Covid Vaccines

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aerostadt

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Covid-19 technology and big business is here to stay. This year is just the start.
 

ksaves2

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Kurt,

CHF is still rare with COVID in the young, but Sudden Cardiac Death and CHF with an ejection fraction of 40 or less is scary. We have had a large number of infections in the military and less than 20 deaths, but we are struggling with how to manage a return to full activity after what might have been very large stress on the body.

I am seeing some patients appear to game the system, but I have to believe that is rare. I hope.
Yeah,

I hate gamers and glad I was able to retire from medicine last July. I had some chronic pain people I was convinced they were absolutely in pain. Many were quite old and didn't have any secondary gain. Some of the younger people I had my doubts but some I was convinced had complex regional pain syndrome which is an absolute b1tch to deal with as a sufferer and physician to try to treat.
Unfortunately I suspect some uncomplicated survivors of Covid might game the system. That is way too bad because I think there are unfortunate Covid survivors who have long term problems after a "recovery". Will make it hard for practitioners to sort out and treat appropriately.
I had a guy in his late 40's early 50's who had an absolutely horrendous viral pneumonia over 15 years ago (not Covid obviously). Sent him to a tertiary care center and was on a ventilator for 2 weeks. They tested him for everything and couldn't find the source of infection. Chest x-ray looked like crap so this was a real issue. When he was discharged, he was obviously cognitively impaired and eventually was placed on disability. Used to drive a semi truck that hauled hazardous materials and couldn't do it anymore.

Kurt
 

ksaves2

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These vaccines are in their infancy. Data will change over time as we get more numbers.
Yup,

In the ensuing years expect to see a pile of data coming out on the vaccines and even the "long" term effectiveness of masks and such. (I wear an N95 out in public mind you. Swiped a bunch before I retired! :))
 

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New research from the Marine Corps shows that the virus is 80% effective at preventing symptomatic COVID. I just started two studies. One to look at vaccination vs infection vs infection with vacination and the immune response. A second to look at asymptomatic spread after vaccination.
 

Zeus-cat

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New research from the Marine Corps shows that the virus is 80% effective at preventing symptomatic COVID. I just started two studies. One to look at vaccination vs infection vs infection with vacination and the immune response. A second to look at asymptomatic spread after vaccination.
I think you meant vaccine is 80% effective...
 

cwbullet

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Looks like J&J might be available on an EUA in a few weeks to a month. Sooner than expacted.
 

SharkWhisperer

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The Moderna early Phase 3 efficacy and safety report just came out tonight in the New Engl J Med. The full text is available at: https://www.nejm.org/doi/full/10.1056/NEJMoa2035389?query=TOC . If anybody has difficulty downloading it, I'm happy to email a copy. If anybody has questions about data interpretation and limitations, I'm a medical researcher and happy to clarify in more digestible terms.

Edited because I momentarily forgot how to properly spell.
 
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FMarvinS

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Thanks for posting. However, no surprises. Of note this analysis encompassed the period between July 27 and Oct 23, 2020. How much exposure to newer SARS-CoV-2 variants was not reported. The J and J vaccine efficacy is lower in part due to subject enrollment in areas where there was a high risk of exposure to the South African variant and the Brazilian variant. For somewhat more objective comparisons between the available (or soon to be) vaccines, this critical info is required; otherwise, its like comparing apples to oranges. This point is exemplified by noting that for the J and J vaccine, efficacy in the U.S.A. was reported at 72% while that in South America and Africa was below 60%. Most likely the high exposure rate respectively to the Brazilian variant (in South America) and the South African variant (in Africa) affected these efficacy rates. The J and J statistical assessment was done while limited exposure to both variants was documented in the U.S.A.
 

SharkWhisperer

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Thanks for posting. However, no surprises. Of note this analysis encompassed the period between July 27 and Oct 23, 2020. How much exposure to newer SARS-CoV-2 variants was not reported. The J and J vaccine efficacy is lower in part due to subject enrollment in areas where there was a high risk of exposure to the South African variant and the Brazilian variant. For somewhat more objective comparisons between the available (or soon to be) vaccines, this critical info is required; otherwise, its like comparing apples to oranges. This point is exemplified by noting that for the J and J vaccine, efficacy in the U.S.A. was reported at 72% while that in South America and Africa was below 60%. Most likely the high exposure rate respectively to the Brazilian variant (in South America) and the South African variant (in Africa) affected these efficacy rates. The J and J statistical assessment was done while limited exposure to both variants was documented in the U.S.A.
Acually, the interim reporting included efficacy data up to Nov 11 and the current report includes all efficacy data through Nov 21, so...not Oct 23. That date was the last day of subject enrollment and randomization into the study. The Moderna protocol has a follow-up of up to 2 years (potentially), so initial results will likely change a bit.

And yes, covid variant subanalyses will be valuable, for all vaccines in development or circulation; that said, most current variants have probably been circulating for much longer than their first identification--this is usual and an expected (and acknowledged) study limitation. There will be genotyping studies defining variant spread and response to vaccines given enough time, and that's important information, but not the current foci of the key players quite yet.
 
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ksaves2

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Viruses:

Very interesting, some say "pseudo" life form who's only goal is to infect and reproduce. That's it.
Kurt
 

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Question: Why is the CDC pushing 2 doses if one does is 60-90% effective?

Answer: We think and research supports the theory that 2 shots will provide longer immunity than a single shot.
 

SharkWhisperer

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Question: Why is the CDC pushing 2 doses if one does is 60-90% effective?

Answer: We think and research supports the theory that 2 shots will provide longer immunity than a single shot.
Remember that the J & J "one-shot" vaccine dosing was earth-shattering news that would have great advantage. Single dosing would for sure reach many more people Yes. In theory. But it wasn't so effective at 1 dose, which is why J & J (and others) modified their protocol and have added a study arm (large) that is receiving two doses, just like the rest.

And I know of absolutely zero covid vaccines that achieve anywhere even remotely close to 90% effectiveness after a single dose--no study I've read, and I'm in the business. Remember that you need a huge study to demonstrate 1-dose effectiveness, and there's limited results available because it's only a 3-4 week analysis window before they get their second shot, so...greatly constrained data. Of the existing (Pfizer/Moderna) US vaccines, a single dose offers some protection after a week (and before their next dose), but it's not remarkable--around 50%, but data are weak because subject numbers in that group are comparatively low, and nobody yet has beyond a clue as to how long protection will last, or how robust that protection actually is. The reason boosters were designed in the first place.

This is not going away. This will likely turn into an annual (or semi-annual) bonanza for pharma, even better than the flu vaccine. Forever money. But it's important. Vaccines don't prevent infection, but they can minimize symptoms (no severe disease, no "long" covid, which is rather disconcerting and you just do not see with other respiratory viruses such as influenza) and probably reduces your viral load to subclinical levels, meaning you carry the virus (under constant assault by your body) but viral load (numbers) are reduced, so you're less likely to pass on an infection to an unprotected individual. This could have critical positive health implications, and may be a small driving force in the dramatic reduction of new cases in the past 2 weeks in the US(the other being that there is quite a bit more immunity/relative immunity because the number of actual covid patients has likely been vastly underreported the whole time.

We are still learning the length limitations of immunity duration, whether as a result of natural infection or due to vaccines. Looking like it won't be much more than half a year, from top-line data from studies, and serological studies on previously infected people. And then there's the variants...
 

dr wogz

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at least you guys get the vaccines!

We (Canada) seem to be getting the run-around from Pfizer & Moderna.. Those two seem to be short-supplying us every shipment.. (even a week or two with no doses received..)




 

SharkWhisperer

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at least you guys get the vaccines!

We (Canada) seem to be getting the run-around from Pfizer & Moderna.. Those two seem to be short-supplying us every shipment.. (even a week or two with no doses received..)




They overextended themselves making too many promises to too many countries. Manufacture and shipping/distribution has fallen behind in the US, too. Perhaps, surprisingly, one of the limiting factors (there are several), at least at the start, was the shortage of suitable glass vials/bottles for packaging! Also, they are expending a lot of resources experimenting with new mRNA sequences to eventually make new vaccine formulations against the evolving (never-ending) viral variants. But they've received a TON of $$ from the government tax payers, and will be rolling in money for the foreseeable future (Pfizer and Moderna were NOT vaccine manufacturers before covid), so that's really no excuse. They've done ok but could and can do better...
 

modeltrains

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Perhaps, surprisingly, one of the limiting factors (there are several), at least at the start, was the shortage of suitable glass vials/bottles for packaging!
Actually, having been in and out of retail from 1980s to 2000s, and briefly in to auto parts delivery, that doesn't surprise me at all.
It's not like the glass vial subcontractor is going to have a hundred million surplus vials sitting for a decade just in case in a rented warehouse & then go test them all every six weeks to make sure the seals are not deteriorating.
 

FMarvinS

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With respect to the duration of protective antibodies either from post-infection or the new vaccines, studies are incomplete. Thus, a lot more needs to be scientifically studied please see below:
1. For example there are 2 pools of sources of viral neutralizing antibodies, initially from a peak after after early infection that involves an initial drop in anti-SARS-CoV-2 antibody synthesis due to a decay of specific B cells (cells that produce antibodies) and after 6 months a slower decay from bone marrow plasma cells (B cells committed to produce, in this case-anti-SARS-CoV-2 antibodies). Most studies to date have only examined antibody duration up to 6 months and did not examine the secondary antibody production from the bone marrow plasma cells which require more than 6 months of sequential assessment.
2. Furthermore, appropriate study would measure the concentration of anti-viral neutralizing antibodies by plaque reduction neutralization assays which is not often done (need a CLIA level-3 viral lab).
3. In addition, T cell (anti viral immune cells) play a role in fighting viruses and very little has been studied to date with regards to SARS-CoV-2 immunity.
4. Even with low anti-viral neutralizing antibodies present, for those with previous infection or vaccination, memory B cells have an anamnestic response that results in renewing the production of (in this case) anti-SARS-CoV-2 neutralizing antibodies. By extrapolation, in previous studies about SARS-CoV-1 infections, specific antibody titers were demonstrated after 3 years post-infection.
Thus, a lot more research is indicated before we are thoroughly informed about the duration of immunity resulting from infection or vaccination. Much of this is reviewed in a recent article in Nature for those interested
(https://www.nature.com/articles/s41467-020-20247-4).

Fred, L2
ICBM, S.C.
KG4YGP
 

BABAR

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Ez2cDave

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Unfortunately there are bad apples in every job category, including healthcare workers.

at least for the time being, every dose declined is likely to find another recipient.
How are people, with medical training and experience, "bad apples", when they make a personal medical decision, based on their qualifications ?

Excerpt from the article :

"A recent survey by the Kaiser Family Foundation found that 29% of healthcare workers were “vaccine hesitant,” a figure slightly higher than the percentage of the general population, 27%."

End excerpt :

Dave F.
 

BABAR

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How are people, with medical training and experience, "bad apples", when they make a personal medical decision, based on their qualifications ?

Excerpt from the article :

"A recent survey by the Kaiser Family Foundation found that 29% of healthcare workers were “vaccine hesitant,” a figure slightly higher than the percentage of the general population, 27%."

End excerpt :

Dave F.
Fair point. U.S. is a relatively free country (there are certainly restrictions as in any civilized society, but overall I think less than most countries) and people including Healthcare professionals have the right to decline. In my opinion (humble or otherwise) vaccination, although not without risk, is the only way as a nation we are going to come out of this close to intact. It is therefore (again in my opinion) incumbent on the leaders and healthcare professionals to be the example. My opinion may well turn out to be wrong, and it is certainly possible that there may be unforeseen (or perhaps to more intelligent vaccine rejecting people, FORESEEN) consequences down the road that make this a bad individual and national decision. But when government leaders and healthcare professionals fail to lead, the people of a nation have no one to follow.

you are correct, name calling even in the form of “bad apples” is probably not my best choice of words. But I also don’t see those declining vaccinations coming up with a good alternative.

I guess it comes down to me being disappointed that some healthcare professionals are making this choice, as I think it encourages others to make the same choice.

a recent article suggested that if a vaccine was 100% effective, it would still take 70 percent of the population to get vaccinated to get to herd immunity. But even the best vaccines currently out there are only quoted as 95% effective, at this level it take a 90% or higher vaccination rate to get to heard immunity. Some of the newer vaccines are showing a lower effectiveness rate, although this may be in part to new strains of the virus which may also reduce the effectiveness of the Pfizer and Moderns vaccines currently touted at 95%.

ESPECIALLY discouraging is SURVIVOR immunity of those recovered from Covid may not be as robust or lasting as we thought, so previous infections may NOT be as helpful in achieving herd immunity as we thought. To be fair, however, with the variants popping up effective vaccines are likely also a potential ”moving target”.

if close to 30% of the population declines immunization, the End of this scourge may be indefinitely beyond reach.

I keep thinking, “Those that aim at nothing are highly likely to hit it.”
 

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Reminds me of:

Q: What do you call the person that graduated at the very bottom of their medical school class?

A: "Doctor"


Same with RNs, LPNs, nursing assistants, transporters, EMTs, all of which are in the cadre of health care workers.
 

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Reminds me of:

Q: What do you call the person that graduated at the very bottom of their medical school class?

A: "Doctor"


Same with RNs, LPNs, nursing assistants, transporters, EMTs, all of which are in the cadre of health care workers.
That initially sounds funny.
But having watched a few people go through medical school and nursing school I have the opinion that the really-weak are weeded out LONG before graduation. And knowing what they have gone through for the last 14 mos. we should consider ourselves lucky that a few decide to pursue the profession to the conclusion.
Simply being successful requires more effort and successes than the majority of the population is willing to do.

Military and law enforcement get the same accolades for commitment and sacrifice.
I'm not ranking either against the other, just be thankful they choose to do it or we would not have the life we have.
 

SharkWhisperer

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Well unfortunately, my experience and observations differ from yours. One of the hardest parts of medical school is acceptance. And some slip by that should never have been there. It is very difficult to get "removed" or flunked out of medical schools because any significant attrition rate would reflect very very poorly on the institution.

And I have known many brilliant doctors and nurses. Unfortunately, I've also known a couple of both that were abject idiots who left me wondering "just...how?".

"
 

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And I have known many brilliant doctors and nurses. Unfortunately, I've also known a couple of both that were abject idiots who left me wondering "just...how?".

"
Shouldn't the fault be assigned to the institutions then? :confused:

I'm not sure that the hardest part is getting accepted. The hours spent to get through it are astronomical.
 

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My wife teaches nursing and it is a lot more work to fail a student than to pass them. Interestingly, at some level of study if a student fails the institution has to pay the government back all the monies it paid towards that student's attempt at education, so there could also be pressure from admin to get more students through. Even if the student is such a dud that they should never have been enrolled in the first place. My wife will always fail a student who is not competent, but other educators don't want the extra work involved and summarily pass their students. What could possibly go wrong?
 

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My medic class was through a hospital and accredited by a state university. There was an interview process to get in that involved written essays, oral interviews with the instructor and medical director of the course, and physical qualification. 14 started, and 9 graduated. Of the 9 of us who finished, there is one woman I can't account for. She left the state and nobody has talked to her since. For the rest of us, a couple of us fly and the others are in leadership positions. I think that speaks well of our instructors that almost everyone who graduated is in the top of our chosen field after 12 years.
 
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Ez2cDave

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AP-NORC poll: A third of US adults skeptical of COVID shots

https://www.aol.com/news/ap-norc-poll-third-us-125919712-141333449.html

February 10, 2021, 8:13 AM

NEW YORK (AP) —

About 1 in 3 Americans say they definitely or probably won’t get the COVID-19 vaccine, according to a new poll that some experts say is discouraging news if the U.S. hopes to achieve herd immunity and vanquish the outbreak.

The poll from The Associated Press-NORC Center for Public Affairs Research found that while 67% of Americans plan to get vaccinated or have already done so, 15% are certain they won't and 17% say probably not. Many expressed doubts about the vaccine's safety and effectiveness.

The poll suggests that substantial skepticism persists more than a month and a half into a U.S. vaccination drive that has encountered few if any serious side effects. It found that resistance runs higher among younger people, people without college degrees, Black Americans and Republicans.

Dr. Anthony Fauci, the government’s leading infectious-disease scientist, has estimated that somewhere between 70% and 85% of the U.S. population needs to get inoculated to stop the scourge that has killed close to 470,000 Americans. More recently, he said the spread of more contagious variants of the virus increases the need for more people to get their shots — and quickly.
So is 67% of Americans enough?

“No. No, no, no, no,” said William Hanage, a Harvard University expert on disease dynamics. He added: “You’re going to need to get quite large proportions of the population vaccinated before you see a real effect."

Nearly 33 million Americans, or about 10% of the population, have received at least one dose, and 9.8 million have been fully vaccinated, according to the Centers of Disease Control and Prevention.

The poll of 1,055 adults, taken Jan. 28 through Feb. 1, provides insight into the skepticism.

Of those who said they definitely will not get the vaccine, 65% cited worries about side effects, despite the shots' safety record over the past months. About the same percentage said they don’t trust COVID-19 vaccines. And 38% said they don’t believe they need a vaccine, with a similar share saying that they don’t know if a COVID-19 vaccine will work and that they don't trust the government.

Of those who probably will not get the vaccine but have not ruled it out completely, 63% said they are waiting to see if it is safe, and 60% said they are concerned about possible side effects.


“I don't trust pharmaceuticals. I really don't. And it doesn't sound like it's going to be safe,” said Debra Nanez, a 67-year-old retired nurse from Tucson, Arizona.

Nanez said she has gotten flu and pneumonia shots but is concerned about rumors about what's in the coronavirus vaccine, and her friends have the same hesitation.

"It would take a while for me to do research on it to make sure it's safe. I just don't want to take anything that's going to harm me," she said.

Baron Walker, a 42-year-old laid-off insulation installer from Parkersburg, West Virginia, said he is in the “probably not” column, at least for now.

He said that if he were elderly, or lived in a densely populated area, he might consider the vaccine more strongly. But he is in rural part of the country, he has been wearing a mask and social-distancing, and he feels there is a good chance the nation will achieve herd immunity, he said.

"I feel like I have plenty of time before I get a chance to get (the vaccine) anyway, to find out if there are bad side effects and whether it’s even worth getting it,” Walker said.

In interviews, some Americans expressed concerns about the revolutionary speed with which the vaccines were developed — less than a year.

“I feel like they rushed it,” Walker said.

That was echoed by Matt Helderman, 31, of Greer, South Carolina.

“I’d like to see more safety data,” said Helderman, a video editor and associate producer for a Christian TV program. He also said that he would like to see more clarity on whether the vaccine is effective against new variants.

Health officials are trying to counter concerns about the vaccine with science.

The latest evidence indicates that the two vaccines being used in the U.S. — Pfizer’s and Moderna’s — are effective even against the variants, Fauci said.

Also, while the development of the vaccines was unusually fast, it was the culmination of many years of research. And the vaccines went through clinical trials involving thousands of people who were monitored for 60 days after their last dose. Studies of other vaccines have found that harmful side effects almost always materialize within 45 days.

“Safety certainly was not compromised, nor was scientific integrity compromised,” Fauci said. “Many have reason for skepticism. But I think that when you explain the facts and the data to them, you can win them over.”

The survey found that older Americans, who are more vulnerable to COVID-19, are especially likely to say they have received a shot or will probably or definitely get vaccinated. Four in 10 of those under 45 say they will probably or definitely not get a vaccine, compared with a quarter of those older.

Black Americans appear less likely than white Americans to say they have received the shot or will definitely or probably get vaccinated, 57% versus 68%. Among Hispanic Americans, 65% say they have gotten or plan to get the vaccine.


Public health experts have long known that some Black Americans are distrustful of the medical establishment because of its history of abuses, including the infamous Tuskegee study, in which Black patients with syphilis were left untreated so that doctors could study the disease.

Americans without a college degree are more likely than college-educated ones to say they will definitely or probably not get vaccinated, 40% versus 17%. And Republicans are more likely than Democrats to say that, 44% versus 17%.
___
The AP-NORC poll of 1,055 adults was conducted Jan. 28-Feb. 1 using a sample drawn from NORC’s probability-based AmeriSpeak Panel, which is designed to be representative of the U.S. population. The margin of sampling error for all respondents is plus or minus 3.8 percentage points.
___
Online:
AP-NORC Center: https://www.apnorc.org/.
___
The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.
 

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AP-NORC poll: A third of US adults skeptical of COVID shots
I am sure this will be one way of weeding out some of the population. It also will leave more shots for patients like the ones that have died in our hospitals over the last week.
 

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I am sure this will be one way of weeding out some of the population. It also will leave more shots for patients like the ones that have died in our hospitals over the last week.
It's not just the USA. In Tanzania last week or the one before, their president said that vaccines were useless and the cure was hard labor and to inhale steam while praying. In Iran, the clerics (vaccinated no doubt) publicly stated last week that vaccines caused homosexuality. And waaaay back in 2006, shortly after I worked a bit at the Cape Heart Center at Groote Schuur Hospital in Capetown (first heart transplant there--Barnard in late '60s), then Health Minister advised treating HIV with "lemon, beetroot, and garlic".

Yes, it's new, and the first mRNA vaccine/biological ever approved for general public distribution, so caution is not unreasonable. But new safety and efficacy data roll in daily, for the Pfizer, Moderna, Astra-Zenica/Oxford, and many other candidate vaccines and treatments undergoing trials, with a longer follow-up periods naturally accumulating over time.
 

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