Today I am filled with questions about the COVID-19 pandemic. Let’s start with this report from the Associated Press by Maria Cheng and Carla K. Johnson, speculating about a possible peak in the number of COVID-19 cases in the U. S. within the next week:
Scientists are seeing signals that COVID-19′s alarming omicron wave may have peaked in Britain and is about to do the same in the U.S., at which point cases may start dropping off dramatically.
The reason: The variant has proved so wildly contagious that it may already be running out of people to infect, just a month and a half after it was first detected in South Africa.
“It’s going to come down as fast as it went up,†said Ali Mokdad, a professor of health metrics sciences at the University of Washington in Seattle.
Also in a round-up of articles about COVID-19 at Outside the Beltway Steven L. Taylor posts a very interesting graph of COVID-19 deaths for vaccinated and unvaccinated people (sampled from an article at SFGate). I recommend you click on over to take a look at the graph. Unfortunately, the legend is clipped off: the graph illustrates deaths in California.
Now my questions.
Will our experience parallel the United Kingdom and South Africa’s?
Our vaccination rate is roughly the same as the UK’s and our population is slightly younger although not as young as that of South Africa. We have some demographic similarities with each but also some differences. It’s presently summer in South Africa but winter in the United Kingdom.
Is California’s experience with vaccinations typical of the rest of the country?
California’s circumstances may well be unique. There are many, many differences in demographics, climate, and general health between California and Illinois, just to take an example with which I’m familiar.
Is there empirical evidence supporting the utility of an “additional” vaccination against COVID-19?
“Additional” vaccination is the terminology presently being used for a fourth vaccination. Third vaccination: booster. Fourth vaccination: additional. The CDC guidance presently recommends an additional vaccination for individuals who are severely or moderately immunocompromised, e.g. have blood cancer or some other depressing condition. Is there empirical evidence to support that? Or is it a guesstimate? If there’s no empirical evidence of additional benefit it would be an important finding.
I’m sure I could come up with other questions but that’s enough for right now.
Ending with the ominous phrase,
“Unless another variant emergesâ€
Which it will.
We’re at the point in viral research as physicists splitting the proton, the closer you are able to observe, things don’t get simpler, they get more complex.
And because we’re able to track viral mutations, (partially), we begin to believe we’re getting somewhere, well, it’s better than bloodletting , but it might not be better than the human immune system which evolved in a viral environment.
The argument for “waning” immunity without perpetual boosters and possibly boosters developed for the variant of the month, is based upon data showing neutralizing antibody levels decreasing over time. This test is easy to perform and commonly used for this type of assessment for some other infectious diseases.
However, unlike some other infectious diseases, correlates of protection have not been determined for COVID-19. Dr. Daniel Griffin who is a clinician in infections diseases in the New York area shared a story about this: a health care professional who was infected early in the pandemic decided to monitor her antibody levels, which remained strong. Nonetheless she was reinfected twice. (She did not get vaccinated, she presumably felt that she was taking adequate precautions)
After virus is cleared, neutralizing antibodies specific to the infection naturally decline through a process called “contraction.” The people identifying weaning antibody levels don’t seem to ever account for “contraction.”
For vaccinated people, the risk of severe disease declines over time as the immune response matures. This CDC analysis indicates that the risk of severe disease is less after 120 days from primary vaccination than it is before 120 days.
https://www.cdc.gov/mmwr/volumes/71/wr/mm7102e1.htm?s_cid=mm7102e1_w
So it appears that neutralizing antibody levels are not the important part of our body’s immune response to this disease. It is probably other components of the immune system, some of which improve over time without boosts.
Looking at the South African chart — there was an initial sharp decline, but the decline has leveled out at 30% of the peak or so.
Translated to the US that would be 200,000 cases a day or so.
I presume further shots offer real benefits like how flu shots are of benefit every year. The key for the general population is further vaccinations beyond the 3rd one should be tailored to the variant of the day; Pfizer and Moderna are now saying they will have an Omicron targeted vaccine in production in March…. which may well be “closing the barn door after horse bolted”. Tailoring vaccines to the variant of the day is an extremely hard problem; its why the flu vaccine has effectiveness that ranges from 70% to 20% every year.
IMO empirical evidence is needed. We’re in new territory here. We shouldn’t just make assumptions.
We still had OK protection with just 2 shots. With 3 it is very good. Unless there is a real change I think we are heading towards once a year shots. Should be pretty tolerable.
We are seeing our numbers drop. We peaked in the middle of last week at about 170 pts being held in the ED. Today it is 90. Still hurting badly for ICU staff. I spent most of the day on that problem.
Steve
“Tailoring vaccines to the variant of the day is an extremely hard problem; its why the flu vaccine has effectiveness that ranges from 70% to 20% every year.”
And aside from the technical problem, think of the political one. Is our one trick pony president going to mandate covid vaccines yearly? Well, how about the common flu? Go ahead, make my day.
I’m not sure what is so interesting about the graph. One of the few “facts” in this whole thing that appears to be true is that vaccines improve outcomes. They were oversold in the notion that they would prevent illness.
BTW – I, my daughter and sister in law, all vaxed and boosted – my daughter with covid in the past – have now contracted Omicron.
There are two things I found of interest. The first is that being vaccinated does, indeed, reduce the likelihood of death and serious disease. Not to zero but nearly to zero which is pretty darned good. While I disagree with vaccine mandates since individual circumstances vary I genuinely don’t understand those who those who oppose getting vaccinated. Yes, individual circumstances differ so there are a few cases in which vaccination would not be recommended. But they are a just a few cases. The other thing is that the deaths of the unvaccinated are decreasing. I don’t know if that’s because treatment is becoming more effective, the omicron variant has lower mortality, or both.
I believe the consensus of the panelist on the most recent This Week in Virology podcast is that the disconnect bw/ cases and hospitalization/deaths in South Africa and the UK can almost entirely be attributed to prior immunity from vaccination / infection and the demographics of those infected (younger).
Dr. Griffin said that he can tell whether a patient has been vaccinated or unvaccinated by the severity of the symptoms. He pushes back strongly on the notion that the omicron variant doesn’t reach the lungs — he says that’s not the case for the unvaccinated. He at least implied many of these aren’t going to make it, so I think we have to at least see if deaths are lagging.
I think Griffin is right that our pts are a bit younger but I am impressed that this virus just isn’t nearly as virulent. We have record numbers of pts. The unvaccinated are clearly sicker. But, even the unvaccinated arent as bad as a group as people were with Delta. It could be because at this point even the unvaccinated have had prior exposure but I think it more likely this is just a milder virus.
“Is our one trick pony president going to mandate covid vaccines yearly? Well, how about the common flu? ”
You do realize that vaccinations for the flu have been mandated in lots of places for a long time w/o any controversy. Hospitals and the military have required them in particular for a long time.
Steve
“I genuinely don’t understand those who those who oppose getting vaccinated. Yes, individual circumstances differ so there are a few cases in which vaccination would not be recommended. But they are a just a few cases.â€
The following is why people oppose getting vaccinated:
According to the end of 2021 government VAERS site there were
1 million adverse reaction;
113,000 hospitalizations;
38,000 permanent disabilities; and
20,000 + deaths reported because of the vaccine.
Since VAERS is a voluntary reporting system, it’s said to really represent a small percentage of adverse reactions. Steve Kirsch, a MIT computer science, statistician, has extrapolated an under-reporting factor (URF) of 41, based on anaphylaxis rates reported in a Blumenthal paper published by JAMA. Dr. Robert Malone also believes under-reporting is inherent in VAERS, saying, though, the numbers to be off base by at least 20 fold.
Bottom line is these vaccines continue to have no culpability or liability because of being distributed under EUAs, which supposedly expires in a few days, 1/15/2022. The clinical trial data has been obscured by Pfizer. Hospital administrators discourage medical personal from associating the timing of medical issues with taking the jabs. Those who have been vaccinated with no adverse effects usually see no harm. However, there are many out there, not making the news or the data bases, who have been needlessly injured, or worse yet died. We probably won’t know the real story or negative effects of these vaccines for some years to come. However, according to Dr. Malone the current mRNA vaccines are one of the most dangerous vaccines since small pox, to protect against a virus which, in most demographics people have a 99% survival rate.
Dave Schuler: Will our experience parallel the United Kingdom and South Africa’s?
More than likely. Omicron is much more contagious than previous variants, and it is expected to quickly run through the susceptible population. This is not an atypical evolution of respiratory viruses. Most seasonal cold and flu viruses may have started as dangerous pandemics, then evolved to be more transmissible but less virulent.
Dave Schuler: Is California’s experience with vaccinations typical of the rest of the country?
Other localities also see that the vast majority of people suffering severe cases of COVID are unvaccinated.
Dave Schuler: Is there empirical evidence supporting the utility of an “additional†vaccination against COVID-19?
An additional vaccination will increase antibodies, but anyone who has been vaccinated or has experienced a previous infection has B cell and T cell immunity, which provides long term protection. B and T cells react after infection to quickly clear the pathogen. That means future infections of COVID may be more akin to a cold or flu in severity.
Grey Shambler: “Unless another variant emergesâ€Which it will.
Sure, but the long term immune response will usually be sufficient to protect most people from severe disease. Until it doesn’t. Pandemics are part of the world, and coronaviruses are quite adaptable. Fortunately, new technology allows for the creation of targeted vaccines very quickly.
Drew: Is our one trick pony president going to mandate covid vaccines yearly?
Once the pandemic ends, the need for vaccines will decrease. Most of the population will have general immunity, while annual shots will probably be recommended for COVID along with flu shots, especially for those most susceptible. As steve points out, vaccines will still be mandated for hospitals to protect patients, and in the military to help ensure preparedness.
So here is the reasoning on a societal level why a 2nd booster/3rd booster maybe compelled by governments (and more often then once a year, possibly once every 4 months).
Even if Omicron and future variants are only as lethal as the flu (IFR of 0.1%), it is far more transmissible then influenza (flu has an R of 1-2, COVID is around 3-4). Uncontrolled spread of a new variant infects far more people and generates proportionately the same extra amount of demand on hospital beds in a compressed period compared to the flu.
And the absolute number of people requiring hospital care can still be very large even among the vaccinated when a wave occurs. For perspective, in the UK, even through a very high percentage of people are vaccinated/boosted — vaccinated patients still made ~50% of patients in critical care during the Omicron wave (when capacity was stretched). i.e. a very very large number multiplied by a tiny percentage is still a very large number in absolute terms.
To avoid overloading the health system during a wave, the only solution is to slow the spread of new variants (i.e. delay infections). And the only known ways to delay infections is (a) NPI measures like social distancing, lockdowns, masks or (b) vaccines. The current vaccines are known to prevent infections at high efficiency for only 2 to 3 months at a time.
Jan: Since VAERS is a voluntary reporting system . . .
VAERS reporting is mandatory for healthcare professionals. Underreporting, a finding based on an old study, primarily concerns minor adverse reactions. Severe outcomes are almost certainly reported. Notably, “While very important in monitoring vaccine safety, VAERS reports alone cannot be used to determine if a vaccine caused or contributed to an adverse event or illness.”
https://vaers.hhs.gov/data.html
Jan: Bottom line is these vaccines continue to have no culpability or liability because of being distributed under EUAs, which supposedly expires in a few days, 1/15/2022.
Liability protection covers vaccines during a declared public health emergency whether or not they are distributed under an EUA per the Public Readiness and Emergency Preparedness (PREP) Act of 2005, 42 U.S. Code § 247d–6d.
CO- Good point. I never really thought about what it would be like if all of our flu pts showed up over the course of 3 weeks rather than the whole flu season. I am guessing that really could approach what we have now with so many pts being held in EDs.
Steve
CuriousOnlooker: (flu has an R of 1-2, COVID is around 3-4)
R0 for COVID will probably decrease as more people acquire immunity.
To emphasize my point about the difficulties of tailoring the vaccines to an emergent variant of concern in the future and rolling it out in time.
https://www.wsj.com/articles/vaccine-makers-pursue-omicron-targeted-shots-that-health-officials-say-might-not-be-needed-11642161601
I am quite concerned with the blasé attitude from government officials expressed in the article towards the problem.
At some point, there will be a new variant that is resistant to vaccines aimed at the “wildtype” strain. It is not a good idea to wait until it happens and found out all the issues with changing the formulation of the vaccine at that point.