, the likelihood of this rare event is going to decrease as well.
2) if correct.... suppose a vaccinated person contracts a mild case, then they're still capable of passing it on to others, right?
I can see how these are confusing. Many answers in science aren't 100% and then we are only really able to comment on what the data actually shows. The vaccine trials looked at symptomatic covid and severe covid as endpoints of their study. So both vaccines had protection against symptomatic covid and that is where the 94-95% comes from. There weren't enough people that got severe covid for Pfizer to say with statistical significance that severe covid was prevented, while there were enough cases for the moderna vaccine. (This is all due to the number of people within the placebo group that got severe covid, and likely has nothing to do with the actual vaccines. Other than they both are likely going to achieve that with time. I say all of that, to state the vaccine trials did not really look at asymptotic cases. (moderna a bit at 2nd shot, but wasn't really part of the study design - and again, was promising, but not high enough numbers to make claims). All this is why we don't have statements on asymptomatic infection in the vaccinated population. To me it stands to reason, and makes sense that there could be some underlying infection going on, however, it is going to be at a much reduced rate, No data on transmission, but likewise, the reasonable assumption is that it is going to be limited as well. So while technically, and given the number of people and their varied immune responses, there is going to be some mild, underlying cases of covid still passed around in the vaccinated population, they are going to have reduced transmission, decreased disease severity, and are going to be extreme outliers, (not frequent at all) and with the total numbers of illness inevitably dropping, the likelihood of this rare event is going to decrease as well.
All data testing vaccine against variants is turning out very positive. I can't find the twitter video I want to post for those concerned about the South African variant. The amount of neutralization taking place has decreased, (6 fold), but can be summarized as going from "Very Awesome Amount of Neutralization" to "Awesome Amount of Neutralization".
So, as of today, 1/27/2021, take all reports/headlines on variants and new strains and vaccine escape with a grain of salt. They make for flashy, attention grabbing headlines, but are clinically just a bit more than a nothing burger and but are like catnip for reporters and scientists who love to sequence things and draw dendrograms.
*I typed 1/27/2021 as my qualifier, in the event something does come out to be more major. The data on increased replication and receptor binding affinity and true data on clinical outcomes isn't all in yet. So there may be some concern on those fronts, but the vaccine will get us where we need to be in time.
So, as of today, 1/27/2021, take all reports/headlines on variants and new strains and vaccine escape with a grain of salt. They make for flashy, attention grabbing headlines, but are clinically just a bit more than a nothing burger and but are like catnip for reporters and scientists who love to sequence things and draw dendrograms.
*I typed 1/27/2021 as my qualifier, in the event something does come out to be more major. The data on increased replication and receptor binding affinity and true data on clinical outcomes isn't all in yet. So there may be some concern on those fronts, but the vaccine will get us where we need to be in time.
Positive news.
Also, I have no data to support it, and just because most health professionals won't say anything or even venture a guess..... If I were to bet on length of time from vaccination until need for a booster, I am going to say minimum of 5 years.
I should add the caveat to my "prediction" that there may be an initial early booster within the next 3 years to help expand response to include some of the variants that exists. Vaccination will win out on this virus though.
The Coronavirus Variants Don't Seem to Be Highly Variable So Far
SARS-CoV-2 may be settling into a limited set of mutations
Help with understanding the variants. This is by a guy I know and have been able to ask direct questions to and have used as a resource for the mutational side of understanding SARS-CoV-2
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Genomic characteristics and clinical effect of the emergent SARS-CoV-2 B.1.1.7 lineage in London, UK: a whole-genome sequencing and hospital-based cohort study
Genomic characteristics and clinical effect of the emergent SARS-CoV-2 B.1.1.7 lineage in London, UK: a whole-genome sequencing and hospital-based cohort study
Emerging evidence exists of increased transmissibility of B.1.1.7, and we found increased virus load by proxy for B.1.1.7 in our data. We did not identify an association of the variant with severe disease in this hospitalised cohort.
www.thelancet.com
Data from the UK about the B.1.1.7 variant.
TL : DR not more virulent.
However, the viral loads were higher so that might lead to increased transmission.
One has to be careful with there terms... virulence is a description of the relative degree of disease. (How sick it makes you)
Might be more people getting sick, but the outcomes aren’t any worse.
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Here are a couple questions I received and my thoughts. More of an opinion piece here.
What I think is likely is that in 6-8 months depending on cases etc. It is likely there will be a variant targeted booster. (I know testing on this is underway).
All return to normalcy, from a public policy point of view is going to be set by some vague, ill-defined level of risk. Silly mitigation efforts likely will remain in place or some locations and removal of all mitigation will be removed in others.
I don't know all the ins and out of what going on in Israel, but the data thus far are encouraging and they are opening back up.
My prediction moving forward. There will not be an annual shot. Booster maybe every 5 years or so... This virus doesn't mutant and undergo genetic reassortment like influenza, so the need for an annual shot seems quite unlikely.
What I think is likely is that in 6-8 months depending on cases etc. It is likely there will be a variant targeted booster. (I know testing on this is underway).
I think the technology adoption cycle is a good analogy for what we are seeing. Our "early adaptor" have jumped at the chance.
This is super hard to answer, as it involves the political response to the situation. I am seeing more reports about "herd immunity" not being achieved. I would take all of those reports with a grain of salt, and watch national data. Pockets of non-immunized individuals always create a risk. I know these reports will be accused of "moving the goal posts" etc. But information on what an individual report thought the goal of herd immunity was, or what model they are using makes a huge difference in how you report. For instance 95% immunization/natural infection is going to almost shut the virus down and would be easy to say that "herd immunity" has been achieved. Sometimes the term is used to describe just the slowing down of passage of infection. The minimum amount of immune population to have a measurable decrease in the R-naught of an infectious agent. The R0 would likely start to drop at 65-70%. But that level of herd immunity is going to still have passage and ongoing infections, just at a lower rate. So again, herd immunity at some level has been achieved.
All return to normalcy, from a public policy point of view is going to be set by some vague, ill-defined level of risk. Silly mitigation efforts likely will remain in place or some locations and removal of all mitigation will be removed in others.
I don't know all the ins and out of what going on in Israel, but the data thus far are encouraging and they are opening back up.
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