Coronavirus: What questions do you have?

[NOLA_BAR]

The CVS pharmacies in my area have both Pfizer and Moderna readily available as initial doses and boosters. However, you have to pick a location based on the vaccine you want, a particular location only offers one or the other. It appears that the demand now is for boosters, even though completed vaccinations is still under 50%.

 

[cwbullet]

Our local area is experiencing a 75% increase in demand. Part of that is boosters and third shots. The rest is either new children or folks being mandated at work. I have mixed feeling about mandates, but it may be needed to get out of this. Part of me thinks, front line workers owe their customers and patients who are high risk protection from this virus. In the end, we will see where the courts side.

 

[davel]

Got my Moderna Booster yesterday. Side effects - only a slightly sore arm.

 

[BABAR]

Not that I am tracking. The only advantage for Pfizer is availability. I will go get mine in the coming two weeks where ever it is available and with either Pfizer or Moderna. I will not wait for Moderna.

I got Pfizer because it was what I had but mainly because it was what was offered. That said, as far as I can tell there were two major differences between the original vaccines, the Moderna dose was 3 and 1/3 times Pfizer some and the interval between was 4 weeks instead of three for Pfizer. It is likely that either one or both of these differences (and I am betting on the bigger dose) accounted for slightly improved initial protection, perhaps statistically insignificant, with Moderna and a definitely longer lasting more robust immunity with Moderna. The booster shots are also different, with Pfizer booster same dose as primary series, Moderna 1/2 original series, so 5/3 times the Pfizer booster dose (so still a bit more mRNA in the Moderna booster than tha Pfizer booster.)

I still am surprised Pfizer hasn’t adjusted their primary series to either give more in each dose and/or change the interval to match Moderna, or at least run some trials.

question @cwbullet . I know the mRNA codes for the spike protein and apparently also includes an adjuvant which makes it more immunogenic.

1. how hard is it to just MAKE the spike protein and inject it directly, instead of mRNA literally playing the middle man? Can’t we just stick the DNA gene in some E. coli and brew up and purify a bunch of spike protein?

2. Is the adjuvent ALSO generated by mRNA, or is it a separate part of the injection?

 

[cwbullet]

I got Pfizer because it was what I had but mainly because it was what was offered. That said, as far as I can tell there were two major differences between the original vaccines, the Moderna dose was 3 and 1/3 times Pfizer some and the interval between was 4 weeks instead of three for Pfizer. It is likely that either one or both of these differences (and I am betting on the bigger dose) accounted for slightly improved initial protection, perhaps statistically insignificant, with Moderna and a definitely longer lasting more robust immunity with Moderna. The booster shots are also different, with Pfizer booster same dose as primary series, Moderna 1/2 original series, so 5/3 times the Pfizer booster dose (so still a bit more mRNA in the Moderna booster than tha Pfizer booster.)

I still am surprised Pfizer hasn’t adjusted their primary series to either give more in each dose and/or change the interval to match Moderna, or at least run some trials.

question @cwbullet . I know the mRNA codes for the spike protein and apparently also includes an adjuvant which makes it more immunogenic.

1. how hard is it to just MAKE the spike protein and inject it directly, instead of mRNA literally playing the middle man? Can’t we just stick the DNA gene in some E. coli and brew up and purify a bunch of spike protein?

2. Is the adjuvent ALSO generated by mRNA, or is it a separate part of the injection?

1. Interesting idea. I am not sure how well thre spike protein maintains it shape without being encorperated in a cell lining.

2. I am not sure. Currently, the mRNA is stabalized by a lipid.

 

[cwbullet]

And absolutely *no one* who has been in the military is the tiniest bit surprised.

The funny part is a lot of military folks are acting like this have never been done before. Gamma Globulin? Anthrax? Small Pox? Give me a break!

 

[BABAR]

The funny part is a lot of military folks are acting like this have never been done before. Gamma Globulin? Anthrax? Small Pox? Give me a break!

When prepping my squadrons for deployment for Desert Shield in 1990, I had just arrived at Altus AFB. I assisted in administering gamma globulin shots in the heinies of the guys and gals deploying (we were a Tanker squadron.). I also had to give the lecture on chemical warfare agents 2PAM chloride and Atropine. Saddam was threatening to send thousands of U.S. troops back in body bags. As you can imagine, people were tense. I knew somebody needed to do something to lighten things up.

just before my lecture, the Wing Commander (who I had yet to meet) walked in. Meeting hall came to attention and Colonel Clapper came in and took his seat. And I took the podium, a very green Captain straight out of internship.

I figured I had to break the tension somehow. So I announced the results of the underwear contest, since I had seen a lot of it that evening.

SSgt Sarah Johnson got third place for red silk.

Major Mark Thomas got second place fo black and white penguins.

And three people I will not name tied for first with yellow in front and brown in back.


Colonel Clapper just about fell out of his chair laughing, along with most of the rest of the room.

at the end of the briefing, one of my squadron commanders informed me I had a “special invitation” from Col. Clapper to ”accompany” them on the deployment (unfortunately Strategic Air Command regulations overruled him, nobody could deploy until they were fully inprocessed, I had only been on base a week. I did go later.)

 

[cwbullet]

People beg for antibiotics when they have an infection but they resist a vaccine? Does not make sense.

 

[kuririn]

at the end of the briefing, one of my squadron commanders informed me I had a “special invitation” from Col. Clapper to ”accompany” them on the deployment (unfortunately Strategic Air Command regulations overruled him, nobody could deploy until they were fully inprocessed, I had only been on base a week. I did go later.)

Good thing you didn't make any jokes involving the good colonels' name.

 

[RobCamele]

….. Part of me thinks, front line workers owe their customers and patients who are high risk protection from this virus.…

How does one of the vaccines for Covid-19 protect anybody else other than the individual receiving it? To my understanding, they all do a good job preventing severe illness but none of them can prevent infection with the virus nor the spread of it.

 

[cwbullet]

How does one of the vaccines for Covid-19 protect anybody else other than the individual receiving it? To my understanding, they all do a good job preventing severe illness but none of them can prevent infection with the virus nor the spread of it.

Good and fair question. Getting the vaccine will reduce the likelihood that you will spread the vaccine. If you are vaccinated, you are providing some protection for your family friends, and cowrokers. It is not as good as them being vaccinated but it is protection.

t depends on how you define "prevent". Too many folks think that prevent means eliminate. Think more in terms of reducing.

 

[cwbullet]

What will antibody levels tell me?

Anybody levels are not great at indicating immunity to COVID. Far too many folks are assuming that they can be tested for immunity with a simple antibody test. A better test is a neutralization assay, but these are often less available and expensive. Neutralization assays basically look at the dilution of your antibody-containing serum that it takes to eliminate 50% of the virus.

What do neutralization assays show? Natural infection with wild-type virus generally confers a titer of 1:400. With Delta, that gets bumped down to 1:100. This is why delta is so dangerous. The immunity conferred by the mRNA vaccines lands at a titer of 1:1,000 when looking at the original virus. Because they are not widely available, we cannot test true immunity.

 

[Marc_G]

How does one of the vaccines for Covid-19 protect anybody else other than the individual receiving it? To my understanding, they all do a good job preventing severe illness but none of them can prevent infection with the virus nor the spread of it.

As always Chuck gets to the root of it. But let me add a few more specifics from my perspective:

Latest figures (factoring in the Delta variant) suggest the vaccines reduce the chance of getting COVID-19 by a factor of 6. So, if you get the vaccine and are one sixth as likely to get infected, you start off being a sixth as likely to spread it out the outset. That's protecting others.

But, if you are a breakthrough case (vaccinated and infected), you are likely to have a case that lasts 1/2-1/3 as long as the case of an unvaccinated person. So, you will be infectious for less time. That's protecting people.

And, if you are vaccinated, you are something like 1/10th as likely to need to go to the hospital with a severe case. By "freeing up" those hospital beds, you are keeping the hospital ready to receive other patients, thus protecting them (be they covid patients, heart attacks, or any other urgent care need).

By being vaccinated, the likelihood that covid will be replicating in you and spawning new variants that could be more infectious than delta is greatly reduced, thus protecting others.

As Chuck said, protection doesn't mean eliminating all risk, it's about reducing the likelihood of spread at each step that confers the protection. That's why even vaxxed folks need to keep wearing masks in relatively high risk situations... we aren't likely to be infected/infectious, but we COULD BE, and that's why masking for source capture works well if everybody does it. You NEVER know who might be an asymptomatic spreader. Until the numbers drop low enough, it's prudent to mask.

 

[cwbullet]

As always Chuck gets to the root of it. But let me add a few more specifics from my perspective:

Latest figures (factoring in the Delta variant) suggest the vaccines reduce the chance of getting COVID-19 by a factor of 6. So, if you get the vaccine and are one sixth as likely to get infected, you start off being a sixth as likely to spread it out the outset. That's protecting others.

But, if you are a breakthrough case (vaccinated and infected), you are likely to have a case that lasts 1/2-1/3 as long as the case of an unvaccinated person. So, you will be infectious for less time. That's protecting people.

And, if you are vaccinated, you are something like 1/10th as likely to need to go to the hospital with a severe case. By "freeing up" those hospital beds, you are keeping the hospital ready to receive other patients, thus protecting them (be they covid patients, heart attacks, or any other urgent care need).

By being vaccinated, the likelihood that covid will be replicating in you and spawning new variants that could be more infectious than delta is greatly reduced, thus protecting others.

As Chuck said, protection doesn't mean eliminating all risk, it's about reducing the likelihood of spread at each step that confers the protection. That's why even vaxxed folks need to keep wearing masks in relatively high risk situations... we aren't likely to be infected/infectious, but we COULD BE, and that's why masking for source capture works well if everybody does it. You NEVER know who might be an asymptomatic spreader. Until the numbers drop low enough, it's prudent to mask.

That is one great summary - The bottom line: Get freakin vaccinated.

 

[BABAR]

That's why even vaxxed folks need to keep wearing masks in relatively high risk situations... we aren't likely to be infected/infectious, but we COULD BE, and that's why masking for source capture works well if everybody does it. You NEVER know who might be an asymptomatic spreader. Until the numbers drop low enough, it's prudent to mask.

Regarding continued mask wear, absolutely true that vaccinated people can get and spread virus and masks reduce that probability.

But even more so is that "human" factor. Masks are inconvenient, and people that are, for whatever reason, vaccine averse, are equally likely to skip mask wearing even though THEY are the most critical people to wear masks. I remember being in the supermarket early after vaccination started, with the overhead announcement droning over and over that "Vaccinated people no longer need to wear masks. Unvaccinated people should still wear masks." I WAS wearing a mask and l I HAD been vaccinated. I was about the only person in the store with a mask, and I guarantee you (especially since this was early in the vaccination phase when vaccinations had just been extended to the general public) that many if not MOST people in the store were NOT vaccinated and NOT wearing masks. So like @ThirstyBarbarian said, you have to make the rule for everybody unless you have a way of marking those who have been vaccinated, and THAT is not a road I want to travel.

Latest tally at our local hospital, 82% of Covid patients NON-vaccinated.

 

[cwbullet]

Latest tally at our local hospital, 82% of Covid patients NON-vaccinated.

There is some variability but the average is close to this,

 

[Bat-mite]

Regarding continued mask wear, absolutely true that vaccinated people can get and spread virus and masks reduce that probability.

But even more so is that "human" factor. Masks are inconvenient, and people that are, for whatever reason, vaccine averse, are equally likely to skip mask wearing even though THEY are the most critical people to wear masks. I remember being in the supermarket early after vaccination started, with the overhead announcement droning over and over that "Vaccinated people no longer need to wear masks. Unvaccinated people should still wear masks." I WAS wearing a mask and l I HAD been vaccinated. I was about the only person in the store with a mask, and I guarantee you (especially since this was early in the vaccination phase when vaccinations had just been extended to the general public) that many if not MOST people in the store were NOT vaccinated and NOT wearing masks. So like @ThirstyBarbarian said, you have to make the rule for everybody unless you have a way of marking those who have been vaccinated, and THAT is not a road I want to travel.

Latest tally at our local hospital, 82% of Covid patients NON-vaccinated.

The people that I know who have refused the vaccine also won't wear masks. They see it as a violation of their Constitutional freedoms to do either one. And talking to them about just serves to end friendships.

 

[cwbullet]

The people that I know who have refused the vaccine also won't wear masks. They see it as a violation of their Constitutional freedoms to do either one. And talking to them about just serves to end friendships.

Well, hopefully, their indignation does not lead to an end of their lives or yours for that matter.

 

[BABAR]

And talking to them about just serves to end friendships.

Yup. Ended a business relationship for me. I simply asked if he had been vaccinated, previously pleasant and mutually beneficial building agreement ended immediately. Acted as if I asked if he was a member of cult that nuked baby seals.

 

[Rocketjunkie]

Well, hopefully, their indignation does not lead to an end of their lives or yours for that matter.

I don't care if they die. Threatening others is NOT acceptable. There is plenty of vaccine available. If they refuse to get vaccinated and get sick, they should not expect to be treated at taxpayer expense!

 

[NateB]

Our covid admissions and vent use are improving. For the EMS and critical care transport side, we're all still pulling extra shifts and it seems like we're held late more than not and still going to a few places outside our normal referral patterns.

If Delta is winding down, are there more variants that could be as bad or are we on the way to covid becoming an endemic disease? Do you/they have any better estimates on flu and pneumonia this year?

 

[Reinhard]

1. how hard is it to just MAKE the spike protein and inject it directly, instead of mRNA literally playing the middle man? Can’t we just stick the DNA gene in some E. coli and brew up and purify a bunch of spike protein?

Among others, Novavax is working on that type of protein based vaccine:
https://en.wikipedia.org/wiki/Novavax_COVID-19_vaccine
Reinhard

 

[tab28682]

Ok. We are in the vicinity of 2/3 of US citizens being vaccinated.

Some number of the remaining 1/3 unvaxed have either had symptomatic Covid and were treated for it (or not treated) and some larger number have actually had Covid with little or no symptoms and were not treated for it.

(The guy I got it from at work last year is a Covid denier and extreme antivaxer, so he falls into the first of the unvaxed catagory above. BTW, he is resigning at the age of 64, a couple of years shy of retirement, from an excellent job in the defense industry rather than get a mandatory vaccination by Dec 8. Sigh)

Anyone have any numbers for the last two catagories nationwide?

Counting the vaxed and the other two categories, we ought to be approaching at least 70-75% of the US having at least some, if not a lot, of Covid protection in their blood.

Discounting mutations, how close are we to herd immunity?

 

[cwbullet]

Our covid admissions and vent use are improving. For the EMS and critical care transport side, we're all still pulling extra shifts and it seems like we're held late more than not and still going to a few places outside our normal referral patterns.

If Delta is winding down, are there more variants that could be as bad or are we on the way to covid becoming an endemic disease? Do you/they have any better estimates on flu and pneumonia this year?

Same here. We are down to almost zero.

 

[ksaves2]

Got my Moderna Booster yesterday. Side effects - only a slightly sore arm.

Holee guacamole. I received my third Moderna Tuesday the 26th and ached all night long and was totally useless the next day. I ached all over and felt sh*tty (malaise) the entire next day. Good thing I'm retired and didn't have to go to work! Back to normal now.
I take it my immune system was "really" activated this time! My symptoms were non-specific with aches and feeling "icky". Small price to pay. My neighbor Barbara who is under treatment for rheumatoid arthritis is very concerned in that she had "zero" side effects from the vaccine. I agree with her as immunosuppressive drugs are used in RA and could suppress the immune response. I haven't had a chance to talk to her and see if she experienced any symptoms after the 3rd shot. We're protected somewhat due to the rural area but still live in a town of 14,022 folks. Had 78 deaths in the county of mostly unfortunate elderly patients with co-morbid conditions and a total of 5,307 cases county wide with a population of 35,733 in the county.
The pharmacist who gave me the 3rd shot said he was worried that Covid vaccine might become a yearly thing like flu vaccine. It's still too early to say though. Flu shifts and drifts hence the yearly recommendation. Hope Covid can't do that as well.

Kurt

 

[NOLA_BAR]

Holee guacamole. I received my third Moderna Tuesday the 26th and ached all night long and was totally useless the next day. I ached all over and felt sh*tty (malaise) the entire next day. Good thing I'm retired and didn't have to go to work! Back to normal now.
I take it my immune system was "really" activated this time! My symptoms were non-specific with aches and feeling "icky". Small price to pay. My neighbor Barbara who is under treatment for rheumatoid arthritis is very concerned in that she had "zero" side effects from the vaccine. I agree with her as immunosuppressive drugs are used in RA and could suppress the immune response. I haven't had a chance to talk to her and see if she experienced any symptoms after the 3rd shot. We're protected somewhat due to the rural area but still live in a town of 14,022 folks. Had 78 deaths in the county of mostly unfortunate elderly patients with co-morbid conditions and a total of 5,307 cases county wide with a population of 35,733 in the county.
The pharmacist who gave me the 3rd shot said he was worried that Covid vaccine might become a yearly thing like flu vaccine. It's still too early to say though. Flu shifts and drifts hence the yearly recommendation. Hope Covid can't do that as well.

Kurt

I got mine last Friday. About the same as the second shot. Slight fever, body aches, chills, etc.

 

[ksaves2]

I got mine last Friday. About the same as the second shot. Slight fever, body aches, chills, etc.

You're lucky. I wouldn't have been able to work with the symptoms I had after the third. Would have been too hard for me to concentrate. The second Moderna shot really didn't bother me much at all. Felt a little "weird" but I still would have been able to keep my mind on my work. Ibuprofen helped immensely at that time but not so much so after the third vaccine shot. I just had to power through it to normalcy today. I used to M.D. for a living until I retired July 2020. I missed out on all the fun and games with the ventilator patients in the ICU. I do have an excuse though to retire as I was widowed and am the sole surviving spouse that takes care of an adult mentally handicapped son. He's doing well and I can take him to launches with no problems. If I got sick and died, his sister would either have to take care of him or get him placed somewhere. I want to put off the latter as much as possible.
Kurt

 

[kuririn]

Holee guacamole. I received my third Moderna Tuesday the 26th and ached all night long and was totally useless the next day.

I got mine last Friday. About the same as the second shot. Slight fever, body aches, chills, etc.

Got my third Pfizer shot a couple of weeks ago.
No ill effects.
Neener, neener.

 

[Marc_G]

My booster will be Monday. Based on data review I'm planning on getting the Moderna.

 

[ksaves2]

Got my third Pfizer shot a couple of weeks ago.
No ill effects.
Neener, neener.

Lucky you! If you're younger, I'm envious. Being a 65 y/o oldster I'm actually heartened by the fact I had a bit of a reaction to suggest my immune system went into overdrive. Yeah the true scientists out there would say, "How do you know you didn't react to one of the excipients in the vaccine?" Ahhhhhh, the early data suggests that the vaccines prevent serious infection was enough for me to get it. Plus I was in med school in the very late 70's early 80's and a virologist professor hammered into us that the pharmaceutical companies are being as fastidious as possible to prevent a recurrence of the swine flu debacle of the mid-70's. I had the swine flu vaccine as a 19 year old and didn't bother me.
(The interested can google it.)

As an aside, when the first hepatitis B vaccine came out, it was derived from human serum. Who was donating serum at that time? A lot of marginalized people like drug addicts and gay men. This was early on before HIV exploded onto the scene. I got the series in 1982 and later found out Merck had a spaz attack when HIV reared its ugly head. They were using human serum for vaccine production and the liability issues were tantamount. Give HIV to "regular folks" through a vaccine and the company might as well go bankrupt. Again, one can google this but there are just a few blurbs on it.

I had some inside info that Merck rented a large factory building, put a vaccine production line inside of it and then purposely ran known HIV infected serum through the standard production line. Probably to their relief, they discovered their vaccine production technique killed the HIV virus 100% of the time. Hence, I'm able to write this as I'd be dead by now if I acquired HIV in the early 80's. My series likely was from human derived sources and we were strongly encouraged to get the Hep-B vaccine. An older surgeon (who was in WWII) told us that hepatitis b screwed up his life and ability to make a living as a surgeon for two years. He was all for it.

Subsequent to this, recombinant DNA research was on the rise and using this, they were able to "train" the common gut bacteria, e. coli to "make" the needed proteins for Hep B vaccine production without any human serum input. So take your Hep B vaccine without fear now. I think they give it to kids if I'm not mistaken. (Excuse me I did geriatrics so not in much pediatric "know how here".)
Kurt Savegnago, M.D. (retired)