Coronavirus: What questions do you have?

[BABAR]

New data: Data from 50,000 patients in the Mayo Clinic Health System, researchers found the effectiveness of Moderna's vaccine against infection has dropped to 76% in July - when the Delta variant was predominant - from 86% in early 2021. Over the same period, the effectiveness of the Pfizer/BioNTech vaccine had fallen to 42% from 76%, researchers said.

The delta variant is clearly a stronger virus and this explains the new spike in infections.

1. Understand first priority is to vaccinate the whole world, as variants developing ANYWHERE rapidly spread EVERYWHERE. So selfish of “developed countries” to be asking for boosters before “developing countries” (I think those are the politically correct term) have gotten through the first round
2. What is the bottleneck for worldwide vaccination in “developing countries”? Not enough vaccine? Refrigeration and distribution issues? If not enough vaccine, I understanding why we should hold off boosters until we can get everybody else at least one full series, otherwise what is the threshold for boosters?

3. If Pfizer is dropping below 50% protection (and are we talking about risk of Asymptotic, mildly symptomatic, and/or severely symptomatic) then unless we are denying the rest of the world vaccine, seems like time to start Boosting. OTOH, do we have evidence that BOOSTERS of the original vaccine are effective against Delta, or should we hold out for a Delta specific vaccine?

 

[boatgeek]

2. What is the bottleneck for worldwide vaccination in “developing countries”? Not enough vaccine? Refrigeration and distribution issues? If not enough vaccine, I understanding why we should hold off boosters until we can get everybody else at least one full series, otherwise what is the threshold for boosters?

Maintaining a cold chain (consistent refrigeration) would be a significant issue for mRNA vaccines, especially outside of major cities. That could probably be resolved by using the military in a goodwill mission*. J&J could easily piggyback on existing vaccination cold chains.

* A C-130 could easily carry the vaccine, power generation, and supplies to vaccinate hundreds to thousands of people, and could land at most any runway.

 

[cwbullet]

Maintaining a cold chain (consistent refrigeration) would be a significant issue for mRNA vaccines, especially outside of major cities. That could probably be resolved by using the military in a goodwill mission*. J&J could easily piggyback on existing vaccination cold chains.

* A C-130 could easily carry the vaccine, power generation, and supplies to vaccinate hundreds to thousands of people, and could land at most any runway.

That is pretty much true, but should we fund the vaccination of the whole world. I think it is time for more counties to step forward.

 

[cwbullet]

1. Understand first priority is to vaccinate the whole world, as variants developing ANYWHERE rapidly spread EVERYWHERE. So selfish of “developed countries” to be asking for boosters before “developing countries” (I think those are the politically correct term) have gotten through the first round

I think we need some sort of evidence that a booster is needed. I really am not going to worry myself about the rest of the world. That is someone else's job.

2. What is the bottleneck for worldwide vaccination in “developing countries”? Not enough vaccine? Refrigeration and distribution issues? If not enough vaccine, I understanding why we should hold off boosters until we can get everybody else at least one full series, otherwise what is the threshold for boosters?

Money, cold chain management, corruption, etc. Pick one and you be right in more than one part of the world. I am not of the belief that the western world needs to fund vaccination for the whole world. We need to vaccinate our population first. We are close to the point of vaccinating all that want it.

Boosters? There is no evidence that is needed yet. I am not even convinced that another shot of Pfizer would help prevent more delta infections. I asked my ID doc and she shrugged her shoulders.

3. If Pfizer is dropping below 50% protection (and are we talking about risk of Asymptotic, mildly symptomatic, and/or severely symptomatic) then unless we are denying the rest of the world vaccine, seems like time to start Boosting. OTOH, do we have evidence that BOOSTERS of the original vaccine are effective against Delta, or should we hold out for a Delta specific vaccine?

No evidence that a booster of Pfizer would increase protection against the delta. No evidence yet that there will be an increase in serious infections with the delta variant.

 

[NateB]

This is a long shot, but I'll ask anyway. We have good guidelines concerning when to transport patients to higher level of care and what type of units are best suited for them based off their needs and wishes for aggressive treatments. Are there any studies to help guide on when not to transport someone or when it might be too late?

Just moving some of these cases to transport carts and exchanging vents can take what little reserves they have away.

 

[cwbullet]

This is a long shot, but I'll ask anyway. We have good guidelines concerning when to transport patients to higher levels of care and what type of units are best suited for them based on their needs and wishes for aggressive treatments. Are there any studies to help guide on when not to transport someone or when it might be too late?

Just moving some of these cases to transport carts and exchanging vents can take what little reserves they have away.

Great question. I am not aware of any but will ask my experts.

 

[NateB]

Thank you, I can give more details about a specific case by PM if it is helpful.

 

[cwbullet]

Thank you, I can give more details about a specific case by PM if it is helpful.

That might be a good place to take it.

 

[cwbullet]

The question has been asked about booster doses. There will probably be one released this fall to winter. The proof is mounting that a booster will boost protection against old and new variants.

https://news.liverpool.ac.uk/2021/0...ainst-variants-of-concern-suggests-new-study/

 

[cwbullet]

Is the delta variant more deadly?

Medicine is an art with a science background. It is ever evolving. I am going to refer to today‘s spike as the delta spike. Currently, there is no evidence that the delta variant is more deadly but we are very early in the delta spike. There is a 2-6 week lag in death data because COVID deaths take time. As it progresses, we will have data to indicate how this vaccine protects against death with the delta variant. I suspect it will be nominally more deadly but the vaccine will continue to show good protection against the virus. Time will give us some truth and only the maker knows the outcome.

 

[kuririn]

This just popped into my head as I was sitting and musing on the couch tonight. I seem to remember early in the pandemic long before vaccines were available that people who recovered from a covid infection were donating their blood serum to help other patients recover. Now that we have millions more people who have been vaccinated, could their blood serum be used to help the scores of unvaccinated patients in the ICUs now?

 

[kuririn]

What can we do about covid misinformation going viral all across social media (including this forum)?
I'm not talking about differing opinions, but patently and demonstrably wrong statements.
Masks don't work.
Vaccines don't work.
Vaccines promote the proliferation of dangerous variants.
Should people call out the BS when we see it?
Should we ignore it?
I'm disgusted with it all.

 

[ThirstyBarbarian]

What can we do about covid misinformation going viral all across social media (including this forum)?
I'm not talking about differing opinions, but patently and demonstrably wrong statements.
Masks don't work.
Vaccines don't work.
Vaccines promote the proliferation of dangerous variants.
Should people call out the BS when we see it?
Should we ignore it?
I'm disgusted with it all.

Some of the people promoting this garbage disinformation seem like they are doing it just for the sake of arguing, too, not so much because they really believe it. The danger with that kind of trolling is that somebody actually will believe it, act on it, and then end up sick or dead. There are a lot of people dying every day because of crap they read on the internet, including the kind of crap being posted daily on this forum.

 

[boomtube-mk2]

2. What is the bottleneck for worldwide vaccination in “developing countries”?

Corrupt and or inept governments.
Lack of a nationwide infrastructure.
Hostile or adversarial governments that actually refuse to accept any vaccines from the U.S.
Nation is undergoing civil unrest or actual civil war.
Population so large it simply can't be dealt with effectively.

 

[kuririn]

The question has been asked about booster doses. There will probably be one released this fall to winter. The proof is mounting that a booster will boost protection against old and new variants.

I just read yesterday that booster shots have been approved for the immune deficient.
Good news.
EDIT: Here's the link:
Covid booster shots: FDA permits third dose for the immune-deficient (cnbc.com)

 

[cwbullet]

I just read yesterday that booster shots have been approved for the immune-deficient.
Good news.
EDIT: Here's the link:
Covid booster shots: FDA permits third dose for the immune-deficient (cnbc.com)

I hinted at this before. It makes sense with certain disease processes.

 

[cwbullet]

I posted earlier that Moderna and Pfizer are less protective against infection in the delta variant.

Good news:
Both the Moderna and Pfizer vaccines are effective at protecting against COVID-associated hospitalization (91.6% vs 85%, respectively) and ICU admission (93.3% vs 87%, respectively). I have yet to find a death attributed to covid from those vaccine recipients.

 

[Bill S]

Any info on J&J vs delta variant?

 

[cwbullet]

Any info on J&J vs delta variant?

The data is in flux, based on what I am seeing, AZ and J&J are clearly inferior to the other two. I have seen research showing that AZ is as low as 30% effective against infections for delta variant and 67-88% against serious infections. J&J might be as low as 33% for serious disease and lower for infections. We really need better data on those two.

Recent studies indicate J&J recipients might require booster shots for better protection against the Delta variant, but public health officials are not recommending boosters for any vaccines at this time.

 

[Marc_G]

The data is in flux, based on what I am seeing, AZ and J&J are clearly inferior to the other two. I have seen research showing that AZ is as low as 30% effective against infections for delta variant and 60-67% against serious infections. J&J might be as low as 33% for serious disease and lower for infections. We really need better data on those two.

Recent studies indicate J&J recipients might require booster shots for better protection against the Delta variant, but public health officials are not recommending boosters for any vaccines at this time.

Thanks for this info. My wife, who is relatively high risk (childhood leukemia survivor, gets sick easily) got J&J. Recent antibody test shows only ~300u/ml vs me and many others at 2000 u/ml. She will be talking to her Dr. about getting mRNA booster.

Her job (starting again after 9 months off for healthy reasons) puts her in direct contact with kids of all ages.

 

[BABAR]

With the above data, why would any individual or any country WANT anything other than Modena or Pfizer? Is it just that Moderna and Pfizer can’t make enough to supply an entire planet? Seems like they should contract it out, at least until the next generation shots are available, which hopefully will
1. Be more effective against current and hopefully future variants
2. Be more portable requiring less strict refrigeration
3. Be easier and cheaper to make “en mass” (hey, we can always hope)

I am curious which will come out first, recommendations for boosters for the average Joe and Josephine or a new next generation shot? I’d prefer the latter, as I think it is to be expected that as more people get vaccinated the strains are going to adapt to and become progressively more vaccine resistant to current vaccines.

 

[NateB]

With the above data, why would any individual or any country WANT anything other than Modena or Pfizer? Is it just that Moderna and Pfizer can’t make enough to supply an entire planet?

I'm sure the super cold transport and storage requirements are a factor. I think it is great that scientists figured out how keep the mRNA stable enough to be useful, the next big breakthrough will be to keep it stable enough to be handled by normal means and be able to reach remote or developing parts of the world.

 

[Bill S]

With the above data, why would any individual or any country WANT anything other than Modena or Pfizer? Is it just that Moderna and Pfizer can’t make enough to supply an entire planet? Seems like they should contract it out, at least until the next generation shots are available, which hopefully will
1. Be more effective against current and hopefully future variants
2. Be more portable requiring less strict refrigeration
3. Be easier and cheaper to make “en mass” (hey, we can always hope)

I am curious which will come out first, recommendations for boosters for the average Joe and Josephine or a new next generation shot? I’d prefer the latter, as I think it is to be expected that as more people get vaccinated the strains are going to adapt to and become progressively more vaccine resistant to current vaccines.

For the wife and I, it was combination of being hesitant about the new tech, and we both have immune system issues, so we thought the J&J being based upon better understood older tech would be safer. We also didn't want to go through 2 rounds of side effects (we both had significant side effects for 2 days, I had some for 3 despite having a weakened immune system due to Lyme Disease).

I'm now willing to take a shot of the Moderna or an J&J booster, if the experts would just make up their minds already on if its safe and effective to do so...

 

[Cl(VII)]

Even more than the cold transport chain is the formulation of the mRNA “envelope”. Since mRNA is rapidly recognized and obliterated by the immune system when found circulating freely in the bloodstream a big challenge of the entire mRNA field is how to formulate it for delivery to cells while protecting it from destruction. Although the chemicals involved are relatively simple (relative to super exotic stuff that is), the process for encapsulating the mRNA requires inherently small volume flow microfluid machines. It is highly specialized equipment of which there was very limited supply at the start of the outbreak. It is also really fidgety to operate and maintain.

The production of the mRNA is also more involved than the production of classic vaccines. Also, these being the first broadly used vaccines of this technology means there isn’t a bunch of the unique infrastructure that can be repurposed for the production of this vaccine from another vaccine. The hardware is just very different, particularly those microfluidic units.

Note: I’m purposefully not going anywhere near the financial arguments around why the mRNA vaccines aren’t available in higher quantities. I’m just trying to stick to some lesser known, but very real, technical reasons.

 

[cwbullet]

Cold Chain Management:

The thing about the freezer and refrigeration requirements is that they are standard for the mRNA shots. The compound class, mRNA, is inherently unstable and temperature-sensitive and thus requires this level of cold storage to be effective. I am not sure we will ever get past that.

 

[OverTheTop]

Hi Chuck. Can you please provide me with a source (if you can) on the stats saying that AstraZeneca is inferior to the Moderna and Pfizer for the delta variant. Our government here is saying that the AZ provides better protection from delta compared to the other two. Curious.

I have just had my Pfizer last week and my daughter has signed up for her AZ on the 25th. My wife has has the AZ.

 

[cwbullet]

Hi Chuck. Can you please provide me with a source (if you can) on the stats saying that AstraZeneca is inferior to the Moderna and Pfizer for the delta variant. Our government here is saying that the AZ provides better protection from delta compared to the other two. Curious.

I have just had my Pfizer last week and my daughter has signed up for her AZ on the 25th. My wife has has the AZ.

Right now, I can't. It is based on news stories and preliminary data from research studies. One research article is still in draft form.

The most recent study shows that AZ with two shots is 67% effective against symptomatic disease and 88% against delta (serious disease). I have been reading a few recently published journal articles:
https://www.nejm.org/doi/full/10.1056/NEJMoa2108891
I am pretty sure that AZ and J&J are still fairly helpful against serious disease.

 

[cwbullet]

33-66% effective is still better than our yearly flu shots.

 

[jderimig]

What can we do about covid misinformation going viral all across social media (including this forum)?
I'm not talking about differing opinions, but patently and demonstrably wrong statements.
Masks don't work.
Vaccines don't work.
Vaccines promote the proliferation of dangerous variants.
Should people call out the BS when we see it?
Should we ignore it?
I'm disgusted with it all.

For the offenders I suggest we:
1. Pray for them.
2. Ask the moderators to ban them from dangerous forums.
3. If they have a business, perhaps start a boycott of their products.

 

[Ez2cDave]

Hi Chuck. Can you please provide me with a source (if you can) on the stats saying that AstraZeneca is inferior to the Moderna and Pfizer for the delta variant. Our government here is saying that the AZ provides better protection from delta compared to the other two. Curious.

Let me look . . .

Dave F.