SARS-CoV-2 and COVID-19 (24...)

Delta Has Changed the Pandemic Risk Calculus
If you’re confused about what you can do right now, you should be.
Amanda Mull | 8/18/2021

...Try thinking about precautions in non-pandemic terms, (Tara Kirk Sell, a researcher who studies risk communication at the Johns Hopkins Center for Health Security) advises. Every day, people follow safety rules that might not be personally necessary for them, but that also aren’t onerous enough to be harmful—doing so is simply part of living in a society in which you share norms and risk with those around you...So, yes, you can probably find it within yourself to continue to wear a mask at the grocery store if the infection rate is growing in your area. You probably do other stuff on that same logic all the time.

...It can be difficult to feel like you’re doing the right thing when what that means is so different from person to person, depending on their particular circumstances...

Americans will likely be riding this roller coaster of risk assessment for some time. Periods of confusion are natural as we learn what waves of the Delta variant under the country’s modest-at-best safety protocols look like, and we’ve yet to see how swiftly the next wave can be expected after one ends. People are tired of good behavior, and they’re tired of self-abnegating to protect others whom they perceive as refusing to protect themselves, even if that’s not an accurate understanding of why many people have yet to be vaccinated. Right now, the best that most people can do is continue to control whichever straightforward variables they can—get vaccinated, sit outside when possible, choose places that require proof of vaccination over those that don’t, avoid visiting Grandma or your cousin’s new baby the week after attending an indoor concert with a thousand screaming people, get a test if your throat is sore. The situation we’re all in is extremely complicated, but the best ways to keep yourself and others safe still aren’t.

https://www.theatlantic.com/health/archive/2021/08/delta-variant-pandemic-risk-s...

Togo vaccinates over 90% of health workers against COVID-19
WHO | Aug 19, 2021

...Togo’s fast and efficient deployment of vaccines to date has been helped by a substantial provision of doses through the COVAX facility, which aims to achieve equal vaccine access for all...

https://www.afro.who.int/news/togo-vaccinates-over-90-health-workers-against-cov...

Why A Push For Boosters Could Make The Pandemic Even Worse
Michaeleen Doucleff | August 18, 2021

U.S. believes you don't have to sacrifice boosters to help the rest of the world
But much of the world lags far behind wealthy countries in vaccine supply
You don't have to turn down a booster, but there are ethical issues for world leaders to consider

...Any available vaccine should first go to people around the world who are at high risk of hospitalization and deaths, said Dr. Michael Ryan of the WHO. "If we think about this in terms of an analogy, we're planning to hand out extra life jackets to people who already have life jackets, while we're leaving other people to drown without a single life jacket."

https://www.npr.org/sections/goatsandsoda/2021/08/18/1028941909/why-a-push-for-b...

The life jacket analogy is flawed because the only reason we're talking about boosters is that the "life jackets" start sinking after 8 months.

>4 jjwilson61: Good point. Right now, though, one might get wet, but likely won't drown.
May not matter much longer? :(

SARS-CoV-2 lambda variant escapes immune response via spike mutations
Dr. Liji Thomas, MD | Aug 20 2021

...A new study published on the preprint server bioRxiv* explores the mechanism by which the SARS-CoV-2 lambda variant (first reported in Peru) has acquired immune evasion capabilities above that of the wildtype. This appears to involve shortening of the epitopes on the viral spike protein, as well as acquiring additional sites that can be N-glycosylated...

...Implications
This prototype modeling analysis of the RBD-receptor complex seems to dissociate the mutations that define the lambda variant from any effect on the RBD-ACE2 binding affinity. The mechanism by which the former affects the transmission of the virus is still uncertain...

...“Biophysical and bioinformatics data suggest that a combination of shortening immunogenic epitope loops and generation of potential N-glycosylation sites may be a viable adaptation strategy potentially allowing this emerging viral variant escaping host immunity.”...

https://www.news-medical.net/news/20210820/SARS-CoV-2-lambda-variant-escapes-imm...
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* Stefano Pascarella et al. 2021. Cutting epitopes to survive: the case of lambda variant. BioRxiv (Aug 16, 2021)
doi: https://doi.org/10.1101/2021.08.14.456353 https://www.biorxiv.org/content/10.1101/2021.08.14.456353v1

This article is a preprint and has not been certified by peer review.

Abstract
This manuscript concisely reports an in-silico (on computer or via computer simulation) study on the potential impact of the Spike protein mutations on immuno-escape ability of SARS-CoV-2 lambda variant. Biophysical and bioinformatics data suggest that a combination of shortening immunogenic epitope loops and generation of potential N-glycosylation sites may be a viable adaptation strategy potentially allowing this emerging viral variant escaping host immunity.

Another design for DIY air filter:

David Elfstrom (P Eng & Certified Energy Mgr) | David Elfstrom
https://threadreaderapp.com/thread/1429526273009889286.html
https://twitter.com/DavidElfstrom/status/1429526273009889286

FINAL OPTIMIZATION! Box fan single filter with 400 CFM measured at 120V. Estimated clean air delivery rate is 248 CFM CADR. Power is just 53 W, placing it well into Energy Star level for air cleaners. Room size: 384 sqft (8' ceilings). Cost: 🇨🇦$55 plus some tape. /1

...A Corsi-Rosenthal cube* will definitely have more flow for the same level of noise.

But for cost-effectiveness this single-filter optimized design can have a huge impact on health, with widespread deployment. /16

... /21

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* Corsi-Rosenthal cube, ~$100 -- https://encycla.com/Corsi-Rosenthal_Cube

And it's official.
The FDA has granted full approval to Pfizer's Covid-19 vaccine, according to a source familiar,
making it the first one in a lengthy process to get approval from federal regulators.
Huge news.

- Kaitlan Collins (CNN) @kaitlancollins | 9:39 AM · Aug 23, 2021

Fascinating. Horrifying. Postively Halloweenie!!

A microscopic video shows the coronavirus on the rampage. Video (0:23)
Andrew Jacobs | Aug. 22, 2021

...The video was produced by Sophie-Marie Aicher and Delphine Planas, virologists at the Pasteur Institute in Paris who won honorable mention in a microscopic video competition sponsored by Nikon, the photography company.

Filmed over 48 hours with an image recorded every 10 minutes, the footage shows the coronavirus as red spots circulating among a mass of gray blobs — the bat’s brain cells. After they are infected, the bat’s cells begin to fuse with neighboring cells. At some point, the entire mass bursts, resulting in the death of the cells.

...(Coronavirus's) special power is the ability to force host cells to fuse with neighboring ones, a process known as syncytia that allows the coronavirus to remain undetected as it replicates.

“Every time the virus has to exit the cell, it’s at risk of detection so if it can go straight from one cell to another, it can work much faster,” Ms. Aicher said...

https://www.nytimes.com/2021/08/22/science/microscopic-bat-brain-virus.html

The Vaccinated Are Worried and Scientists Don’t Have Answers
Kristen V. Brown and Rebecca Torrence | 8/23/2021

...Though it is evident vaccination still provides powerful protection against the virus, there’s growing concern that vaccinated people may be more vulnerable to serious illness than previously thought.

There’s a dearth of scientific studies with concrete answers, leaving public policy makers and corporate executives to formulate plans based on fragmented information. While some are renewing mask mandates or delaying office reopenings, others cite the lack of clarity to justify staying the course. It can all feel like a mess.

...some facts are well established at this point. Vaccinated people infected with the virus are much less likely to need to go to the hospital, much less likely to need intubation and much less likely to die from the illness. There’s no doubt that vaccines provide significant protection. But a large proportion of the nation -- almost 30% of U.S. adults -- have not been vaccinated, a fact that has conspired with the highly contagious delta variant to push the country into a new wave of outbreaks.

...For the time being, there are simply more questions than answers. Are breakthrough infections ticking up because of the delta variant, waning immunity or a return to normal life? Are vaccinated people more vulnerable to severe illness than previously thought? Just how common are breakthrough infections? It’s anyone’s guess...

https://www.msn.com/en-us/news/us/the-vaccinated-are-worried-and-scientists-dont...

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Israel's COVID-19 vaccine boosters show signs of taming Delta
In the past 10 days, the pandemic is abating among the first age group, more than a million of whom have received a third vaccine dose, according to Israeli health ministry data.
REUTERS | AUGUST 24, 2021

...Delta hit Israel in June, just as the country began to reap the benefits of one of the world's fastest vaccine roll-outs.
With an open economy and most curbs scrapped, Israel went from single-digit daily infections and zero deaths to around 7,500 daily cases last week, 600 people hospitalized in serious condition and more than 150 people dying in that week alone.

...On July 30, it began administering a third dose of the Pfizer/BioNtech vaccine to people over 60, the first country to do so. On Thursday it expanded eligibility to 40-year-olds and up whose second dose was given at least 5 months prior, saying the age may drop further.

In the past 10 days, the pandemic is abating among the first age group, more than a million of whom have received a third vaccine dose,...The rate of disease spread among vaccinated people age 60 and over - known as the reproduction rate - began falling steadily around Aug. 13 and has dipped below 1, indicating that each infected person is transmitting the virus to fewer than one other person. A reproduction rate of less than 1 means an outbreak is subsiding.

...factors (other than 3rd booster shots vaccine) are likely contributing to the decline...an uptake in people taking the first dose...natural immunity...more cautious behavior recently

...Dvir Aran, a biomedical data scientist at Technion - Israel's Institute of Technology, said that while cases are retreating, other measures are needed alongside boosters to stop the pandemic. "It will take a long time until enough people get a third dose and until then thousands more people will getting seriously ill."...

...Since Delta's surge, Israel has reimposed indoor mask-wearing, limitations on gatherings, and ramped up rapid testing. Its "living with COVID" policy will be tested come September, when schools reopen after summer break and when the Jewish holiday season starts, with families traditionally gathering to celebrate.

https://www.jpost.com/health-science/israels-covid-19-vaccine-boosters-show-sign...

Despite obstacles, Native Americans have the nation’s highest COVID-19 vaccination rate
Richard Read | Aug. 12, 2021

...worst fears never materialized. Instead, they helped fuel a highly successful vaccination campaign that has pushed life on the reservation back toward normal.

...data — collected by the U.S. Centers for Disease Control and Prevention — suggest that Native Americans are 24% more likely than whites to be fully vaccinated, 31% more likely than Latinos, 64% more likely than African Americans and 11% more likely than Asian Americans.

...In a survey last fall — before clinical trial results came out showing vaccines to be safe and effective — only 35% of Indian Health Service field workers said they would “definitely” or “probably” get shots.

But tribal leaders understood that vaccines were the clearest way out of the pandemic. They took to the radio and social media to promote them, warning that elders faced the greatest danger in communities vulnerable due to high rates of diabetes, heart disease and obesity.

They reminded people of the damage COVID-19 had already wrought — killing Native Americans at 2½ times the rate of white Americans — as well as of the smallpox epidemics of the 18th and 19th centuries that decimated many tribes...

https://www.latimes.com/world-nation/story/2021-08-12/native-american-covid-19-v...

CDC study shows unvaccinated people are 29 times more likely to be hospitalized with Covid
Berkeley Lovelace Jr. | Aug 24, 2021

Key Points

Unvaccinated people are about 29 times more likely to be hospitalized with Covid-19 than those who are fully vaccinated, according to a CDC study released Tuesday.*

The new study also found that unvaccinated people were nearly five times more likely to be infected with Covid than vaccinated people.

The data is in line with comments from federal and state health officials, who have been saying for weeks that millions of unvaccinated Americans have been putting themselves at serious risk...

https://www.cnbc.com/2021/08/24/cdc-study-shows-unvaccinated-people-are-29-times...
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* Fowlkes A, Gaglani M, Groover K, et al. Effectiveness of COVID-19 Vaccines in Preventing SARS-CoV-2 Infection Among Frontline Workers Before and During B.1.617.2 (Delta) Variant Predominance — Eight U.S. Locations, December 2020–August 2021. MMWR Morb Mortal Wkly Rep. ePub: 24 August 2021. DOI: http://dx.doi.org/10.15585/mmwr.mm7034e4 https://www.cdc.gov/mmwr/volumes/70/wr/mm7034e4.htm

Coronavirus origins: US intelligence report 'inconclusive' (BBC)

A US intelligence report requested by President Biden into the origins of the coronavirus pandemic is inconclusive, US media reports say. Agencies are reportedly divided on whether the virus - first seen in China - was the result of a natural spillover from animals to humans or was caused by a laboratory accident. An summary of the report is expected to be published in the coming days.

China's foreign minister has dismissed the report as "anti-science". Wang Yi said Washington had "ignored and abandoned" research carried out by the World Health Organization (WHO) for a report that would only service its "political purposes"... A WHO team, which visited Wuhan, concluded in a report earlier this year that the disease most likely spilled over from an animal sold at a market. The report appears to dismiss the possibility that the virus might have leaked accidentally from the Wuhan Institute of Virology, which has studied coronaviruses in bats for more than a decade...

B.C. sees big jump in vaccination bookings after announcing COVID-19 vaccine passport
Province says largest increase in appointments and registrations is among people under 40
CBC News · Posted: Aug 25, 2021 5:06 PM PT | Last Updated: August 25

The B.C. government says it's seeing a massive increase in interest in the COVID-19 vaccine since announcing a new program to require proof of vaccination for a wide range of social and recreational activities.

Since Monday, the number of people registering for the vaccination program or booking appointments each day has jumped by as much as 201 per cent compared to a week earlier, according to a statement from the province. The biggest jumps, the government says, have been in people under the age of 40.

Monday is the date when officials announced that proof of vaccination would be required to do things like eating at a restaurant, seeing a movie in the theatre or taking part in a fitness class...

https://www.cbc.ca/news/canada/british-columbia/bc-sees-big-jump-in-vaccinations...

..
^

FHA Survey: 68 Florida Hospitals Have Less Than 48 Hours Worth Of Oxygen
Abe Aboraya | August 26, 2021 at 8:10 AM EDT

Hospitals are using three to four times as much oxygen as they were before the pandemic. Also, a lack of delivery drivers is adding to the problem.

The Florida Hospital Association is sounding the alarm, saying a survey shows 68 hospitals have less than a 48-hour supply of oxygen.

Hospitals are using three to four times as much oxygen as they were before the pandemic because more than 17,000 patients are hospitalized statewide with COVID-19.

The FHA survey, which was done Wednesday, shows 68 hospitals have less than 48 hours worth of supply, with about half of these have less than 36 hours.

The association represents more than 200 member hospitals...

https://wusfnews.wusf.usf.edu/health-news-florida/2021-08-26/survey-68-florida-h...
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AdventHealth morgues reach capacity due to COVID-19 deaths
Lauren Seabrook and Adam Poulisse | August 26, 2021 at 3:23 pm EDT

ORANGE COUNTY, Fla. — The Central Florida Division of AdventHealth has reached capacity at its hospital morgues due to an influx of COVID-19 patients...“We have begun utilizing rented, refrigerated coolers at 10 of our campuses throughout Orange, Osceola, Polk, Seminole, & Volusia counties...These coolers are quickly becoming filled also.”...

...AdventHealth officials said the backup is believed to be due to a slowdown at local funeral homes, “which is causing us to hold decedents for a longer period of time.”...

https://www.wftv.com/news/health/adventhealth-morgues-reach-capacity-due-covid-1...

J&J: booster increases antibodies 9x

...Johnson & Johnson also said Wednesday that studies show a booster dose of its vaccine offered a ninefold increase in antibodies compared with the single-shot vaccine on its own...

https://www.usatoday.com/story/news/health/2021/08/25/covid-booster-johnson-anti...

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Heart Problem More Common After Covid-19 Than After Vaccination, Study Finds
Emily Anthes and Noah Weiland | Aug. 25, 2021

The Pfizer-BioNTech Covid-19 vaccine is associated with an increased risk of myocarditis, an inflammation of the heart muscle, a large new study from Israel confirms. But the side effect remains rare, and Covid-19 is more likely to cause myocarditis than the vaccine is, scientists reported on Wednesday...

https://www.nytimes.com/2021/08/25/health/covid-myocarditis-vaccine.html

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ETA: Myocarditis:
Pfizer vaccine: ~3 excess events per 100,000, mediam age 25, 90.9% male
COVID infection -- 11 excess events per 100,000
(Worth reading conclusion, or searching for any other concerns such as Bell's Palsy.)

Noam Barda et al. 2021. Safety of the BNT162b2 mRNA Covid-19 Vaccine in a Nationwide Setting. NEJM August 25, 2021. DOI: 10.1056/NEJMoa2110475 https://www.nejm.org/doi/full/10.1056/NEJMoa2110475

Abstract
...In the vaccination analysis, the vaccinated and control groups each included a mean of 884,828 persons. Vaccination was most strongly associated with an elevated risk of myocarditis..., lymphadenopathy ..., appendicitis ..., and herpes zoster infection... SARS-CoV-2 infection was associated with a substantially increased risk of myocarditis ...and of additional serious adverse events, including pericarditis, arrhythmia, deep-vein thrombosis, pulmonary embolism, myocardial infarction, intracranial hemorrhage, and thrombocytopenia.

...In this study in a nationwide mass vaccination setting, the BNT162b2 vaccine was not associated with an elevated risk of most of the adverse events examined. The vaccine was associated with an excess risk of myocarditis (1 to 5 events per 100,000 persons). The risk of this potentially serious adverse event and of many other serious adverse events was substantially increased after SARS-CoV-2 infection.
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Grace M. Lee. 2021. The Importance of Context in Covid-19 Vaccine Safety (Editorial). NEJM August 25, 2021
DOI: 10.1056/NEJMe2112543 https://www.nejm.org/doi/full/10.1056/NEJMe2112543

Eric Topol @EricTopol | 11:59 AM · Aug 27, 2021:

Timing may not be everything but likely very important.
Countries that fully vaccinated later, proximal to Delta's arrival, more, and with dose-spacing have done quite well
vs first mover

Image- graph, vaxx doses by country Dec 2020- Aug 2021
https://twitter.com/EricTopol/status/1431285176101867522/photo/1

Florida Judge Throws Out Gov. Ron DeSantis' Order Prohibiting Masks In Schools
Greg Allen, Russell Lewis | August 27, 2021

...Judge John Cooper ruled on a lawsuit brought by parents who say DeSantis overstepped his authority when his administration said school districts couldn't order students to wear masks. DeSantis had warned that "there will be consequences" for districts that defied the ban.

Ruling from the bench at the conclusion of a five-day trial, Cooper said that face mask mandates that follow guidance from the Centers for Disease Control and Prevention are "reasonable and consistent with the best scientific and medical opinion in this country." He found that the DeSantis administration violated the law when it banned school districts from requiring masks...

https://www.npr.org/sections/back-to-school-live-updates/2021/08/27/1031714923/f...

Given the lengthy presymptomatic phase and asymptomatic infections, a new #SciMagPerspective argues that wearing well-fitted masks, especially in enclosed indoor spaces, is important to help prevent #SARSCoV2 transmission.

Kimberly A. Prather et al. 2021. Reducing transmission of SARS-CoV-2. Science 26 Jun 2020: Vol. 368, Issue 6498, pp. 1422-1424. DOI: 10.1126/science.abc6197 https://fcld.ly/n2dl9mj

Uh oh...

Eric Topol @EricTopol | 4:37 PM · Aug 27, 2021
The evidence of mRNA vaccine effectiveness (VE) waning grows:
large Qatar experience shows substantial 5 month attrition for symptomatic infection VE below 50% and,
to a lesser extent, vs hospitalization and death

Image- Table 3, Pfizer effectiveness, highlighted
https://twitter.com/EricTopol/status/1431355127747674112/photo/1

Image-graphs, effectiveness
https://twitter.com/EricTopol/status/1431355127747674112/photo/2

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Hiam Chemaitelly et al. 2021. Waning of BNT162b2 vaccine protection against SARS-CoV-2 infection in Qatar. MedRxiv
MedRxiv (Aug. 27, 2021) doi: https://doi.org/10.1101/2021.08.25.21262584 https://medrxiv.org/content/10.1101/2021.08.25.21262584v1

This article is a preprint and has not been certified by peer review

Abstract

BACKGROUND: Waning of vaccine protection against SARS-CoV-2 infection or COVID-19 disease is a concern. This study investigated persistence of BNT162b2 (Pfizer-BioNTech) vaccine effectiveness against infection and disease in Qatar, where the Beta and Delta variants have dominated incidence and PCR testing is done at a mass scale. METHODS: A matched test-negative, case-control study design was used to estimate vaccine effectiveness against SARS-CoV-2 infection and against any severe, critical, or fatal COVID-19 disease, between January 1, 2021 to August 15, 2021. RESULTS: Estimated BNT162b2 effectiveness against any infection, asymptomatic or symptomatic, was negligible for the first two weeks after the first dose, increased to 36.5% (95% CI: 33.1-39.8) in the third week after the first dose, and reached its peak at 72.1% (95% CI: 70.9-73.2) in the first five weeks after the second dose. Effectiveness declined gradually thereafter, with the decline accelerating ≥15 weeks after the second dose, reaching diminished levels of protection by the 20th week. Effectiveness against symptomatic infection was higher than against asymptomatic infection, but still waned in the same fashion. Effectiveness against any severe, critical, or fatal disease increased rapidly to 67.7% (95% CI: 59.1-74.7) by the third week after the first dose, and reached 95.4% (95% CI: 93.4-96.9) in the first five weeks after the second dose, where it persisted at about this level for six months. CONCLUSIONS: BNT162b2-induced protection against infection appears to wane rapidly after its peak right after the second dose, but it persists at a robust level against hospitalization and death for at least six months following the second dose.  

>15 margd: 2nd dose J&J, contd.

Jerald Sadoff et al. 2021. Durability of antibody responses elicited by a single dose of Ad26.COV2.S and substantial increase following late boosting. MedRxiv ( Aug 26, 2021 ) doi: https://doi.org/10.1101/2021.08.25.21262569 https://www.medrxiv.org/content/10.1101/2021.08.25.21262569v1

This article is a preprint and has not been certified by peer review

Abstract
...A single dose of Ad26.COV2.S elicited neutralizing antibodies that remained largely stable for approximately 8–9 months and binding antibodies that remained stable for at least 6 months irrespective of age group. A 5x1010 vp booster dose at 6 months post prime vaccination in 18–55-year-old adults elicited a steep and robust 9-fold increase at Day 7 post boost compared to Day 29 levels following the initial immunization. A lower booster dose of 1.25x1010 vp at 6 months in adults 18–55 and ≥65 years of age also elicited a rapid and high increase of 6–7.7 fold at Day 28 post boost compared to Day 29 levels following the initial immunization, with similar magnitude of post-boost responses in both age groups.

...A single dose of Ad26.COV2.S, which demonstrated protection in a Phase 3 efficacy trial, elicited durable neutralizing and binding antibodies for at least 8 and 6 months, respectively, in adults >18 margd: years of age at levels similar to Day 29 responses. A 5x1010 vp or 1.25x1010 vp booster dose at 6 months elicited rapid and robust increases in spike binding antibody levels. The anamnestic responses after booster immunization imply robust immune memory elicited by single-dose Ad26.COV2.S...

The US report into Covid’s origins is little use in averting another pandemic (Guardian)

Regardless of where the virus came from, there’s a growing risk of another Covid-like phenomenon occurring...

US intelligence services have just briefed the president, Joe Biden, on the results of their 90-day investigation into the origins of Covid-19. They were asked to test two hypotheses: that it had a “natural” origin, or that it escaped from a lab. Preliminary reports suggest that their findings are inconclusive. Few scientists will be surprised by this, and yet the investigation has been the subject of intense – and intensely divisive – political and media interest over the past three months... But that won’t change the fact that two investigations down, we’re still in the dark as to how this pandemic started...

To be clear, the only reason these investigations are valuable is scientific – because the knowledge they provide could help prevent something similar from happening again... a lab accident is not a violation of any international law, and even if it were, establishing causation would be tricky...

“Many nations faced similar challenges in this pandemic and did not suffer the United States’ poor health outcomes”...

Covid origin: US spy agencies publish 'inconclusive' report (BBC)

The US intelligence community has been unable to determine the origins of Covid-19, and is split on whether it leaked from a lab or developed in nature, according to a new report. The report issued by the office that oversees the nation's 18 spy agencies did conclusively determine that it was not developed as a biological weapon... The report from the Office of the Director of National Intelligence said the intelligence community remains divided on Covid's most likely origin. "All agencies assess that two hypotheses are plausible: natural exposure to an infected animal and a laboratory-associated incident"...

People with delta variant twice as likely to be hospitalized: study
Jordan Williams - 08/27/21

...accounting for certain factors that contribute to the risk of hospitalization such as age, sex, recent travel and vaccination status, the delta variant was associated with a 2.26-fold increased risk of hospitalization over the original variant. The delta variant was also responsible for a 1.45-fold increased risk of requiring emergency care...

https://thehill.com/policy/healthcare/569823-people-with-delta-variant-twice-as-...

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Katherine A Twohig et al. 2021. Hospital admission and emergency care attendance risk for SARS-CoV-2 delta (B.1.617.2) compared with alpha (B.1.1.7) variants of concern: a cohort study. The Lancet Infectious Diseases. Published: August 27, 2021 DOI:https://doi.org/10.1016/S1473-3099(21)00475-8 https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(21)00475-8/fullt...

Summary
...Findings
Individual-level data on 43 338 COVID-19-positive patients (8682 with the delta variant, 34 656 with the alpha variant; median age 31 years...were included in our analysis. 196 (2·3%) patients with the delta variant versus 764 (2·2%) patients with the alpha variant were admitted to hospital within 14 days after the specimen was taken ... 498 (5·7%) patients with the delta variant versus 1448 (4·2%) patients with the alpha variant were admitted to hospital or attended emergency care within 14 days... Most patients were unvaccinated (32 078 (74·0%) across both groups). The HRs (adjusted hazard ratio) for vaccinated patients with the delta variant versus the alpha variant ... and for hospital admission or emergency care attendance...were similar to the HRs for unvaccinated patients... but the precision for the vaccinated subgroup was low.

Interpretation
This large national study found a higher hospital admission or emergency care attendance risk for patients with COVID-19 infected with the delta variant compared with the alpha variant. Results suggest that outbreaks of the delta variant in unvaccinated populations might lead to a greater burden on health-care services than the alpha variant.

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Delta variant increases risk in hospitalizations: study
A Scottish study suggests the variant is more likely to cause hospitalizations than other variants.
Alexandra Kelley | June 14, 2021

The Delta variant of COVID-19 has been linked to an increased risk of hospitalizations.

Vaccine efficacy was shown to have a positive but diminished effect on the Delta variant, dubbed B.1.617.2.

CDC data suggests the Delta variant composes at most 3.4 percent of cases in the U.S...

https://thehill.com/changing-america/well-being/prevention-cures/558372-delta-va...

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Aziz Sheikh et al. 2021. SARS-CoV-2 Delta VOC in Scotland: demographics, risk of hospital admission, and vaccine effectiveness. The Lancet. Volume 397, ISSUE 10293, P2461-2462, June 26, 2021 DOI:https://doi.org/10.1016/S0140-6736(21)01358-1 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01358-1/fullt...

...In summary, we show that the Delta VOC in Scotland was found mainly in younger, more affluent groups. Risk of COVID-19 hospital admission was approximately doubled in those with the Delta VOC when compared to the Alpha VOC, with risk of admission particularly increased in those with five or more relevant comorbidities. Both the Oxford–AstraZeneca and Pfizer–BioNTech COVID-19 vaccines were effective in reducing the risk of SARS-CoV-2 infection and COVID-19 hospitalisation in people with the Delta VOC, but these effects on infection appeared to be diminished when compared to those with the Alpha VOC. We had insufficient numbers of hospital admissions to compare between vaccines in this respect. The Oxford–AstraZeneca vaccine appeared less effective than the Pfizer–BioNTech vaccine in preventing SARS-CoV-2 infection in those with the Delta VOC. Given the observational nature of these data, estimates of vaccine effectiveness need to be interpreted with caution.

Eric Topol @EricTopol | 9:35 AM · Aug 28, 2021:
First mover (ISRAEL) disadvantage
Waning immunity,
3 week dose-spacing,
insufficient population vaccinated, and
other factors contributing to this unexpected outcome.

Image-graph, % fully vaxxed by country, Dec 2020-Aug 2021
https://twitter.com/EricTopol/status/1431611453602029574/photo/1

Image-graph -graph, new cases by country, Dec 2020-Aug 2021
https://twitter.com/EricTopol/status/1431611453602029574/photo/1

Eric Topol @EricTopol | 1:24 PM · Aug 25, 2021:

With the @Pfizer/@BioNTech_Group vaccine,
significantly higher levels of receptor binding domain antibodies induced
with the 8-12 week dose spacing compared with 3-6 weeks

Image-https://twitter.com/EricTopol/status/1430581936246775809/photo/1

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Victoria Hall et al. 2021. Delayed interval BNT162b2 mRNA COVID-19 vaccination provides robust immunity. Research Square. 11 p. https://assets.researchsquare.com/files/rs-793234/v1/2615242f-5371-4194-9ae8-b31...

PREPRINT

Abstract
Shortages of COVID-19 vaccines have results in delayed dosing intervals as a strategy to immunize a
greater proportion of the population. The effect of this strategy on vaccine immunogenicity is not well
studied. Humoral (anti-RBD levels and neutralization) and cellular immune responses were compared in
health care workers receiving two doses of BNT162b2 (Pfizer-BioNTech) vaccines at standard (3-6 week)
and delayed (8-12 week) intervals. In the delayed group, anti-RBD antibody titres were significantly
enhanced compared to the standard interval group. Neutralizing antibody responses were excellent and
comparable in both groups. A slight decrease in Spike-specific polyfunctional CD4+ T-cells expressing
interferon-γ and IL-2 as well as monofunctional CD4+ T-cells was seen in the delayed group. Both
polyfunctional and monofunctional CD8+ T-cell responses were comparable. Our data suggest that the
strategy of delayed second dose mRNA vaccination is not overtly detrimental, and specifially may lead
to an enhanced humoral immune response.

New Strain of Delta Variant Surfaces in Britain

Almost 5,000 infections have been linked to the Boardmasters (music) festival in Cornwall produced a sharp spike in cases among younger people.

Public Health England (PHE) is understood to be investigating a possible new Delta strain that may have emerged from the. . .festival in Newquay two weeks ago. . .which now has the highest rate of infection in England at more than 2,000 per 100,000 people.

“It was traced because they can identify where it came from by genetic changes in the code.”

While it is being referred to among hospital staff in Devon and Cornwall as the “festival variant”, it is believed to be a new strain of Delta rather than an entirely new variant. Delta already has around a dozen different strains.

WHO African Region @WHOAFRO | 6:01 AM · Aug 30, 2021:

Congo - Brazzaville first #COVAX delivery arrived in Brazzaville this weekend!
The country received 302,400 #COVID19 vaccine doses shared by United States.

Over 15 million vaccine doses have arrived in the Africa Region this month.

Image-photo, pallet received ( https://twitter.com/WHOAFRO/status/1432282234942337024/photo/1 )
Congo-Brazzaville and 3 others

No-o-o!

Eric Feigl-Ding @DrEricDing | 12:35 AM · Aug 30, 2021:
Thread ( https://twitter.com/DrEricDing/status/1432200392776028162 )

NEW VARIANT—a new #SARSCoV2 variant C.1.2 just identified in South Africa & several countries,
with concerns it could be more infectious and evade vaccines.
#C12 also has mutation rate that is nearly **twice as fast** as the rate of the other variants.
Image- variants' relationships ( https://twitter.com/DrEricDing/status/1432200392776028162/photo/1 )

2) Study comes from a new preprint by South Africa's National Institute for Communicable Diseases.
The new variant has "mutated substantially" and
is more mutations away from the original virus than any other variant detected so far worldwide”—wow!

3) What does that mean above? It means that #C12 variant has somehow mutated so fast and far that it is now the FURTHEST MUTATED variant found to date! It has mutated the greatest genetic distance from the original Wuhan 1.0 strain—and implies potential troubles for 1.0 vaccines.

4) it gets worse with #C12… it has a 1.7x to 1.8x faster mutation rate than the average of all other variants! The authors note this coincides with the emergence pattern of other really bad VOC variants.
https://medrxiv.org/content/10.110

5) Let’s visualize how much farther and faster the new #C12 variant is - it is much much faster in mutation rate and it has gained the farthest distance from Wuhan 1.0 strain (denoted by “0” distance). This means #C12 is the most mutant of all mutant variants found to date!

6) “The study found consistent increases in the number of C.1.2 genomes in South Africa on a monthly basis, rising from 0.2% of genomes sequenced in May to 1.6% in June and then to 2% in July, similar to increases seen with Beta & Delta variants there.” Rightwards arrowPattern recognition Bell?

7) To be clear, the mutation rate of #C12 being “nearly twice as fast” is how quickly it gained mutations in a short period. It won’t necessarily continue to - but it certainly did in the time of window that it took to emerge.

8) “More than half (about 52%) of the mutations in the spike region of the C.1.2 sequences have previously been seen in other VOCs and VOIs. The mutations N440K and Y449H, which have been associated with escape from certain antibodies, have also been noticed in C.1.2 sequences.”

9) “The scientists stressed that the combination of these mutations, as well as changes in other parts of the virus, likely help the virus evade antibodies and immune responses, including in patients who have already been infected with the Alpha or Beta variants.” Eyes oh boy.

10) Why is #C12 worrisome for immune escape? Here are many technical mutation details why. Also, I highlighted the worry about #C12’s mutations on the virus furin cleavage site- which helps the virus bind human cells faster. Bottomline—The authors are worried.

11) This #C12 is obviously a very fast moving variant. We don’t know exact transmission yet or severity or vaccine efficacy yet. But the best advice that will serve us well is to take the PRECAUTIONARY PRINCIPLE as the approach—“move fast”!!! ...

13) UPDATE—I have just gotten direct confirmation from my WHO colleagues that they are investigating and following up on the new #C12 variant from South Africa. Also note that C12 is already detected in England, Switzerland, Portugal, Mauritius, China, and New Zealand! ...

-----------------------------------------------------------------

New COVID variant detected in South Africa, most mutated variant so far
The C.1.2 variant first detected in South Africa is more mutated compared to the original virus than any other known variant.
TZVI JOFFRE | AUGUST 29, 2021
https://jpost.com/health-science/new-covid-variant-detected-in-south-africa-most...

-----------------------------------------------------------------

Cathrine Scheepers et al. 2021. The continuous evolution of SARS-CoV-2 in South Africa: a new lineage with rapid accumulation of mutations of concern and global detection. MedRxi (Aug 26, 2021) doi: https://doi.org/10.1101/2021.08.20.21262342

This article is a preprint and has not been certified by peer review

Abstract
SARS-CoV-2 variants of interest have been associated with increased transmissibility, neutralization resistance and disease severity. Ongoing SARS-CoV-2 genomic surveillance world-wide has improved our ability to rapidly identify such variants. Here we report the identification of a potential variant of interest assigned to the PANGO lineage C.1.2. This lineage was first identified in May 2021 and evolved from C.1, one of the lineages that dominated the first wave of SARS-CoV-2 infections in South Africa and was last detected in January 2021. C.1.2 has since been detected across the majority of the provinces in South Africa and in seven other countries spanning Africa, Europe, Asia and Oceania. The emergence of C.1.2 was associated with an increased substitution rate, as was previously observed with the emergence of the Alpha, Beta and Gamma variants of concern (VOCs). C.1.2 contains multiple substitutions (R190S, D215G, E484K, N501Y, H655Y and T859N) and deletions (Y144del, L242-A243del) within the spike protein, which have been observed in other VOCs and are associated with increased transmissibility and reduced neutralization sensitivity. Of greater concern is the accumulation of additional mutations (C136F, Y449H and N679K) which are also likely to impact neutralization sensitivity or furin cleavage and therefore replicative fitness. While the phenotypic characteristics and epidemiology of C.1.2 are being defined, it is important to highlight this lineage given its concerning constellations of mutations.

Eric Feigl-Ding @DrEricDing | 2:28 PM · Feb 11, 2021
Thread https://twitter.com/DrEricDing/status/1359947539483684866

JUST ONE PERSON—United Kingdom scientists think one immunocompromised person who cleared virus slowly & only partially wiped out an infection, leaving behind genetically-hardier viruses that rebound & learn how to survive better. That’s likely how #B117 started.

A lone infection may have changed the course of the pandemic
Matt Reynolds | 10.02.2021

The number of mutations in the UK variant took scientists by surprise. Now they think its origins may lie in one person, chronically infected with the virus...

https://wired.co.uk/article/chronic-infection-uk-coronavirus-variant

Delta variant may double risk of hospitalization for the unvaccinated, study finds
Lilia Luciano | August 30, 2021

...The Delta variant — which is more contagious than the original "Alpha variant" that spread globally — more than doubles the risk of hospitalization for the unvaccinated, according to a U.K. study published in The Lancet Infectious Diseases...The findings closely resembled preliminary data from a Scottish study that indicated the Delta variant caused more hospitalizations...

https://www.cbsnews.com/news/covid19-delta-variant-unvaccinated-hospitalization-...
--------------------------------------------------------

Katherine A Twohig et al. 2021. Hospital admission and emergency care attendance risk for SARS-CoV-2 delta (B.1.617.2) compared with alpha (B.1.1.7) variants of concern: a cohort study. Ther Lancet Infectious Diseases (August 27, 2021). DOI:https://doi.org/10.1016/S1473-3099(21)00475-8 https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(21)00475-8/fullt...

Summary
Background
Methods

Findings
Individual-level data on 43 338 COVID-19-positive patients (8682 with the delta variant, 34 656 with the alpha variant; median age 31 years ...) were included in our analysis. 196 (2·3%) patients with the delta variant versus 764 (2·2%) patients with the alpha variant were admitted to hospital within 14 days after the specimen was taken (adjusted hazard ratio (HR) 2·26... 498 (5·7%) patients with the delta variant versus 1448 (4·2%) patients with the alpha variant were admitted to hospital or attended emergency care within 14 days... Most patients were unvaccinated (32 078 (74·0%) across both groups). The HRs for vaccinated patients with the delta variant versus the alpha variant (adjusted HR for hospital admission 1·94... and for hospital admission or emergency care attendance 1·58 ...) were similar to the HRs for unvaccinated patients (2·32... and 1·43 ...) but the precision for the vaccinated subgroup was low.

Interpretation
This large national study found a higher hospital admission or emergency care attendance risk for patients with COVID-19 infected with the delta variant compared with the alpha variant. Results suggest that outbreaks of the delta variant in unvaccinated populations might lead to a greater burden on health-care services than the alpha variant.

!!

David Frum @davidfrum | 7:43 AM · Aug 31, 2021:

I first read this on Twitter, didn't believe it, but it's true:
Iowa has followed Texas in dropping quarantine requirements for COVID-positive teachers and students.

Image-
https://idph.iowa.gov/Portals/1/userfiles/61/covid19/resources/School%20Update%2...

Comparing serious outcomes in kids of flu and Delta:

Kashif Pirzada, MD (emergency Toronto, dad) @KashPrime | 8:14 AM · Aug 31, 2021

Data from @AmerAcadPeds for the week ending Aug 19:
more than 200K infections in children in the US per week and growing
~1/100 hospitalization rate (0.9%)
24 deaths in week ended Aug 19, and an avg rate of 1 for every 10000 cases
https://aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/children-and...

If you compare it to the flu in kids, by my rough math,
- Hospitalization rate is about 2.2X higher
- the mortality rate for Covid (.01% vs .0042%) is about 2.4X higher
https://www.cdc.gov/flu/about/burden/2018-2019.html

But Delta Covid is more contagious, R0 >7 margd: vs 1.3 for Flu
11m kid caught flu in the 2018-2019, out of ~81m total kids in the US
Some estimate that 70% of kids will catch Covid this fall. That's about 56m kids.
So 5X the cases, 2.4X the mortality. The math is not pretty.

I am no statistician, and would really appreciate if @COVIDSciOntario (Ontario's COVID Science Table--Science & health leaders, informing Ontario’s COVID-19 response with emerging evidence) can release their prediction models for the fall, so parents can make an informed choice of what to do next week.

Untested, unvaxxed, unmasked etc.
5-day youth camp and 2-day men's conference in IL linked to 180 cases:

Matthias J, Patrick S, Wiringa A, et al. Epidemiologically Linked COVID-19 Outbreaks at a Youth Camp and Men’s Conference — Illinois, June–July 2021. MMWR Morb Mortal Wkly Rep. ePub: 31 August 2021. DOI: http://dx.doi.org/10.15585/mmwr.mm7035e4 https://www.cdc.gov/mmwr/volumes/70/wr/mm7035e4.htm?s_cid=mm7035e4_w

Summary

What is already known about this topic?
The Illinois Department of Public Health investigated COVID-19 outbreaks at two events sponsored by the same organization: a 5-day overnight church camp for persons aged 14–18 years and a 2-day men’s conference.

What is added by this report?
Neither COVID-19 vaccination nor COVID-19 testing was required before either event. Among 122 primary cases, 104 (85%) were in persons who were not fully vaccinated, and 18 (15%) were in fully vaccinated persons. Eight of 38 (21%) close contacts of the 18 fully vaccinated persons subsequently became infected with SARS-CoV-2. No vaccinated persons with COVID-19 were hospitalized.

What are the implications for public health practice?
This investigation underscores the impact of secondary SARS-CoV-2 transmission during large events such as camps and conferences when COVID-19 prevention strategies, including vaccination, masking, physical distancing, and screening testing, are not implemented.

Moderna vaccine could create twice as many COVID antibodies as Pfizer vaccine, study says
Katherine Rodriguez | Aug. 31, 2021

...The study of nearly 2,500 workers at a major Belgium hospital system discovered that the average antibody levels of those who took a full course of the Moderna vaccine was 3836 U/mL while those who took a full course of the Pfizer vaccine had antibody levels of 1444 U/mL.

Both vaccines have been shown to be highly effective against serious illness and death.

...the differences in immune response might be explained by two things:

The Moderna vaccine contains more of an active ingredient than the Pfizer vaccine (100 micrograms vs. 30 micrograms).

There is a longer amount of time between the doses of the Moderna vaccine than the Pfizer vaccine. Moderna’s two shots are spread out by four weeks while Pfizer’s shots are spread out by three weeks...

https://www.nj.com/coronavirus/2021/08/moderna-vaccine-could-create-twice-as-man...

----------------------------------------------------------

Deborah Steensels et al. 2021. Comparison of SARS-CoV-2 Antibody Response Following Vaccination With BNT162b2 and mRNA-1273 (Research Letter). JAMA. Published online August 30, 2021. doi:10.1001/jama.2021.15125

...Discussion
This study demonstrated a significantly higher humoral immunogenicity of the SARS-CoV-2 mRNA-1273 vaccine (Moderna) compared with the BNT162b2 vaccine (Pfizer-BioNTech), in infected as well as uninfected participants, and across age categories. The higher mRNA content in mRNA-1273 compared with BNT162b2 and the longer interval between priming and boosting for mRNA-12733 (4 weeks vs 3 weeks for BNT162b2) might explain this difference...

https://jamanetwork.com/journals/jama/fullarticle/2783797

Dave Blake, PhD @_stah | 12:06 PM · Aug 31, 2021:

New study relevant to infection derived immunity compared to vaccine derived immunity from the UK.

Effectiveness against symptoms in delta (full 2 doses vs infection)
Pfizer/BioNTech: 86%
Astrazeneca: 70%
Infection derived: 83%
Image ( https://twitter.com/_stah/status/1432736448378179584/photo/1 )

Details:
Koen B. Pouwels et al. 2021. Impact of Delta on viral burden and vaccine effectiveness against new SARS-CoV-2 infections in the UK. MedRxiv Aug 24, 2021. https://medrxiv.org/content/10.1101/2021.08.18.21262237v1.full.pdf

PREPRINT

Abstract
The effectiveness of BNT162b2, ChAdOx1, and mRNA-1273 vaccines against new SARS-CoV-2 infections
requires continuous re-evaluation, given the increasingly dominant Delta variant. We investigated the
effectiveness of the vaccines in a large community-based survey of randomly selected households across
the UK. We found that the effectiveness of BNT162b2 and ChAd0x1 against any infections (new PCR
positives) and infections with symptoms or high viral burden is reduced with the Delta variant. A single
dose of the mRNA-1273 vaccine had similar or greater effectiveness compared to a single dose of
BNT162b2 or ChAdOx1. Effectiveness of two doses remains at least as great as protection afforded by prior
natural infection. The dynamics of immunity following second doses differed significantly between
BNT162b2 and ChAdOx1, with greater initial effectiveness against new PCR-positives but faster declines in
protection against high viral burden and symptomatic infection with BNT162b2. There was no evidence
that effectiveness varied by dosing interval, but protection was higher among those vaccinated following a
prior infection and younger adults. With Delta, infections occurring following two vaccinations had similar
peak viral burden to those in unvaccinated individuals. SARS-CoV-2 vaccination still reduces new infections,
but effectiveness and attenuation of peak viral burden are reduced with Delta.

Vaccines cut risk of ‘long covid’ in half, major study finds
Bryan Pietsch, Adela Suliman and Annabelle Timsit | Sept 2, 2021

A new study that included more than a million adults in Britain has found that instances of people contracting the coronavirus after full vaccination are extremely rare — and that their risk of experiencing lingering symptoms of the disease in what’s known as “long covid” is reduced by almost half...

https://www.washingtonpost.com/nation/2021/09/02/covid-delta-variant-live-update...

-----------------------------------------------------------

Michela Antonelli et al. 2021. Risk factors and disease profile of post-vaccination SARS-CoV-2 infection in UK users of the COVID Symptom Study app: a prospective, community-based, nested, case-control study. The Lancet Infectious Diseases. Published:September 01, 2021 DOI:https://doi.org/10.1016/S1473-3099(21)00460-6

Summary
Background
COVID-19 vaccines show excellent efficacy in clinical trials and effectiveness in real-world data, but some people still become infected with SARS-CoV-2 after vaccination. This study aimed to identify risk factors for post-vaccination SARS-CoV-2 infection and describe the characteristics of post-vaccination illness.

Methods
This prospective, community-based, nested, case-control study used self-reported data (eg, on demographics, geographical location, health risk factors, and COVID-19 test results, symptoms, and vaccinations) from UK-based, adult (≥18 years) users of the COVID Symptom Study mobile phone app. For the risk factor analysis, cases had received a first or second dose of a COVID-19 vaccine between Dec 8, 2020, and July 4, 2021; had either a positive COVID-19 test at least 14 days after their first vaccination (but before their second; cases 1) or a positive test at least 7 days after their second vaccination (cases 2); and had no positive test before vaccination. Two control groups were selected (who also had not tested positive for SARS-CoV-2 before vaccination): users reporting a negative test at least 14 days after their first vaccination but before their second (controls 1) and users reporting a negative test at least 7 days after their second vaccination (controls 2). Controls 1 and controls 2 were matched (1:1) with cases 1 and cases 2, respectively, by the date of the post-vaccination test, health-care worker status, and sex. In the disease profile analysis, we sub-selected participants from cases 1 and cases 2 who had used the app for at least 14 consecutive days after testing positive for SARS-CoV-2 (cases 3 and cases 4, respectively). Controls 3 and controls 4 were unvaccinated participants reporting a positive SARS-CoV-2 test who had used the app for at least 14 consecutive days after the test, and were matched (1:1) with cases 3 and 4, respectively, by the date of the positive test, health-care worker status, sex, body-mass index (BMI), and age. We used univariate logistic regression models (adjusted for age, BMI, and sex) to analyse the associations between risk factors and post-vaccination infection, and the associations of individual symptoms, overall disease duration, and disease severity with vaccination status.

Findings
Between Dec 8, 2020, and July 4, 2021, 1 240 009 COVID Symptom Study app users reported a first vaccine dose, of whom 6030 (0·5%) subsequently tested positive for SARS-CoV-2 (cases 1), and 971 504 reported a second dose, of whom 2370 (0·2%) subsequently tested positive for SARS-CoV-2 (cases 2). In the risk factor analysis, frailty was associated with post-vaccination infection in older adults (60 years or older) after their first vaccine dose (odds ratio (OR) 1·93...), and individuals living in highly deprived areas had increased odds of post-vaccination infection following their first vaccine dose (OR 1·11...). Individuals without obesity (BMI less than 30 kg/m2) had lower odds of infection following their first vaccine dose (OR 0·84...). For the disease profile analysis, 3825 users from cases 1 were included in cases 3 and 906 users from cases 2 were included in cases 4. Vaccination (compared with no vaccination) was associated with reduced odds of hospitalisation or having more than five symptoms in the first week of illness following the first or second dose, and long-duration (28 or more days) symptoms following the second dose. Almost all symptoms were reported less frequently in infected vaccinated individuals than in infected unvaccinated individuals, and vaccinated participants were more likely to be completely asymptomatic, especially if they were 60 years or older.

Interpretation
To minimise SARS-CoV-2 infection, at-risk populations must be targeted in efforts to boost vaccine effectiveness and infection control measures. Our findings might support caution around relaxing physical distancing and other personal protective measures in the post-vaccination era, particularly around frail older adults and individuals living in more deprived areas, even if these individuals are vaccinated, and might have implications for strategies such as booster vaccinations.

Children's Hospitals Are Pleading For Federal Help As They Run Out Of Beds
Joe Hernandez | Sept 1, 2021

A group of more than 220 children's hospitals is imploring the Biden administration for help, as a surge of young COVID-19 patients puts an "unprecedented strain" on their facilities and staff across the country.

Pediatric hospitals are "at or near capacity" and they expect to see more child patients as the school year resumes, according to the Children's Hospital Association.

...The recent surge in COVID-19 cases driven by the delta variant has afflicted children more seriously than previous strains had, and children under age 12 still cannot get vaccinated. Some children are coming down with the coronavirus and RSV, a seasonal respiratory virus that can be dangerous in kids, at the same time...

https://www.npr.org/sections/coronavirus-live-updates/2021/09/01/1033233408/chil...

More kids hospitalized with Covid-19 in states with lower vaccination rates, CDC report finds
Jen Christensen | September 3, 2021
https://www.cnn.com/2021/09/03/health/kids-hospitalized-covid/index.html
---------------------------------------------------

Siegel DA, Reses HE, Cool AJ, et al. Trends in COVID-19 Cases, Emergency Department Visits, and Hospital Admissions Among Children and Adolescents Aged 0–17 Years — United States, August 2020–August 2021. MMWR Morb Mortal Wkly Rep. ePub: 3 September 2021. DOI: http://dx.doi.org/10.15585/mmwr.mm7036e1external icon https://www.cdc.gov/mmwr/volumes/70/wr/mm7036e1.htm

Summary
What is already know about this topic?
Severe illness from COVID-19 can and does occur in children and adolescents.

What is added by this report?
COVID-19 cases, emergency department visits, and hospital admissions increased from June to August 2021 among persons aged 0-17 years. Emergency department visits and hospital admissions in a 2-week period in August 2021 were higher in states with lower population vaccination coverage and lower in states with higher vaccination coverage.

What are the implications for public health?
Community vaccination, in coordination with testing strategies and other prevention measures, is critical to protecting pediatric populations from SARS-CoV-2 infection and severe COVID-19.

Richard Levitan (@airwaycam) Tweeted:
Mortality from Covid halved with post-diagnosis pulse oximetry monitoring!—38,660 patient study just published: https://t.co/bgG006rAM6 Patients monitored w oximeters presented earlier with lower CRP levels. Silent hypoxia kills. Pulse ox monitoring should be standard of care! https://twitter.com/airwaycam/status/1433788230760124453?s=20

The US, with world's heaviest burden of COVID cases and, I assume, lots of immune-suppressed folks, has yet to produce a seriously more transmissible, vaccine-evading variant(?) There have been a few oddities out of NY and CA, but the biggies so far originate from the southern hemisphere? Is that correct assessment? If yes, wonder why?

Below, two new ones (post-delta):
variant of interest 'mu' from Columbia and
not-yet-designated C.1.2. from South Africa:

New ‘mu’ COVID variant now found in 49 U.S. states
Brandon Sapienza | 9/6/2021

Since being discovered in Colombia in January, the mu variant of COVID-19 has spread to nearly four dozen countries and has made its presence known in Hawaii and Alaska. It has so far been found in 49 states with Nebraska being the only state to not have a mu variant case detected.

Health officials believe mu is even more transmissible that the delta variant and has the potential to resist vaccines...

https://www.msn.com/en-us/news/us/new-mu-covid-variant-now-found-in-49-u-s-state...
-----------------------------------------------------------

Mu COVID variant found in at least 50 patients at Houston Methodist Hospital, doctors confirm
Brandon Walker | September 6, 2021

...The World Health Organization last week identified the “Mu” variant as a “variant of interest.”

Since the designation, doctors at Houston Methodist confirmed cases of the Mu variant in roughly 50 patients.

“We had our first case of Mu back in May,” said Dr. Wesley Long, medical director of diagnostic microbiology at Houston Methodist and a clinical pathologist...

https://www.click2houston.com/news/local/2021/09/07/mu-covid-variant-found-in-at...
______________________________________________

Then there's this one :(

What we know about the new C.1.2 coronavirus variant
Dr Amir Khan | 7 Sep 2021

While much of the world’s focus has been on the Delta variant of coronavirus, a new variant has been identified in South Africa.

Currently referred to as the C.1.2 variant, it is yet to be called a variant of interest or concern by the World Health Organization (WHO), but is drawing the attention of scientists due to the number and types of mutations it contains and the speed at which the mutations have occurred.

...A pre-print study* put out by South Africa’s National Institute for Communicable Diseases said the C.1.2 variant was first identified in the Gauteng and Mpumalanga provinces in May 2021; it has since been found in other South African provinces as well as in the Democratic Republic of the Congo, Mauritius, New Zealand, Portugal and Switzerland.

According to the preprint, there are several mutations carried on the C.1.2 variant – and some of these may make it more transmissible and even evade vaccine protection, though this is yet to be formally concluded...

https://www.aljazeera.com/features/2021/9/7/what-we-know-about-the-new-c-1-2-cov...

---------------------------------------------------------------

* Cathrine Scheepers et al. 2021. The continuous evolution of SARS-CoV-2 in South Africa: a new lineage with rapid accumulation of mutations of concern and global detection. MedRxiv (Aug 24, 2021)
doi: https://doi.org/10.1101/2021.08.20.21262342 https://www.medrxiv.org/content/10.1101/2021.08.20.21262342v1.full

This article is a preprint and has not been peer-reviewed

Abstract
SARS-CoV-2 variants of interest have been associated with increased transmissibility, neutralization resistance and disease severity. Ongoing SARS-CoV-2 genomic surveillance world-wide has improved our ability to rapidly identify such variants. Here we report the identification of a potential variant of interest assigned to the PANGO lineage C.1.2. This lineage was first identified in May 2021 and evolved from C.1, one of the lineages that dominated the first wave of SARS-CoV-2 infections in South Africa and was last detected in January 2021. C.1.2 has since been detected across the majority of the provinces in South Africa and in seven other countries spanning Africa, Europe, Asia and Oceania. The emergence of C.1.2 was associated with an increased substitution rate, as was previously observed with the emergence of the Alpha, Beta and Gamma variants of concern (VOCs). C.1.2 contains multiple substitutions (R190S, D215G, N484K, N501Y, H655Y and T859N) and deletions (Y144del, L242-A243del) within the spike protein, which have been observed in other VOCs and are associated with increased transmissibility and reduced neutralization sensitivity. Of greater concern is the accumulation of additional mutations (C136F, Y449H and N679K) which are also likely to impact neutralization sensitivity or furin cleavage and therefore replicative fitness. While the phenotypic characteristics and epidemiology of C.1.2 are being defined, it is important to highlight this lineage given its concerning constellations of mutations.

>39 margd: Mu, contd.

COVID Mu: Everything You Need To Know About the New Coronavirus Variant
Luke O'Neill | September 7, 2021

...It’s possible that mu’s genetic changes might make it more transmissible, allow it to cause more severe disease and render it more able to escape the immune response driven by vaccines or infection with previous variants. This in turn might leave it less susceptible to treatments.

Note the word might. A VOI (Variant of Interest) is not a variant of concern (VOC), which is a variant that has been proven to acquire one of those characteristics, making it more dangerous and so more consequential. Mu is being monitored closely to see if it should be re-designated as a VOC. We have to hope not.

There are four other VOIs being watched by the WHO – eta, iota, kappa and lambda – but none of these have been reclassified as a VOC. That might be the case with mu as well, but we have to await further data.

What makes mu particularly interesting (and concerning) is that it has what the WHO calls a “constellation of mutations that indicate potential properties of immune escape”. In other words, it has the hallmarks of being able to get around existing vaccine protection.

Where is it spreading?
Mu was first seen in Colombia in January 2021, when it was given the designation B1621. It has since been detected in 40 countries, but is thought to currently be responsible for only 0.1% of infections globally.

Mu has been much more prevalent in Colombia than anywhere else. When looking at coronavirus samples that have been genetically sequenced, 39% of those analysed in Colombia have been mu – though no mu samples have been recorded there in the past four weeks...

How dangerous is it?
What happens next?

https://scitechdaily.com/covid-mu-everything-you-need-to-know-about-the-new-coro...

Ohio judge reverses court order forcing hospital to treat Covid patient with ivermectin (Guardian)

An Ohio judge has reversed a court order that forced a local hospital to treat a Covid-19 patient with the anti-parasitic drug ivermectin...

Worried About Breakthrough Infections? Here’s How to Navigate This Phase of the Pandemic.
Tara Parker-Pope | Sept. 3, 2021

...Your individual risk for Covid after vaccination...depends on local conditions, your overall health, the precautions you take and how often you are exposed to unvaccinated people who could be infected...

Dr. Sharon Balter, director of the division of communicable disease control and prevention at the Los Angeles County Department of Public Health...team has recently collected surveillance data* that give us a clearer picture of the difference in risk to the vaccinated and unvaccinated as the Delta variant surged...

The rate of infection in unvaccinated people is five times the rate of infection in vaccinated people...

The rate of hospitalization among the vaccinated was 1 per 100,000 people. The age-adjusted hospitalization rate in unvaccinated persons was 29.4 per 100,000...

Older vaccinated people were most vulnerable to serious illness after a breakthrough infection...

The Delta variant appears to have increased (doubled?) the risk of breakthrough infections to vaccinated people....

What’s the chance of a vaccinated person spreading Covid-19?
Is it still safe to gather unmasked with vaccinated people?
How can unvaccinated children go to school safely?
Can a vaccinated person visit with an elderly vaccinated person indoors without a mask?
Is it safe to work in an office?
Should I get a booster shot, and will it help protect me against Delta?

https://www.nytimes.com/article/breakthrough-infections-covid-19-coronavirus.htm...

-------------------------------------------------------

* Griffin JB, Haddix M, Danza P, et al. SARS-CoV-2 Infections and Hospitalizations Among Persons Aged 16 Years (& older), by Vaccination Status — Los Angeles County, California, May 1–July 25, 2021. MMWR Morb Mortal Wkly Rep Aug 27, 2021;70:1170–1176. DOI: http://dx.doi.org/10.15585/mmwr.mm7034e5external icon. https://www.cdc.gov/mmwr/volumes/70/wr/mm7034e5.htm#F1_down

Summary
What is already known about this topic?
Although COVID-19 vaccines are highly effective, some fully vaccinated persons will be infected with SARS-CoV-2.

What is added by this report?
During May 1–July 25, 2021, among 43,127 SARS-CoV-2 infections in residents of Los Angeles County, California, 10,895 (25.3%) were in fully vaccinated persons, 1,431 (3.3%) were in partially vaccinated persons, and 30,801 (71.4%) were in unvaccinated persons. On July 25, infection and hospitalization rates among unvaccinated persons were 4.9 and 29.2 times, respectively, those in fully vaccinated persons. In July, when the Delta variant was predominant, cycle threshold values were similar for unvaccinated, partially vaccinated, and vaccinated persons.

What are the implications for public health practice?
Efforts to enhance COVID-19 vaccination coverage, in coordination with other prevention strategies, are critical to preventing COVID-19–related hospitalizations and deaths.

>42 margd: contd.

Uh oh? Even before Delta, more severe breakthrough illness with Pfizer than Moderna or J&J vaccines?

Prerak V Juthani et al. 2021. Hospitalisation among vaccine breakthrough COVID-19 infections (Comment). The Lancet. Published:September 07, 2021. DOI:https://doi.org/10.1016/S1473-3099(21)00558-2 https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(21)00558-2/fullt...

...Although the incidence of severe or critical COVID-19 illness remains low in those who are fully vaccinated, we observed a higher number of patients with severe or critical illness in those who received the BNT162b2 vaccine than in those who received mRNA-1273 or Ad.26.COV2.S (total number of vaccine doses distributed in Connecticut USA until May 17, 2021, was 1 358 175 for BNT162b2, 1 044 420 for mRNA-1273, and 267 000 for Ad.26.COV2.S)...This finding would benefit from further investigation...

Babies, The Delta Variant And COVID: What Parents Need To Know
Selena Simmons-Duffin | Sept 9, 2021

1. How to pass along some coronavirus antibodies during pregnancy
2. Breastfeeding can help, too, if you've been vaccinated or already had COVID-19
3. Try to create a caregiver force field
4. Where to (not) go and who to (not) see
5. Watch for these red-flag signs of COVID-19 in your infant
So, when will babies be eligible for vaccination against this virus?

https://www.npr.org/sections/health-shots/2021/09/09/1035274872/babies-covid-del...

Very difficult to study benefits of nutrients, particularly in isolation, particularly in humans whose background levels are highly variable. Many of us are deficient in vitamins such as D, so while one doesn't trust in them for vaccine-level protection, doesn't hurt / might help to supplement! IMO, anyway!

Fact check: Over-the-counter vitamins not proven to treat, prevent COVID-19
McKenzie Sadeghi | Sept 8, 2021

...an Aug. 25 Facebook post with more than 25,000 shares features a list of what it calls “over the counter vitamins for Covid,” including vitamin C, vitamin D, melatonin, zinc, aspirin and quercetin.

...Our rating: Partly false

Based on our research, we rate PARTLY FALSE the claim that melatonin, aspirin, vitamins, zinc and quercetin can prevent or treat COVID-19.

Experts say more research is needed to determine if vitamins C and D can play a role in treating the virus, but current research provides little to no evidence of effectiveness. There is not enough evidence to support the use of zinc or melatonin in treating the virus.

Aspirin has demonstrated benefits in hospitalized patients, but researchers say more studies are needed to establish a direct link. Papers looking into quercetin (flavonol in red onions and kale, etc.) have found it demonstrates antiviral properties, but data from large-scale clinical trials is lacking.

https://www.usatoday.com/story/news/factcheck/2021/09/08/fact-check-over-counter...

The Plan to Stop Every Respiratory Virus at Once
The benefits of ventilation reach far beyond the coronavirus.
What if we stop taking colds and flus for granted, too?
Sarah Zhang | September 7, 2021

...To understand why pathogens can spread through the air, it helps to understand just how much of it we breathe. “About eight to 10 liters a minute,” says Catherine Noakes, who studies indoor air quality at the University of Leeds, in England. Think four or five big soda bottles per minute, multiply that by the number of people in a room, and you can see how we are constantly breathing in one another’s lung secretions.

...COVID-19 does not kill as high a proportion of its victims as cholera did in the 19th century. But it has claimed well over 600,000 lives in the U.S. Even a typical flu season kills 12,000 to 61,000 people every year. Are these emergencies? If so, what would it take for us, collectively, to treat them as such? The pandemic has made clear that Americans do not agree on how far they are willing to go to suppress the coronavirus. If we can’t get people to accept vaccines and wear masks in a pandemic, how do we get the money and the will to rehaul all our ventilation systems?

...In their Science editorial, Morawska and her co-authors wrote, “While the scale of the changes required is enormous, this is not beyond the capabilities of our society, as has been shown in relation to food and waterborne disease, which have largely been controlled and monitored.” Morawska is optimistic, which perhaps you have to be to embark on this endeavor. The changes might take too long to matter for this current pandemic, but there are other viruses that spread through the air, and there will be more pandemics...

https://www.theatlantic.com/health/archive/2021/09/coronavirus-pandemic-ventilat...

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Lidia Morawska et al. 2021. A paradigm shift to combat indoor respiratory infection (Policy Forum). Science • 14 May 2021 • Vol 372, Issue 6543 • pp. 689-691 • DOI: 10.1126/science.abg2025
https://www.science.org/doi/abs/10.1126/science.abg2025

Abstract
There is great disparity in the way we think about and address different sources of environmental infection. Governments have for decades promulgated a large amount of legislation and invested heavily in food safety, sanitation, and drinking water for public health purposes. By contrast, airborne pathogens and respiratory infections, whether seasonal influenza or COVID-19, are addressed fairly weakly, if at all, in terms of regulations, standards, and building design and operation, pertaining to the air we breathe. We suggest that the rapid growth in our understanding of the mechanisms behind respiratory infection transmission should drive a paradigm shift in how we view and address the transmission of respiratory infections to protect against unnecessary suffering and economic losses. It starts with a recognition that preventing respiratory infection, like reducing waterborne or foodborne disease, is a tractable problem.

Breakthrough Infections: Four Factors That Increase the Risk of Vaccinated People Getting COVID
University of East Anglia | September 9, 2021

1. Vaccine type
2. Time since vaccination
3. Variants
4. Your immune system

Do you need to worry?
Vaccines still vastly reduce your chances of getting COVID-19. They also to an even greater degree protect against hospitalization and death.

However, it’s concerning seeing breakthrough infections, and the worry is that they might increase if vaccine protection does, as suspected, fall over time. Hence the UK government is planning to give a booster dose to those most vulnerable, and is also considering whether boosters should be given more widely. Other countries, including France and Germany, are already planning on offering boosters to groups considered to be at higher risk from COVID-19.

But even boosters end up being used, this shouldn’t be interpreted as vaccines not working. And in the meantime, it’s essential to promote vaccination to all those eligible who have not yet been vaccinated.

https://scitechdaily.com/breakthrough-infections-four-factors-that-increase-the-...

Why Do People with Diabetes Develop Severe COVID-19?
A new study reveals the mechanism behind cytokine storm during coronavirus infection.
Kelly Malcom | September 07, 2021

...Type 2 diabetes—a condition affecting more than 10 percent of the U.S. population—is one of the main risk factors for severe COVID-19 illness.

The culprit appears to be an enzyme called SETDB2. This same enzyme has been implicated in the non-healing, inflammatory wounds found in people with diabetes.

...In the mouse and human models, ...as SETDB2 went down, inflammation went up. In addition, they revealed that a pathway known as JAK1/STAT3 regulates SETDB2 in macrophages during coronavirus infection.

Taken together, the results point to a potential therapeutic pathway. Previous findings from the lab demonstrated that interferon, a cytokine important for viral immunity, increased SETDB2 in response to wound healing. In their new study, they found blood serum from patients in the ICU with diabetes and severe COVID-19 had reduced levels of interferon-beta compared to patients without diabetes.

...hope the findings of this study will inform ongoing clinical trials of interferon or other downstream components of the pathway, including epigenetic targets, for COVID-19. Their work also highlights the need to understand the timing and cell-specificity of therapy and to tailor its application to patients’ underlying conditions, especially patients with diabetes.

“Our research is showing that maybe if we are able to target patients with diabetes with interferon, especially early in their infection, that may actually make a big difference,” (W. James Melvin, M.D.) said.

https://labblog.uofmhealth.org/lab-report/why-do-people-diabetes-develop-severe-...
--------------------------------------------------------

William J. Melvin et al. 2021. Coronavirus induces diabetic macrophage-mediated inflammation via SETDB2. Proceedings of the National Academy of Sciences, September 21, 2021 118 (38) e2101071118; DOI: 10.1073/pnas.2101071118 https://www.pnas.org/content/118/38/e2101071118

Significance
The COVID-19 pandemic has disproportionately affected patients with comorbidities, namely, obesity and type 2 diabetes. Macrophages (Mφs) are a key innate immune cell primarily responsible for the harmful, hyperinflammatory “cytokine storm” in patients that develop severe COVID-19. We describe a mechanism for this Mφ-mediated cytokine storm in response to coronavirus. In response to coronavirus infection, expression of the chromatin-modifying enzyme, SETDB2, decreases in Mφs, leading to increased transcription of inflammatory cytokines. Further, we find SETDB2 is regulated by an interferon beta (IFNβ)/JaK/STAT3 mechanism, and that exogenous administration of IFNβ can reverse inflammation, particularly in diabetic Mφs via an increase in SETDB2. Together, these results suggest therapeutic targeting of the IFNβ/SETDB2 axis in diabetic patients with COVID-19 may decrease pathologic inflammation...

Vincent Rajkumar (Mayo Clinic) @VincentRK | 4:46 AM · Sep 12, 2021:

Fully vaccinated people are more than 10 times less likely to to be hospitalized or die from COVID, even with delta variant.

More than 5 times less likely to get infected means much less likely to get Long COVID or spread COVID to others.

Image ( https://twitter.com/VincentRK/status/1436974437149052934/photo/1 )

Scobie HM, Johnson AG, Suthar AB, et al. 2021. Monitoring Incidence of COVID-19 Cases, Hospitalizations, and Deaths, by Vaccination Status — 13 U.S. Jurisdictions, April 4–July 17, 2021. MMWR Morb Mortal Wkly Rep. ePub: 10 September 2021. DOI: http://dx.doi.org/10.15585/mmwr.mm7037e1external icon https://www.cdc.gov/mmwr/volumes/70/wr/mm7037e1.htm?s_cid=mm7037e1_w

Summary
What is already known about this topic?
The incidence of SARS-CoV-2 infection, hospitalization, and death is higher in unvaccinated than vaccinated persons, and the incidence rate ratios are related to vaccine effectiveness.

What is added by this report?
Across 13 U.S. jurisdictions, incidence rate ratios for hospitalization and death changed relatively little after the SARS-CoV-2 B.1.617.2 (Delta) variant reached predominance, suggesting high, continued vaccine effectiveness against severe COVID-19. Case IRRs (averaged weekly, age-standardized incidence rate ratios) decreased, suggesting reduced vaccine effectiveness for prevention of SARS-CoV-2 infections.

What are the implications for public health practice?
Getting vaccinated protects against severe illness from COVID-19, including the Delta variant. Monitoring COVID-19 incidence by vaccination status might provide early signals of potential changes in vaccine effectiveness that can be confirmed through robust controlled studies.

DeSantis can mess with case reporting, but not deaths?

Eric Feigl-Ding @DrEricDing | 2:11 AM · Sep 15, 2021:
FLORIDA. 7 day average deaths. I’ve been worried—but this #DeltaVariant wave is approaching India level bad under Modi.

Can @GovRonDeSantis finally admit he needs to get new advisors who are either not anti-vax disinformation peddlers or not mass infection #COVID19 minimizers?

Graph of FL deaths ( https://twitter.com/DrEricDing/status/1438022590396870658/photo/1 )

COVID-19: Experimental vaccine lasts 1 month at room temperature
Deep Shukla | September 14, 2021

lthough the currently available COVID-19 vaccines are highly effective, limited manufacturing capacity and the need for cold-chain storage hinder their global distribution.

A recent study tested the efficacy of a new adeno-associated virus (AAV) vector-based vaccine in mice and macaques.

A single dose of the AAV-based vaccine provided protection against SARS-CoV-2 infection in macaques and elicited a potent immune response against the virus for at least 11 months.

The vaccine was stable at room temperature for 1 month and could potentially be manufactured on a large scale using established processes...

https://www.medicalnewstoday.com/articles/covid-19-experimental-vaccine-lasts-1-...

-----------------------------------------------------

Nerea Zabaleta et a, 2021. An AAV-based, room-temperature-stable, single-dose COVID-19 vaccine provides durable immunogenicity and protection in non-human primates. Cell Host & Microbe. Volume 29, ISSUE 9, P1437-1453.e8, September 08, 2021 DOI:https://doi.org/10.1016/j.chom.2021.08.002 https://www.cell.com/cell-host-microbe/fulltext/S1931-3128(21)00378-4

Summary
The SARS-CoV-2 pandemic has affected more than 185 million people worldwide resulting in over 4 million deaths. To contain the pandemic, there is a continued need for safe vaccines that provide durable protection at low and scalable doses and can be deployed easily. Here, AAVCOVID-1, an adeno-associated viral (AAV), spike-gene-based vaccine candidate demonstrates potent immunogenicity in mouse and non-human primates following a single injection and confers complete protection from SARS-CoV-2 challenge in macaques. Peak neutralizing antibody titers are sustained at 1 year and complemented by functional memory T cell responses. The AAVCOVID vector has no relevant pre-existing immunity in humans and does not elicit cross-reactivity to common AAVs used in gene therapy. Vector genome persistence and expression wanes following injection. The single low-dose requirement, high-yield manufacturability, and 1-month stability for storage at room temperature may make this technology well suited to support effective immunization campaigns for emerging pathogens on a global scale.

Eric Topol @EricTopol | 12:15 PM · Sep 15, 2021
This new @TheLancetInfDis review on #SARSCoV2 transmission makes the strong case for mucosal immunity, which could be achieved via nasal or oral vaccines, that are unfortunately not getting priority for development

Image ( https://twitter.com/EricTopol/status/1438174690615300104/photo/1 )

Darius Mostaghimi et al. 2021. Prevention of host-to-host transmission by SARS-CoV-2 vaccines.
The Lancet Infectious Diseases. Published:September 14, 2021 DOI:https://doi.org/10.1016/S1473-3099(21)00472-2 https://thelancet.com/journals/laninf/article/PIIS1473-3099(21)00472-2/fulltext

Summary
As the number of individuals vaccinated against SARS-CoV-2 rises worldwide, population-level data regarding the vaccines' ability to reduce infection are being generated. Randomised trials have shown that these vaccines dramatically reduce symptomatic COVID-19; however, less is known about their effects on transmission between individuals. The natural course of infection with SARS-CoV-2 involves infection of the respiratory epithelia and replication within the mucosa to sufficient viral titres for transmission via aerosol particles and droplets. Here we discuss the available data on the existing, approved SARS-CoV-2 vaccines' capacity to reduce transmissibility by reducing primary infection, viral replication, capacity for transmission, and symptomaticity. The potential for mucosal-targeted SARS-CoV-2 vaccine strategies to more effectively limit transmission than intramuscular vaccines is considered with regard to known immunological mechanisms. Finally, we enumerate the population-level effects of approved vaccines on transmission through observational studies following clinical trials and vaccine distribution in real-world settings.

Did 1 in 500 US Residents Die From COVID-19 by September 2021?
A total of nearly 664,000 people were lost to the virus in the United States by Sept. 14, 2021.
Dan MacGuill | 15 September 2021

Claim
By September 2021, one COVID-19 death had taken place for every 500 people living in the United States.

Rating
True...

https://www.snopes.com/fact-check/1-in-500-us-covid-deaths/

>53 margd:, yup, that's a pretty straight forward arithmetic problem 500 x 664000 = 332,000,000. According to the Census Bureau the estimated population of the U.S. was 331,449,281 as of April 26, 2021. Add a few months and I'm sure we're at the 332 million by now.

Lots of caveats, but interesting...

Bill Comeau (Cdn chartmaker) Billius27 | 6:55 PM · Sep 16, 2021:

Ontario identified outbreak cases since Step 3 started on July 16. #covid19ontario

Image-graphs on activities associated with outbreaks
https://twitter.com/Billius27/status/1438637622360952840/photo/1

FDA panel endorses Pfizer’s COVID-19 vaccine booster for people 65 and older, high-risk patients
The vote will now go before the FDA to issue a final decision
Kayla Rivas | Sept 17, 2021

A U.S. Food and Drug Administration (FDA) advisory panel on Friday endorsed (18-0) emergency approval for the Pfizer-BioNTech COVID-19 vaccine booster shot at least six months following the second dose among people ages 65 and older and those at high risk of occupational exposure and severe COVID-19.

...the FDA to issue a final decision.

The panel earlier Friday afternoon voted to reject (2-16) licensure of Pfizer's booster vaccine in people ages 16 and older...insufficient data among younger groups and concerns over potential increased risk for heart inflammation, particularly among males ages 16-17...

https://www.foxnews.com/health/fda-panel-pfizer-covid-19-vaccine-booster
______________________________________
Eric Topol @EricTopol | 9:44 PM · Sep 17, 2021:
https://twitter.com/EricTopol/status/1439042701995888641

Today’s FDA Advisory for Pfizer didn’t address the vulnerability of people who received J&J shots.
But these data of low antibody levels...for J&J suggest high vulnerability—
an mRNA vaccine 2nd shot is overdue to be addressed by CDC/FDA and should be supported.

New @CDCMMWR on US vaccinations, antibody (Ab) response, and
protection from hospitalization (H) in non-immunocompromised people, March-August
https://cdc.gov/mmwr/volumes/70/wr/mm7038e1.htm?s_cid=mm7038e1_w

Vaccine Effectiveness vs H (hospitalization):
Moderna 93%, Pfizer 88%, J&J 71%
See Table below for details, Figure for Ab response
Image ( https://twitter.com/EricTopol/status/1438919014504296448/photo/1 )
Image ( https://twitter.com/EricTopol/status/1438919014504296448/photo/2 )

Note Pfizer's data after 120 days reduction of vaccine effectiveness vs hospitalization 91% (88-93) to 77% (67-84). That is statistically significant and not trivial.

These US IVY network data and much more (including July/August timing) were not part of today's @US_FDA VRBPAC and Monday's ACIP Pfizer booster review. That is unfortunate with continued assertions by many that there is fully preserved vaccine protection from hospitalizations

N.J.’s least vaccinated counties are seeing 60% more COVID-19 cases than the most vaccinated
Nick Devlin | Sep. 18, 2021

...An NJ Advance Media analysis of new cases during the period from August 1 to September 15 showed that those with a lower case number tended to be among those who had higher vaccination rates.

The five counties with the highest vaccination rates combined to add 6.3 new COVID-19 cases per 1,000 people during the period analyzed. The counties with the five lowest vaccinates rates, meanwhile, added 10.1 new cases per 1,000 people — a rate 60% higher.

...Seven of the 10 counties with the highest vaccination rates were also among the 10 with the fewest cases. On the flip side, seven of the 10 least vaccinated counties were also in the top 10 for cases.

On the whole, New Jersey had vaccinated the equivalent of 58.5% of its population as of September 15, a figure that did not account for the large numbers of children who are ineligible for vaccination. There have been 7.3 new cases of COVID-19 for every 1,000 people in the state since August 1...

https://www.nj.com/coronavirus/2021/09/njs-least-vaccinated-counties-are-seeing-...

Isaac Bogoch @BogochIsaac (infectious disease MD scientist U Toronto) | 7:14 AM · Sep 20, 2021
1/ Pfizer announces that their #COVID19 vaccine for 5-11 year olds is safe & provides a strong immune response.

Glad there are no safety signals, but can really see the true incidence of myocarditis (heart inflammation) in post marketing surveillance.

Press Release. https://bit.ly/3knNCKw

2/ Pfizer enrolled 2,268 children 5-11 here. They used a "two-dose regimen of 10 µg administered 21 days apart, a smaller dose than the 30 used for people 12 and older."

The vaccine may be authorized for use in the US as early as late Oct.

Reuters Article: https://www.reuters.com/business/healthcare-pharmaceuticals/exclusive-us-decisio...

Eric Topol @EricTopol | 9:59 PM · Sep 19, 2021
The US has now fallen to #45 on the list of countries fully vaccinated and
is in rapid further descent

Table ( https://twitter.com/EricTopol/status/1439771092487327747/photo/1 )

https://ig.ft.com/coronavirus-vaccine-tracker/?areas=gbr&areas=isr&areas...
Image

>50 margd: There is view that can certainly explain DeSantis's approach to the pandemic. If you kill off enough kids you won't have to spend nearly the amount you would have to for things like education and general child healthcare. If you kill off enough old people you will save a lot with respect to care for the elderly, social security payments, etc. In short, taking the Logan's Run approach to state management means a lot less in terms of wasting state monies on those who, in your estimation, are of no value.

Ashish K. Jha, MD, MPH (Brown School Public Health) @ashishkjha | 7:24 AM · Sep 21, 2021:
Important new data from J&J

Few takeaways:
Single shot seems to provide durable protection without waning
2nd shot 2 months later seems to boost protection
2nd shot 6 months later likely even better

Lots to sort out in the data but this is good news
--------------------------------------------------

Johnson & Johnson says additional dose boosts Covid vaccine efficacy
Matthew Herper | Sept. 21, 2021

The two-dose regimen prevented 75% of moderate to severe Covid cases in all countries where it was tested — and 94% of such cases in the U.S...

https://www.statnews.com/2021/09/21/johnson-johnson-says-additional-dose-boosts-...

Eric Topol (Scripps) @EricTopol | 12:46 PM · Aug 14, 2021
New @MedCellPress
Prior Measles-Mumps-Rubella (MMR) or Tetanus-Diptheria-Pertussis (Tdap) vaccination i
nduces a T-cell response that overlaps with #SARSCoV2 and
appears to offer some (~20-30%) protection from severe Covid-19
Infographic ( https://twitter.com/EricTopol/status/1426586022129717251/photo/1 )

-----------------------------------------------------------------

Vijayashree Mysore et al. 2021. Protective heterologous T cell immunity in COVID-19 induced by the trivalent MMR and Tdap vaccine antigens. Clinical and Translational Article| Volume 2, ISSUE 9, P1050-1071.e7, September 10, 2021. DOI:https://doi.org/10.1016/j.medj.2021.08.004
https://cell.com/med/fulltext/S2666-6340(21)00289-0#relatedArticles

Highlights
T cell responses to SARS-CoV-2, MMR, and Tdap vaccine proteins are highly correlated
SARS-CoV-2, MMR, and Tdap antigen-experienced T cells share identical TCRs
T cells with shared TCRs have features of TEMRA, a memory anti-viral T cell subset
Prior MMR or Tdap vaccination correlates with reduced COVID-19 severity

>62 margd:

I've often heard people here in Africa wonder whether the fact that we have had a multitude of vaccinations and regular booster shots over the course of our lifetimes might provide some protection. Looks as if it might be the case.

>63 John5918: So we should harvest your blood and make it into miracle medicine ? (Might in fact make sense for smaller portions.)

But it reminded me of this one :-)
https://www.buttersafe.com/2020/01/16/donating-blood/

>64 bnielsen:

Welcome! Although many years ago the UK blood transfusion service stopped accepting my blood as I had been exposed to malaria. I don't know whether that restriction still applies.

>65 John5918: It probably does. The Danish blood transfusion service is also rather picky. (My blood type is very common, so they kindly asked me to stop giving blood, since I grew pale and sweaty when they put the needle in :-)

Right now, they are trying to get a lot more people to join the stem cell register and one of the tricks is to drop the requirement of being a blood donor.

U.S. to donate millions more Pfizer-BioNTech vaccine doses to poorer nations
Holly Ellyatt | Sep 22 20216:02 AM EDT

Key Points
Pfizer and BioNTech will provide an additional 500 million doses of their Covid-19 vaccine to the U.S. government.

These will then be donated to low and lower-middle-income countries.

The move announced Wednesday represents an expansion of the companies’ existing agreement with the government to provide extra vaccine doses at a not-for-profit price for less-advantaged nations...

https://www.cnbc.com/2021/09/22/us-to-donate-millions-more-pfizer-biontech-vacci...

Ventilation ( Australia )

Governments failing to heed 'paradigm change' call on ventilation to slow COVID-19 spread, experts say
Emma Pollard | Sept 21 (22 update), 2021

Key points:
Australia has no legal standards on indoor air quality
Professor Lidia Morawska says lives could have been saved with better ventilation
Experts are calling for air filters in schools where children remain unvaccinated

...Queensland University of Technology professor Lidia Morawska was recently named by Time magazine as one of the 100 most influential people in the world for her role in highlighting the airborne transmission of COVID-19.

She said the lack of indoor air quality standards in Australia is "a big problem" because without them "no-one does anything".

...Carbon dioxide (CO2) monitors – which measure human exhalation – should be displayed in "every public space" so individuals can improve ventilation or leave if concentrations are too high, she said.

...Professor Morawska's advice is to "do everything possible" to bring outdoor air inside.

If that is not an option and air-conditioning is not reducing CO2 levels, then air purifiers, such as high-efficiency particulate air (HEPA) filters, can be used.

...A Melbourne study found two small portable HEPA filters cleared 99 per cent of aerosols from a hospital room within 5.5 minutes...

'That could be in my lungs'
'We've seen what's happened'
'Are homemade air filters an option?
'We must be prepared'

...Australian Primary Principals Association president Malcolm Elliott said...there is now less acceptance of the idea that schools are places where children and teachers inevitably pick up illnesses...

https://www.abc.net.au/news/2021-09-22/qld-school-ventilation-paradigm-shift-cor...

______________________________________________

Here is Aranet monitor in photo: https://www.amazon.com/dp/B07YY7BH2W/?coliid=I4VKMQ8XQF64I&colid=3R7ENENG96Q...

>63 John5918: Case incidence is so patchy and complex that it's amazing any associations can be made!

1. pathogen--Delta knocked stuffing out of India
2. host--genes, age, "co-morbidities", plus everything we've been exposed to incl. other pathogens / vaccines, drugs, non-pharmaceutical protective measures
3. environment--temperature & humidity (how it affects virus, plus exposure to unfiltered indoor air), D (sun, fiber in diet), etc.

>68 margd: If you are interested in monitoring your own air quality, there's a nice input here:
https://www.jeffgeerling.com/blog/2021/airgradient-diy-air-quality-monitor-co2-p...

(It made me buy a cheap standalone co2 monitor (without connection to an app or a cloud provider)).

>70 bnielsen: Thanks. Two engineers in the family--I should tell them THAT's what I want for Christmas! The Aranet one in #68 is pricey--I liked that it gave numbers for CO2 and was something I (or one of my guys) could carry unnoticed into restaurants or (in their cases) workplaces. One of my engineers is known to calibrate my kitchen scale, etc., so being made in Europe (Latvia and Switzerland), the Aranet hopefully would meet his approval? (The other engineer sleeps in a basement bedroom despite earlier radon concerns, since allayed they tell me, but I don't think I need worry about him calibrating any monitor I bring home!)

Healthcare pros discuss strategies to protect unvaxxed pregnant women and their families in office and hospital:

David Rouselle (OB-GYN Ontario) @DRouselle | 6:14 AM · Sep 23, 2021
Strategies for protecting unvaccinated pregnant patients in office visits? First appointment of the day? Suggest/supply N95 respirators? Limit visits as we were doing in spring 2020?

Kashif Pirzada, MD (Emergency, Toronto) @KashPrime
Hepa filters in each room, n95 on each staff, keep waiting room empty and call people in from their cars. That’s what I’ve been doing in my clinic practice, so far no cases yet.

David Rouselle @DRouselle
Have not had to call from cars as under booking to keep wait room down (accountant asking why I didn’t tell him I retired...).

Kashif Pirzada, MD @KashPrime
We’ve been running a near normal schedule with phoning people in, also made a bunch of these, hepa filters with $50 worth of furnace filters, fans and duct tape, based on this design: https://twitter.com/DavidElfstrom/status/1429526273009889286

Allyn Walsh (Prof Emiratus Family Med) @allynewalsh
And a Covid-19 vaccination ASAP

David Rouselle @DRouselle
Yeah no, these are patients I’ve had THE TALK with, multiple times. Time to mitigate risk (and maybe demonstrate how worried I am, on their behalf..)

Allyn Walsh @allynewalsh
So sad, they have been mislead into risking their health and that of their baby. I hope there aren’t many pregnant women declining to be vaccinated...

Amy Burke (RN, Industrial Eng) @AmyBurke_EngRN
These are great questions to ask. I also have similar questions about how to protect them during their hospital admission for delivery. We still have postpartum patients (vaccinated or not) sharing rooms and no one has been COVID tested unless they were symptomatic.

David Rouselle @DRouselle
We’re doing a rapid test in admission and mostly have private rooms.

Karen M Hartmann (Nurse Practitioner) @kmhartmann
Schedule pts so they are the only family in the office, screen everyone for symptoms or possible exposure to COVID prior to coming in. We've been doing this in our Paeds practice since March 2020. It means we see less patients, we handle sick children over the phone.

Dr. Dustin Costescu (McMaster U) @BirthControlDoc
There are too many in practice to offer first appointment, and it's a baby boom. Decreased visit frequency to WHO minimums is really your safest strategy.

Mapping America’s hospitalization and vaccination divide
Stark differences across the country revealed
https://www.washingtonpost.com/health/2021/09/23/covid-vaccination-hospitalizati...

CDC:
Guidance for COVID-19 Prevention in K-12 Schools

UPDATE
Given new evidence on the B.1.617.2 (Delta) variant, CDC has updated the guidance for fully vaccinated people. CDC recommends universal indoor masking for all teachers, staff, students, and visitors to K-12 schools, regardless of vaccination status. Children should return to full-time in-person learning in the fall with layered prevention strategies in place.

https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/k-12-guida...
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Masks help keep schools open, CDC finds
Alexander Nazaryan | September 24, 2021

Mask mandates keep the coronavirus from spreading in schools, according to three studies published on Friday by the Centers for Disease Control and Prevention. ...

One of the three studies compared masking policies in Maricopa and Pima counties, the largest in Arizona. In both counties, some school districts imposed mask mandates while others did not. Those that did saw far lower likelihood of the coronavirus spreading among students.

“The odds of a school-associated COVID-19 outbreak in schools with no mask requirement were 3.7 times higher than those in schools with an early mask requirement,” the CDC analysis concluded...

https://news.yahoo.com/masks-help-keep-schools-open-cdc-finds-181915677.html
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CDC removes guidance for phasing out masks in schools, say it’s ‘always being revised’
Joshua Rhett Miller | September 24, 2021
https://nypost.com/2021/09/24/cdc-removes-guidance-for-phasing-out-masks-in-scho...
___________________________________________________

Kids 5-11 aren't vaxxed, but still!

Regina Bateson (U Ottawa) @regina_bateson | 12:27 PM · Sep 24, 2021:
Hello #Ottawa! If you kids, have kids, teach kids, or just want to see the pandemic crushed once & for all ... this is for you. Right now, kids 5-11 have highest rate of COVID in #Ottawa, more than 3x rate for adults. 83/100k/wk for kids vs. 26/100k/wk for adults!

‘Post-Vax COVID’ Is a New Disease
Katherine J. Wu | September 21, 2021

...Next to other airway-loving viruses, such as the ones that cause the flu and common colds, SARS-CoV-2 can be a bit of an oddball. It lopes almost indiscriminately throughout the body, invading a plethora of tissues; it winds up certain immune responses, while dialing others down, sparking bouts of inflammation that can afflict everything from brain to toe. COVID symptom lists that at first focused on the virus’s ground zero—the respiratory tract—eventually ballooned to include nausea, vomiting, changes in mental status, and chest pain. Infection severity operates on a continuum, and SARS-CoV-2 occupies its spectrum fully. Many people never realize they’re infected; others might have a two-day tickle in their throat, while some weather the disability of long-haul COVID for months; a fraction end up ventilated in the ICU.

The experience of having COVID is now poised to splinter further, along immunological boundaries largely defined by vaccines. Inoculated bodies are less hospitable to SARS-CoV-2, making it harder for the pathogen to infect them; when it still manages to, it seems to be purged much faster, affording it less time to cause symptoms—especially the bad ones—and fewer opportunities to hop into other hosts...

...on a population level, our future could look quite good. Most people will end up getting COVID-19 in their lifetime. In most cases, it won’t be so bad. Eventually, silent or mild infections will feel less catastrophic, because many of us will have confidence that they are unlikely to progress. Outbreaks might be smaller and slower-spreading, and breakthroughs will no longer be headline-making news. Positive test results, in the absence of symptoms, could generally be shrugged off, and infection will no longer feel quite so synonymous with disease. Our bodies will come to see the virus as familiar—not necessarily a welcome guest, but not quite the intruder it was before...

https://www.theatlantic.com/science/archive/2021/09/post-vaccination-covid/62014...

Preliminary research finds that even mild cases of COVID-19 leave a mark on the brain – but it’s not yet clear how long it lasts
Jessica Bernard, Associate Professor, Texas A&M University | September 24, 2021

Peering in at the brain’s response to COVID-19
...The (UK) team found marked differences in gray matter – which is made up of the cell bodies of neurons that process information in the brain – between those who had been infected with COVID-19 and those who had not.* Specifically, the thickness of the gray matter tissue in brain regions known as the frontal and temporal lobes was reduced in the COVID-19 group, differing from the typical patterns seen in the group that hadn’t experienced COVID-19.

In the general population, it is normal to see some change in gray matter volume or thickness over time as people age, but the changes were larger than normal in those who had been infected with COVID-19.

Interestingly, when the researchers separated the individuals who had severe enough illness to require hospitalization, the results were the same as for those who had experienced milder COVID-19. That is, people who had been infected with COVID-19 showed a loss of brain volume even when the disease was not severe enough to require hospitalization.

Finally, researchers also investigated changes in performance on cognitive tasks and found that those who had contracted COVID-19 were slower in processing information, relative to those who had not.

While we have to be careful interpreting these findings as they await formal peer review, the large sample, pre- and post-illness data in the same people and careful matching with people who had not had COVID-19 have made this preliminary work particularly valuable....

What do these changes in brain volume mean?...
Looking ahead...

https://theconversation.com/preliminary-research-finds-that-even-mild-cases-of-c...

------------------------------------------------------

* Gwenaëlle Douaud et al. 2021. Brain imaging before and after COVID-19 in UK Biobank. MedRxiv August 18, 2021 doi: https://doi.org/10.1101/2021.06.11.21258690 https://www.medrxiv.org/content/10.1101/2021.06.11.21258690v3

Llama antibodies show 'significant potential' as COVID-19 treatment
Leigh Ann Green | September 27, 2021

...In the race to discover effective treatments for COVID-19, some scientists have turned to using antibodies from people who have recovered from COVID-19.

Although this approach has seen some success, these treatments tend to be difficult to manufacture and expensive.

A recent study, which appears in the journal Nature Communications*, investigates a type of antibody derived from a llama. The authors hope that this approach will be simpler and more cost effective...

https://www.medicalnewstoday.com/articles/llama-antibodies-show-significant-pote...

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* Jiandong Huo et al. 2021. A potent SARS-CoV-2 neutralising nanobody shows therapeutic efficacy in the Syrian golden hamster model of COVID-19. Nature Communications volume 12, Article number: 5469 (2021) https://www.nature.com/articles/s41467-021-25480-z

Abstract
SARS-CoV-2 remains a global threat to human health particularly as escape mutants emerge. There is an unmet need for effective treatments against COVID-19 for which neutralizing single domain antibodies (nanobodies) have significant potential. Their small size and stability mean that nanobodies are compatible with respiratory administration. We report four nanobodies (C5, H3, C1, F2) engineered as homotrimers with pmolar affinity for the receptor binding domain (RBD) of the SARS-CoV-2 spike protein. Crystal structures show C5 and H3 overlap the ACE2 epitope, whilst C1 and F2 bind to a different epitope. Cryo Electron Microscopy shows C5 binding results in an all down arrangement of the Spike protein. C1, H3 and C5 all neutralize the Victoria strain, and the highly transmissible Alpha (B.1.1.7 first identified in Kent, UK) strain and C1 also neutralizes the Beta (B.1.35, first identified in South Africa). Administration of C5-trimer via the respiratory route showed potent therapeutic efficacy in the Syrian hamster model of COVID-19 and separately, effective prophylaxis. The molecule was similarly potent by intraperitoneal injection.

Summary of (CANADA) National Advisory Committee on Immunization (NACI) statement: Recommendations on the use of COVID-19 vaccines
Publication date: September 28, 2021

...NACI now recommends that:

COVID-19 vaccines may be given at the same time as, or any time before or after, other vaccines, including live, non-live, adjuvanted or unadjuvanted vaccines....

https://www.canada.ca/en/public-health/services/immunization/national-advisory-c...

Isaac Bogoch (U Toronto) @BogochIsaac | 2:21 PM · Sep 28, 2021:
https://twitter.com/BogochIsaac/status/1442917319148142593

New Ontario Science Table projections for #COVID19. Summary:
1. Things are going relatively well now, but if we lift public health measures then the wheels can fall off the wagon.
2. These vaccines are phenomenal.
Link: https://bit.ly/3AKy8Gl
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Bruce Arthur (Toronto Star) @bruce_arthur | 2:27 PM · Sep 28, 2021:
https://twitter.com/bruce_arthur/status/1442918987944194056

Among everything else, the science table cites data saying
you're 60 times more likely to go to the ICU if you aren't vaccinated, and
have about a 12% chance of not being back on the job after a year due to long Covid if you get infected.
Please get vaccinated!

Isaac Bogoch (U Toronto) @BogochIsaac | 10:15 AM · Sep 27, 2021:
1/ A case series of lung transplantation in those with severe #COVID19 infection who have little/no chance of a meaningful recovery.
Also a very insightful discussion around eligibility & outcomes (eg. median 6 yr survival?).*

Image-lung X-rays
https://twitter.com/BogochIsaac/status/1442493188766420995/photo/1

Image-text, key pts
https://twitter.com/BogochIsaac/status/1442493188766420995/photo/2

Image-text, timing for transplant
"...some patients become completely dependent on ECLS (= Extracorporeal Life Support = ECMO) for survival for months & imaging usually shows pulmonary fibrosis and bronchiectasis that is unlikely to improve. At this point, lung transplantation becomes the only option..."
https://twitter.com/BogochIsaac/status/1442493188766420995/photo/3
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* Jonathan C. Yeung et al. 2021. Lung transplantation for acute COVID-19: the Toronto Lung Transplant Program experience. CMAJ September 27, 2021 193 (38) E1494-E1497; DOI: https://doi.org/10.1503/cmaj.211143

KEY POINTS
Lung transplantation for COVID-19 acute respiratory distress syndrome (ARDS) is feasible but requires careful assessment of candidacy.

Single-organ failure, ability to consent, participation in physiotherapy and negative results for COVID-19 polymerase chain reaction tests are key considerations when evaluating candidacy for lung transplantation in patients with acute ARDS.

Selected patients with ARDS-related pulmonary fibrosis after COVID-19 may be lung transplant candidates in the future.

IF INFECTED, vaxxed have same viral load as unvaxxed.

Charlotte B. Acharya et al. 2021. No Significant Difference in Viral Load Between Vaccinated and Unvaccinated, Asymptomatic and Symptomatic Groups Infected with SARS-CoV-2 Delta Variant. MedRxiv (Sept 29, 2021) doi: https://doi.org/10.1101/2021.09.28.21264262 https://www.medrxiv.org/content/10.1101/2021.09.28.21264262v1

This article is a preprint and has not been certified by peer review.

Abstract
We found no significant difference in cycle threshold values between vaccinated and unvaccinated, asymptomatic and symptomatic groups infected with SARS-CoV-2 Delta. Given the substantial proportion of asymptomatic vaccine breakthrough cases with high viral levels, interventions, including masking and testing, should be considered for all in settings with elevated COVID-19 transmission.

https://twitter.com/EricTopol/status/1443256765466877954/photo/1

CDC issues an 'urgent' warning for pregnant people to get vaccinated as new data show pregnancy almost doubles the risk of death from COVID-19
Hilary Brueck | September 29, 2021

The CDC is issuing an urgent health advisory to encourage more vaccinations of pregnant people.

People who get COVID-19 during pregnancy have a two-fold risk of admission into the ICU and a 70% increased risk of death, according to the CDC.

In August, 22 pregnant people died from COVID-19, CDC data say..

https://www.yahoo.com/news/cdc-issues-urgent-warning-pregnant-162959633.html

------------------------------------------------
Not yet updated?

COVID-19 Vaccines While Pregnant or Breastfeeding
Updated Aug. 11, 2021
https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/pregnancy.htm...

Unvaccinated 60 times more likely to end up in ICU with COVID-19, Ontario data shows
Leslie Young | September 29, 2021

...The report, released Tuesday afternoon by the Ontario COVID-19 Science Advisory Table, found that
compared with fully vaccinated people, unvaccinated individuals are
seven times more likely to catch COVID-19,
25 times more likely to be hospitalized, and
60 times more likely to be in the ICU due to the disease...

https://globalnews.ca/news/8230051/covid-vaccine-hospitalization-risk-ontario/
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Update on COVID-19 Projections
Ontario COVID-19 Science Advisory Table and Modelling Consensus Table
Published: September 28, 2021
https://covid19-sciencetable.ca/sciencebrief/update-on-covid-19-projections-11/

Moderna vs. Pfizer: Here’s Ontario’s vaccine update
John Michael McGrath | Sep 29, 2021

...Out of what it’s calling “an abundance of caution,” the Ontario government is recommending that people 18 to 24 be immunized with the Pfizer vaccine instead of the one made by Moderna, due to concerns of the higher risk of myocarditis or pericarditis in people — particularly males — in that age group...

https://www.tvo.org/article/moderna-vs-pfizer-heres-ontarios-vaccine-update

Merck’s antiviral pill reduces hospitalization of Covid patients, a possible game-changer for treatment
Matthew Herper | Oct. 1, 2021

...A five-day course of molnupiravir, developed by Merck and Ridgeback Biotherapeutics, reduced both hospitalization and death compared to a placebo. In the placebo group, 53 patients, or 14.1%, were hospitalized or died. For those who received the drug, 28, or 7.3%, were hospitalized or died.

A simple oral medication...

...Patients in the study had mild-to-moderate Covid-19, were within five days of symptom onset when dosed, and had at least one risk factor associated with poor disease outcomes.

Only limited information on side effects was made public in the press release, but the companies said rates were similar between the placebo group and the treated group. An adverse event, or bad outcome, occurred in 35% of those who received molnupiravir and 40% of those who received placebo. Only 1.3% of molnupiravir-treated subjects discontinued the drug because of an adverse event, compared to 3.4% who discontinued placebo.

...In June, Merck entered into an agreement to supply the U.S. government 1.7 million courses of the drug for $1.2 billion, or $700 a course. That price could be out of reach for some countries. But Merck also has said it will enter into licensing agreements with generic drug makers to accelerate the availability of the drug in more than 100 low- and middle-income countries. “We are committed to making sure that there is access to this drug,” Daria Hazuda, a Merck vice president, told reporters on a conference call Friday morning.

...Molnupiravir works in a manner different from other antiviral drugs, creating multiple errors in the virus’s RNA and impairing its ability to replicate. Because there is not much experience with this mechanism, Pavia said, safety data will need to be scrutinized. He also said he doubted the drug will be used in pregnant people. None were included in the study.

...The drug appeared effective against so-called variants of concern, including the Gamma, Delta, and Mu variants of the virus.

...The study had enrolled 90% of the 1,500 volunteers it planned to include, but the decision to stop it was based on data from 762 patients. A breakdown on the background, ethnicity, and gender of the participants was not immediately available, but the trial was conducted in countries across the world, including Argentina, Italy, Japan, the United Kingdom, and the United States...

https://www.statnews.com/2021/10/01/mercks-antiviral-pill-reduces-hospitalizatio...

U.S. Coronavirus Death Toll Surpasses 700,000 Despite Wide Availability of Vaccines
The latest Covid-19 deaths were concentrated in the South, and included more younger people than before. Every age group under 55 saw its highest death toll of the pandemic this August.
Julie Bosman and Lauren Leatherby | Oct. 1, 2021

(See US map of most recent deaths...)
Recent Covid-19 deaths
Deaths per 100,000 residents since June 16: 0 - 120

(See graphics...)
Recent Covid-19 deaths since June 16, 2021 (6000,000 deaths) compared with state vaccination rates
The pace of Covid-19 deaths nationwide
Monthly Covid-19 deaths by age

https://www.nytimes.com/2021/10/01/us/us-covid-deaths-700k.html

>86 margd:....and in related news - Dear Old DeSantis, ever striving to be #1, is closing in on an obviously long sought goal - surpassing NY in terms of total number of COVID dead - as of this morning (2 October) the CDC count was NY - 55416 and Florida - 55299. A quick check of past counts clearly illustrates DeSantis's efforts. On 4 September the CDC count for NY was 54378 and for Florida it was 46324 so in less than a month's time DeSantis has added an impressive 8975 dead whereas NY has only been able to muster a measly 1038 for the same period - way to go DeSantis!

>87 alco261: DeSantis can mess with case data but more difficult with deaths... No longer running for prez, I read. (WHEW!!)
___________________________________________________

For unvaccinated, reinfection by SARS-CoV-2 is likely, study finds
Michael Greenwood | October 1, 2021
https://news.yale.edu/2021/10/01/unvaccinated-reinfection-sars-cov-2-likely-stud...
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Jeffrey P Townsend et al. 2021. The durability of immunity against reinfection by SARS-CoV-2: a comparative evolutionary study. The Lancet Microbe (Oct 1, 2021) https://www.thelancet.com/pdfs/journals/lanmic/PIIS2666-5247(21)00219-6.pdf

Summary
Background...
Methods...

Findings
...Reinfection by SARS-CoV-2 under endemic conditions would likely occur between 3 months and 5·1 years after peak antibody response, with a median of 16 months. This protection is less than half the duration revealed for the endemic (cold-causing) coronaviruses circulating among humans... For SARS-CoV, the 5–95% quantiles were 4 months to 6 years, whereas the 95% quantiles for MERS-CoV were inconsistent by dataset.

Interpretation
The timeframe for reinfection is fundamental to numerous aspects of public health decision making. As the COVID-19 pandemic continues, reinfection is likely to become increasingly common. Maintaining public health measures that curb transmission—including among individuals who were previously infected with SARS-CoV-2—coupled with persistent efforts to accelerate vaccination worldwide is critical to the prevention of COVID-19 morbidity and mortality.

Eric Topol @EricTopol | 2:14 PM · Oct 3, 2021
Where it was to where it is.
https://nytimes.com/interactive/2021/us/covid-cases.html
Image-US map, Aug 12 & Oct 3, 2021 ( https://twitter.com/EricTopol/status/1444727604179730434/photo/1 )

Pregnant and Unvaccinated: Delta’s Deadly Toll

The number of pregnant people suffering from severe COVID is preventable tragedy
Carolyn Barber | Oct 1, 2021

...Pregnant people tend to be more susceptible to viral diseases in general, Tucker says, which may be because of “the mechanical effects of the advancing pregnancy, especially for pulmonary infections or changes in one ’s immune system.” Being pregnant may weaken one ’s immune system and render it susceptible to the highly contagious Delta variant. Delta now represents more than 99 percent of cases of COVID tracked in the country.

A CDC study of 400,000 women aged 15 to 44 who were diagnosed with symptomatic COVID-19 found that, although the absolute risk of severe outcomes was low, the pregnant women had a higher risk of severe disease and death than the nonpregnant ones. Likewise, a study of about 870,000 women found that, compared with those who did not give birth with COVID-19, those who did so had a nearly one-and-a-half-fold increase in preterm births, a sixfold increase in ICU admissions, a 14-fold increase in mechanical ventilation and a 15-fold increase in death...

https://www.scientificamerican.com/article/pregnant-and-unvaccinated-deltas-dead...

...Pregnant people tend to be more susceptible to viral diseases in general, Tucker says, which may be because of “the mechanical effects of the advancing pregnancy, especially for pulmonary infections or changes in one ’s immune system.” Being pregnant may weaken one ’s immune system and render it susceptible to the highly contagious Delta variant. Delta now represents more than 99 percent of cases of COVID tracked in the country.

A CDC study of 400,000 women aged 15 to 44 who were diagnosed with symptomatic COVID-19 found that, although the absolute risk of severe outcomes was low, the pregnant women had a higher risk of severe disease and death than the nonpregnant ones. Likewise, a study of about 870,000 women found that, compared with those who did not give birth with COVID-19, those who did so had a nearly one-and-a-half-fold increase in preterm births, a sixfold increase in ICU admissions, a 14-fold increase in mechanical ventilation and a 15-fold increase in death...

https://www.scientificamerican.com/article/pregnant-and-unvaccinated-deltas-dead...

Eric Topol @EricTopol | 10:45 PM · Oct 3, 2021:
An extraordinary 90 second video of the hotspots and spread throughout the American pandemic, by @BioTurboNick
Watch COVID-19 spread across the United States (9/30/21)

Used the Johns Hopkins University data (https://coronavirus.jhu.edu/map.html) for individual counties since the beginning of the pandemic to visualize the spread...
1:30 https://twitter.com/EricTopol/status/1444856163720257541

Vaccination vs shingles was associated with a 32% reduced risk of Covid hospitalization.


Katia J Bruxvoort et al. 2021. Recombinant adjuvanted zoster vaccine and reduced risk of COVID-19 diagnosis and hospitalization in older adults. MedRxiv (Oct 3, 2021) doi: https://doi.org/10.1101/2021.10.01.21264400 https://www.medrxiv.org/content/10.1101/2021.10.01.21264400v1

This article is a preprint and has not been certified by peer review

Abstract
...Conclusion: RZV ( recombinant adjuvanted zoster vaccine) vaccination was associated with a 16% lower risk of COVID-19 diagnosis and 32% lower risk of hospitalization, suggesting RZV elicits heterologous protection, possibly through trained immunity.

Image ( https://twitter.com/EricTopol/status/1444807655030067201/photo/1 )

Eric Topol @EricTopol | 1:38 AM · Oct 4, 2021
The 30+ fold impact of vaccination for reducing hospitalization for age 60+ vs under-18 years

Infographic ( https://twitter.com/EricTopol/status/1444899816299905024/photo/1 )

Eight countries show vaccinations hitting a wall.
Australians at least keep turning up at vaxx clinics--thus far anyway...

Daily Vaxx v Population Vaccinated
X: Rate of Vaccination
Y: Pace of Vaccination
Image ( https://twitter.com/behrooz_hm/status/1444184180456235010/photo/1 )

-Dr Behrooz Hassani-M @behrooz_hm | 2:15 AM · Oct 2, 2021

Eric Topol (Scripps) @EricTopol | 11:27 AM · Oct 4, 2021
New report on very rare acute myocarditis after mRNA vaccination in age 18+
5.8 cases/million after 2nd dose, 0.8/million 1st dose, all cases fully resolved with conservative management

-------------------------------------------------

Anthony Simone et al. 2021. Acute Myocarditis Following COVID-19 mRNA Vaccination in Adults Aged 18 Years or Older (Research Letter). JAMA Internal medicine (October 4, 2021) doi:10.1001/jamainternmed.2021.5511 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2784800

Discussion
In this population-based cohort study of 2 392 924 individuals who received at least 1 dose of COVID-19 mRNA vaccines, acute myocarditis was rare, at an incidence of 5.8 cases per 1 million individuals after the second dose (1 case per 172 414 fully vaccinated individuals). The signal of increased myocarditis in young men warrants further investigation.

This vaccinated cohort is unique in its racial and ethnic diversity and in receiving care at community hospitals with treatment reflective of real-world practice. Limitations of this study include the observational design; short follow-up time; absence of myocardial biopsy for definitive diagnosis; lack of uniform testing of all cases; possible more extensive workup of chest pain in vaccinated individuals during the immediate postvaccination period; and possible underdiagnosis of subclinical cases. No relationship between COVID-19 mRNA vaccination and postvaccination myocarditis can been established given the observational nature of this study.

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Vinay Guduguntla and Mitchell H. Katz. 2021. COVID-19 Messenger RNA Vaccination and Myocarditis—A Rare and Mostly Mild Adverse Effect (Editorial). JAMA Intern Med. Published online October 4, 2021. doi:10.1001/jamainternmed.2021.5634 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2784801

...the affected patients were all men younger than 40 years with no prior cardiac history, and they were discharged within a week of conservative management.3 These results parallel prior studies that showed incidence of post–COVID-19 mRNA vaccination myocarditis primarily in young men who have recently received their second vaccine dose.1

Overall, vaccination-related myocarditis was a rare and mostly mild adverse event. Data from the Vaccine Adverse Event Reporting System indicate that it is not unique to just the COVID-19 mRNA vaccine.4 Moreover, this risk is small when weighed with the morbidity and mortality of COVID-19 infection, in which up to 28% of hospitalized patients showed signs of myocardial injury...

I won't hold my breath, but my fingers ARE crossed:

Chise (vaxx sci) @sailorrooscout | 9:46 AM · Oct 5, 2021:
This has not been shared widely in the media so let’s fix that.
COVID-19 is now in retreat in the United States, the United Kingdom, AND Worldwide.
Worldwide, cases have fallen MORE THAN 30% since late August and weekly deaths have fallen MORE THAN 15%.
It gets better. Read on.Thread

•U.S. cases and hospitalizations have fallen 35% and 25% respectively since September 1st.
•Daily deaths in the U.S. have fallen 10% since September 20th. It is the FIRST sustained decline in deaths since the early summer.
•Deaths in the U.K. have fallen 21% since their-
Graphs
https://twitter.com/sailorrooscout/status/1445384902984278027/photo/1
https://twitter.com/sailorrooscout/status/1445384902984278027/photo/2

•Hospitalizations in the U.K. are down 28% since their September peak.
•The pattern has also been evident within countries, including India, Indonesia, Thailand, Britain, France, and Spain. In each of them, the Delta variant led to a surge in cases lasting-

somewhere from one and a half to two and a half months.
•In the U.S., the Delta surge started in several Southern states in June and began receding in those states in August. In much of the rest of the U.S., it began in July, and cases have begun falling the past few weeks.
Graph ( https://twitter.com/sailorrooscout/status/1445385163412807692/photo/1 )

Even pediatric cases are falling, despite the lack of vaccine authorization for children under 12.
•The share of those in the U.S. 12 and over who have received at least one vaccine shot has reached 76%.
•MORE THAN 6 BILLION vaccine doses have been administered worldwide.

•Lastly, around 1/2 of those in the U.S. have probably had COVID already, giving them some natural immunity. This matters and counts.
“Eventually, immunity will become widespread enough that another wave as large and damaging as the Delta wave will not be possible.

“Barring something unexpected,” Dr. Scott Gottlieb, has stated: “I’m of the opinion that this is the LAST major wave of infection.”
“COVID isn’t going to disappear anytime soon. It will continue to circulate for years, many scientists believe. BUT the vaccines can transform

COVID into a MANAGEABLE disease, not so different from a flu or common cold. In the past few weeks, the country appears to have moved closer to that less grim future. Whatever this autumn brings, the worst of the pandemic is almost certainly behind us.”

Let’s keep going. Our focus should now be on countries that need vaccines the most to stop COVID in its tracks. You can read all of this and more here: https://nytimes.com/2021/10/04/briefing/covid-caseload-retreat-us-cases.html and https://firstpost.com/world/covid-19

One thing I want to add onto this thread that is circulating in the media. This particular study out of The Lancet. PLEASE NOTE: Vaccine effectiveness in preventing hospitalization and death remained high at 90% for AT LEAST (NOT ONLY) SIX MONTHS, even against the highly

contagious Delta variant. That’s from the actual study itself. Felt the need to put that out there since most headlines today have been extremely misleading. You can find that study here: https://thelancet.com/journals/lancet/article/PIIS0140-6736(21)02183-8/fulltext.

And if you should need it to compare this time last year to now. https://ourworldindata.org/grapher/curren
https://twitter.com/sailorrooscout/status/1445409596122746896/photo/1

Sounds like the time for home antigen tests has arrived. Our county in Michigan gave out boxes of 25 upon request a few months ago: though vaxxed, it is a comfort to test oneself before spending time with potentially vulnerable people!

Covid News: F.D.A. Says Rapid Home Testing Capacity Will Soon Double
NYT | Oct. 5, 2021. Updated Oct. 6, 2021

Rapid at-home Covid-19 testing is about to become much more widely available in the United States, the Food and Drug Administration says, following authorization of a mass-produced testing kit.

Competing at-home tests have been on the market for months, but Acon Laboratories’ test, authorized by the agency on Monday, “is expected to double rapid at-home testing capacity in the U.S. over the next several weeks,” Dr. Jeffrey E. Shuren, the director of the F.D.A.’s Center for Devices and Radiological Health, said in a statement.

“By year’s end, the manufacturer plans to produce more than 100 million tests per month, and this number will rise to 200 million per month by February 2022,” he said.

Like tests already available from Abbott, Quidel, Becton Dickinson and other makers, Acon’s test is made to detect antigens, proteins from the coronavirus, on a nasal swab, and produces results in 15 minutes...

https://www.nytimes.com/live/2021/10/05/world/covid-vaccine-cases#rapid-at-home-...
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Coronavirus (COVID-19) Update: FDA Authorizes Additional OTC Home Test to Increase Access to Rapid Testing for Consumers
For Immediate Release: October 04, 2021
Statement From: Jeffrey E. Shuren, MD, JD, Director - CDRH (Center for Devices and Radiological Health)

...Today’s authorization for the ACON Laboratories Flowflex COVID-19 Home Test should significantly increase the availability of rapid, at-home tests and is expected to double rapid at-home testing capacity in the U.S. over the next several weeks. By years end, the manufacturer plans to produce more than 100 million tests per month, and this number will rise to 200 million per month by February 2022...

https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-...
_________________________________________________

Eric Feigl-Ding (epidemiologist economist) @DrEricDing | 8:46 AM · Oct 6, 2021
...The goal is to also reduce the cost of these tests dramatically. And many vendors have already stepped up to say they will subsidize the costs of the tests to lower the price.

‘Covid toe’ may be side-effect of immune response, says study
Chilblain-like inflammation causes redness on hands and feet and can last for months
Kevin Rawlinson and agency | 6 Oct 2021

...one mechanism behind both types of the condition involved the body generating an immune response with high levels of certain autoantibodies, which mistakenly target and react with a person’s own cells and tissues as well as the invading virus. They also found an overlap with type I interferon, a key protein in the antiviral response.

In addition to the immune system, cells lining blood vessels that supply the affected areas also appeared to play a critical role in the development of Covid toes and chilblains...

https://www.theguardian.com/world/2021/oct/06/covid-toe-may-be-side-effect-immun...

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L. Frumholtz etr al. 2021. Type I interferon response and vascular alteration in chilblain-like lesions during the COVID-19 outbreak. British J. Dermatology. First published: 05 October 2021. https://doi.org/10.1111/bjd.20707 https://onlinelibrary.wiley.com/doi/10.1111/bjd.20707

Summary
...Results
Histological patterns were similar and transcriptomic signatures overlapped in both the CLL (chilblain-like lesions) and SC (seasonal chilblains) groups, with type I interferon polarization and a cytotoxic–natural killer gene signature. CLL were characterized by higher IgA tissue deposition and more significant transcriptomic activation of complement and angiogenesis factors compared with SC. We observed in CLL a systemic immune response associated with IgA antineutrophil cytoplasmic antibodies in 73% of patients, and elevated type I interferon blood signature in comparison with healthy controls. Finally, using blood biomarkers related to endothelial dysfunction and activation, and to angiogenesis or endothelial progenitor cell mobilization, we confirmed endothelial dysfunction in CLL.

Conclusions
Our findings support an activation loop in the skin in CLL associated with endothelial alteration and immune infiltration of cytotoxic and type I IFN-polarized cells leading to clinical manifestations.

Eric Topol @EricTopol | 10:19 PM · Oct 6, 2021:
Covid vaccines are essential and have had a profoundly positive impact.
There's controversy as to whether boosters will be useful for age 60 and under.
New data highlights significantly less protection vs symptomatic infections and, to a lesser extent, hospitalizations /1

Summary of the recent data for vaccine effectiveness vs symptomatic infections.
At 2 months, this was well over 90% for mRNA vaccines, but by 4-6+ months has declined to between 44-70%.
All ages.
Data for Pfizer, Moderna, and AZ /2
Table. Studies of Vaccines' effectiveness agst variants( https://twitter.com/EricTopol/status/1445936870634885123/photo/1 )

The Qatar data (showing greatest decline in Pfizer Vaccine Effectiveness) were just published @NEJM*
https://twitter.com/EricTopol/status/1445856967860228102
Here are the ICATT data (age under 65), presented at the recent CDC ACIP meeting /3
Graph-VE v Delta ( https://twitter.com/EricTopol/status/1445936876012015623/photo/1 )

Just published @NEJM*
Pfizer vaccine waning in Qatar over time among ~115,000 vaccinees + controls
Attrition in protection vs infections, including symptomatic (to 43%, 4 months), + Delta data; well preserved vs hospitalizations
http://nejm.org/doi/full/10.10
Text-abstract, highlighted ( https://twitter.com/EricTopol/status/1445856967860228102/photo/1 )
Graphs-effectiveness v Delta ( https://twitter.com/EricTopol/status/1445856967860228102/photo/2 )
Table-symptomatic infection over time ( https://twitter.com/EricTopol/status/1445856967860228102/photo/3 )
Table-infection over time ( https://twitter.com/EricTopol/status/1445856967860228102/photo/4 )
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* Hiam Chemaitelly et al. 2021. Waning of BNT162b2 Vaccine Protection against SARS-CoV-2 Infection in Qatar. NEJM October 6, 2021. DOI: 10.1056/NEJMoa2114114 https://www.nejm.org/doi/full/10.1056/NEJMoa2114114

Abstract
Background
Waning of vaccine protection against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or coronavirus disease 2019 (Covid-19) is a concern. The persistence of BNT162b2 (Pfizer–BioNTech) vaccine effectiveness against infection and disease in Qatar, where the B.1.351 (or beta) and B.1.617.2 (or delta) variants have dominated incidence and polymerase-chain-reaction testing is done on a mass scale, is unclear.

Methods
We used a matched test-negative, case–control study design to estimate vaccine effectiveness against any SARS-CoV-2 infection and against any severe, critical, or fatal case of Covid-19, from January 1 to September 5, 2021.

Results
Estimated BNT162b2 effectiveness against any SARS-CoV-2 infection was negligible in the first 2 weeks after the first dose. It increased to 36.8% ... in the third week after the first dose and reached its peak at 77.5% (95% CI, 76.4 to 78.6) in the first month after the second dose. Effectiveness declined gradually thereafter, with the decline accelerating after the fourth month to reach approximately 20% in months 5 through 7 after the second dose. Effectiveness against symptomatic infection was higher than effectiveness against asymptomatic infection but waned similarly. Variant-specific effectiveness waned in the same pattern. Effectiveness against any severe, critical, or fatal case of Covid-19 increased rapidly to 66.1% ... by the third week after the first dose and reached 96% or higher in the first 2 months after the second dose; effectiveness persisted at approximately this level for 6 months.

Conclusions
BNT162b2-induced protection against SARS-COV-2 infection appeared to wane rapidly following its peak after the second dose, but protection against hospitalization and death persisted at a robust level for 6 months after the second dose.

The 2,000-year-old airborne disease theory that blinded Covid experts
As a result precautions such as wearing masks and better ventilation in public spaces were tragically delayed, says a new report
Paul Nuki, Jennifer Rigby, and Anne Gulland | 2 October 2021

...A new paper published by leading academics argues that the western medical profession’s centuries-long battle against (Hippocrates') miasma theory initially blinded it to the fact that Sars-CoV-2 was airborne..."Echoes Through Time: The Historical Origins of the Droplet Dogma and its Role in the Misidentification of Airborne Respiratory Infection Transmission, the paper is co-authored by more than 20 leading academics from around the world and is likely to cause a major stir as it moves through the peer-review process...

...Only now - 160 years after John Snow (cholera spread through water, not gases) - has there finally begun a new “paradigm shift in the understanding of disease transmission”, say the authors.

“Not only are respiratory diseases not transmitted exclusively by droplets, but also it is likely that many or most respiratory diseases have an important airborne component...This does not mark a return to past miasmatic ideas, but a more informed understanding of airborne transmission.”

...Professor Jose-Luis Jimenez, lead author of the paper and a chemistry professor at the University of Colorado, says the medical profession’s history left it blinkered to a startling degree.

...an experimental error made over a century ago which has been taught in medical schools ever since. In 1910, an American doctor, Charles Chapin, made a name for himself by proving pathogens could spread via exhaled droplets but he over interpreted his results. His finding that pathogens could be “sprayborne” was accepted - wrongly - as proof that more general aerosol transmission did not exist. Droplet borne infection freed us “from the specter of infected air - a specter which has pursued the race from the time of Hippocrates”, declared Dr Chapin at the time.

Policymakers and politicians also have a natural bias against the idea that diseases may be airborne, says Professor Jimenez. "Droplets and surfaces are very convenient for people in power - all of the responsibility is on the individual,” he said. “On the other hand, if you admit it is airborne, institutions, governments and companies have to do something.”...

https://www.telegraph.co.uk/global-health/science-and-disease/every-medical-auth...

Tensions grow between Moderna, White House over vaccine production
The Biden administration has urged Moderna for months to increase its production domestically.
RIN BANCO, ADAM CANCRYN and SARAH OWERMOHLE | 10/07/2021

...The Biden administration has urged Moderna for months to increase its production domestically, in an attempt to help deliver on the president’s pledge to make the U.S. “an arsenal of vaccines” for the world. The White House has donated tens of millions of Moderna doses abroad. Its push for more comes despite the company’s agreement to supply 500 million doses to low- and middle-income countries, including 34 million doses this year, through the international vaccine aid program known as the COVAX Facility.

Moderna, which developed its shot with scientific and financial help from the government, has shied away making additional commitments...The company has cited worries about its ability to balance its domestic and international responsibilities.

But administration officials privately believe the reluctance is also driven in part by financial concerns: If Moderna agreed to sell the Biden administration doses for poorer countries it would likely be asked to do so at cost, one source said, putting pressure on its bottom line.

The company’s stance has infuriated top Biden health officials...

...amid the ongoing tension, the company announced early Thursday that it will build a vaccine-production hub in Africa to produce up to 500 million doses each year. It has not chosen a site or set a timeline for opening the facility, however.

...The Biden administration’s strained talks with Moderna stand in stark contrast to its relationship with Pfizer and BioNTech. The partners turned down government aid to develop their Covid-19 shot but have worked with the administration to increase global vaccination. In September, the two companies signed a deal with the federal government to deliver 1 billion doses of their vaccine for international donation by the end of September 2022.

...The (8) billions of taxpayer dollars poured into developing the vaccine have only deepened U.S. officials' frustration with (Moderna's) hesitation to further aid the president's international efforts.

...In the meantime, Moderna is also facing — and resisting — growing pressure from activists and international organizations to share the formula for its vaccine with manufacturers in other countries.

The Biden administration earlier this year formally backed waiving patent protections for Covid-19 vaccines to expand production worldwide. But that proposal is fiercely opposed by both drug manufacturers and some European countries.

https://www.politico.com/news/2021/10/07/biden-admins-moderna-international-dona...

>101 margd: ...So, I think a shout out is in order for DeSantis - the boy did it! As of this morning (9 October - 8:45AM) the CDC death count in Florida is 56667 and in New York it is 55645 giving Florida a comfortable lead of 1022 deaths. What a guy! Even more impressive is the slaughter for the last 7 days - Florida managed to kill off 1368 vs New York's loss of 229. So, in Florida, people were dying at the rate of slightly more than 8/hour or one dead every 7.5 minutes!

Vincent Rajkumar (Mayo Clinic) @VincentRK | 3:36 PM · Oct 8, 2021:
Only 30% of people who needed to be hospitalized for COVID were back to normal about 6 months after discharge.
Infographic-https://twitter.com/VincentRK/status/1446560064941273089/photo/1
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Rachael A Evans et al. 2021. Physical, cognitive, and mental health impacts of COVID-19 after hospitalisation (PHOSP-COVID): a UK multicentre, prospective cohort study, The Lancet Respiratory Medicine. October 07, 2021. DOI:https://doi.org/10.1016/S2213-2600(21)00383-0 https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(21)00383-0/fullt...

SUMMARY...
Findings
We report findings for 1077 patients discharged from hospital between March 5 and Nov 30, 2020, who underwent assessment at a median of 5·9 months... after discharge. Participants had a mean age of 58 years ...; 384 (36%) were female, 710 (69%) were of white ethnicity, 288 (27%) had received mechanical ventilation, and 540 (50%) had at least two comorbidities. At follow-up, only 239 (29%) of 830 participants felt fully recovered,
158 (20%) of 806 had a new disability (assessed by the Washington Group Short Set on Functioning), and
124 (19%) of 641 experienced a health-related change in occupation.
Factors associated with not recovering were female sex, middle age (40–59 years), two or more comorbidities, and more severe acute illness. The magnitude of the persistent health burden was substantial but only weakly associated with the severity of acute illness. Four clusters were identified with different severities of mental and physical health impairment (n=767): very severe (131 patients, 17%), severe (159, 21%), moderate along with cognitive impairment (127, 17%), and mild (350, 46%). Of the outcomes used in the cluster analysis, all were closely related except for cognitive impairment. Three (3%) of 113 patients in the very severe cluster, nine (7%) of 129 in the severe cluster, 36 (36%) of 99 in the moderate cluster, and 114 (43%) of 267 in the mild cluster reported feeling fully recovered. Persistently elevated serum C-reactive protein was positively associated with cluster severity.

Interpretation
We identified factors related to not recovering after hospital admission with COVID-19 at 6 months after discharge (eg, female sex, middle age, two or more comorbidities, and more acute severe illness), and four different recovery phenotypes. The severity of physical and mental health impairments were closely related, whereas cognitive health impairments were independent. In clinical care, a proactive approach is needed across the acute severity spectrum, with interdisciplinary working, wide access to COVID-19 holistic clinical services, and the potential to stratify care.

NHS (National Health Services England) encourages pregnant women to get COVID-19 vaccine
11 October 2021

The NHS is encouraging pregnant women to get the COVID-19 vaccine as new data shows that nearly 20 per cent of the most critically ill COVID patients are pregnant women who have not been vaccinated.

Since July, one in five COVID patients receiving treatment through a special lung-bypass machine were expectant mums who have not had their first jab.

Pregnant women have been treated with a therapy, called Extracorporeal Membrane Oxygenation (ECMO), used only when a patient’s lungs are so damaged by COVID that a ventilator cannot maintain oxygen levels.

England’s top midwife is today reassuring women that the vaccine is safe and effective during pregnancy and is recommended by clinicians and charities.

Out of all women between the ages of 16 and 49 on ECMO in intensive care, pregnant women make up almost a third (32 percent) – up from just 6 per cent at the start of the pandemic, March 2020.

A mum-to-be who spent nearly a month in an NHS hospital’s critical care unit after catching coronavirus during her pregnancy has now joined health chiefs in encouraging pregnant women to get the live-saving COVID vaccine.

Claire, 33, from Kent, was hospitalised with coronavirus for a month in July this year, and wants fellow expectant mothers to know the serious health risks that not having the COVID-19 vaccine poses to them and their unborn baby.

Claire said: “I completely understand the hesitation not to get vaccinated when you are growing a child inside you, and after experiencing two miscarriages before the pandemic, the fear of being pregnant again with the worry of COVID was sending my anxiety through the roof.

“But after what happened, I can honestly say that the risk of not having the COVID vaccine far outweighs any doubts about having it”.

A few days after testing positive for COVID on 7 July, Claire was admitted to her local hospital in Kent with difficulty breathing, where she was then put on a ventilator while in a medically induced coma.

Unfortunately, her condition deteriorated, so medics told Claire and her husband to prepare for the possibility of an emergency c-section at just 26 weeks into her pregnancy.

With her condition continuing to get worse, Claire was transferred to another hospital in London where the clinical team managed to ensure she did not need an early c-section.

On 4 August, nearly a month after she was initially admitted to hospital, Claire was allowed to go home, where she is gradually recovering with her husband, and their unborn child, who is doing well.

Claire is now urging other pregnant women to consider getting the COVID vaccine to significantly reduce their risk of catching coronavirus and having the same experience.

Since vaccinations began in December 2020, almost every person who has received ECMO for COVID in the UK has been unvaccinated, NHS data shows.

Data from Public Health England showed that over 81,000 pregnant women have received the first dose of the life-saving COVID jab, and around 65,000 have received their second dose.

Health chiefs are now calling on all expectant mums to get vaccinated to protect them and their baby against coronavirus.

Jacqueline Dunkley-Bent, Chief Midwifery Officer for England, said: “This is another stark reminder that the COVID-19 jab can keep you, your baby and your loved ones, safe and out of hospital. You can receive vaccination at any time in pregnancy, but the risks that unvaccinated pregnant women face of becoming severely unwell if they catch COVID-19 show exactly why we advise you to do so as soon as possible”.

COVID vaccination in pregnancy is considered safe and is recommended by the Royal College of Obstetricians, Royal College of Midwives and the UK Tetralogy Service. Data from over 100,000 COVID vaccinations in pregnancy in England and Scotland, and a further 160,000 in the US, show there has been no subsequent harm to the foetus or infant.

The Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives have both recommended vaccination as one of the best defences for pregnant women against severe COVID-19 infection, while the independent JCVI confirms the jab has been shown to be effective and safe for women carrying a baby.

Dr Edward Morris, President of the Royal College of Obstetricians and Gynaecologists, said: “We are urgently calling for all pregnant women to come forward for their vaccinations. There is robust evidence showing that the vaccine is the most effective way to protect both mother and baby against the possibility of severe illness from COVID-19. The disproportionate number of unvaccinated pregnant women in intensive care demonstrates that there is a significant risk of severe illness from COVID-19 in pregnancy.

“We do understand women’s concerns about having the vaccine in pregnancy, and we want to reassure women that there is no link between having the vaccine and an increased risk of miscarriage, premature birth, or stillbirth.”

Pregnant women were first offered the vaccine in December 2020, if they were health or care workers or in an at risk group. Since April 2021, pregnant women have been offered the vaccine as part of the standard age based rollout of the vaccination programme. The NHS has arranged for the vaccine to be expectant mums at a number of convenient local locations, including at some antenatal clinics, and pregnant women are encouraged to speak to their GP or midwife if they have questions about getting the jab.

Health and Social Care Secretary Sajid Javid said: “It is desperately sad that nearly 1 in 5 COVID-19 patients who are most critically ill are pregnant women who have not been vaccinated. This shows just how important it is that expectant mothers get the vaccine to keep themselves and their babies safe.

“Over 81,000 pregnant women have so far received their first dose, with 65,000 being double-jabbed, which is fantastic, but there’s still more to be done.
“The COVID-19 vaccines are safe and effective for pregnant women and I urge everyone to get their vaccines as soon as they can to secure this significant protection”.

https://www.england.nhs.uk/2021/10/nhs-encourages-pregnant-women-to-get-covid-19...

"...The breakthrough cases attributed to the Delta variant are unlikely to arise from a failure of vaccines, Akiko Iwasaki (Yale) said. Rather, they likely stem from the extremely infectious nature of the Delta variant, which can overcome the immune defense, she said..." https://news.yale.edu/2021/10/11/vaccines-effective-against-most-sars-cov-2-vari...
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Prof. Akiko Iwasaki (Yale) @VirusesImmunity | 7:45 PM · Oct 11, 2021
In our study published today, we show;
1) mRNA vaccines (2 shots) induce robust antibodies & T cells to SARS-CoV-2
2) certain mutations in VOC (increase antibody) Ab escape
3) prior infection + 2 mRNA shots produce very high neutralizing Ab against most VOC (Variants of Concern)
Barg graph-vaxx/infection history v variants ( https://twitter.com/VirusesImmunity/status/1447709980514295810/photo/1 )

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Carolina Lucas...Akiko Iwasaki. 2021. Impact of circulating SARS-CoV-2 variants on mRNA vaccine-induced immunity.
Nature (11 October 2021) https://doi.org/10.1038/s41586-021-04085-y https://www.nature.com/articles/s41586-021-04085-y
https://www.nature.com/articles/s41586-021-04085-y.epdf

Unedited manuscript that has been accepted for publication. (Previously shared here as preprint?)

Abstract

The emergence of SARS-CoV-2 variants with mutations in major neutralizing antibody-binding sites can affect humoral immunity induced by infection or vaccination... We analysed the development of anti-SARS-CoV-2 antibody and T cell responses in previously infected (recovered) or uninfected (naive) individuals that received mRNA vaccines to SARS-CoV-2. While previously infected individuals sustained higher antibody titres than uninfected individuals post-vaccination, the latter reached comparable levels of neutralization responses to the ancestral strain after the second vaccine dose. T cell activation markers measured upon spike or nucleocapsid peptide in vitro stimulation showed a progressive increase after vaccination. Comprehensive analysis of plasma neutralization using 16 authentic isolates of distinct locally circulating SARS-CoV-2 variants revealed a range of reduction in the neutralization capacity associated with specific mutations in the spike gene: lineages with E484K and N501Y/T (e.g., B.1.351 (S. Africa) and P.1 (Brazil)) had the greatest reduction, followed by lineages with L452R (e.g., B.1.617.2 (Delta, India)). While both groups retained neutralization capacity against all variants, plasma from previously infected vaccinated individuals displayed overall better neutralization capacity when compared to plasma from uninfected individuals that also received two vaccine doses, pointing to vaccine boosters as a relevant future strategy to alleviate the impact of emerging variants on antibody neutralizing activity.

...Discussion
Human NAbs (nano antibodies) against SARS-CoV-2 can be categorized as belonging to four classes on the basis of their target regions on the RBD(receptor Binding Domain). Although the RBD is immunodominant, there is evidence for a substantial role of other spike regions in antigenicity, most notably the NTD supersite22–24. These antibodies target epitopes that are closely associated with NTD and RBD residues L18 and ΔH69/V70, and K417, L452, S477, T478, E484 and N501. Previous studies using pseudovirus constructs reported a significant impact of single S amino acid substitutions, including S477N and E484K located at the RBD-ACE2 interface, in the neutralization activity of plasma from vaccinated individuals1–5,25. Using a large panel of genetically diverse authentic SARS-CoV-2 isolates, we found that lineages with E484K and N501Y/T led to the most severe decreases in mRNA vaccine-induced neutralization (+10 fold in previously uninfected vaccinated individuals). This group includes B.1.351 (Beta) and P.1 (Gamma), further supporting their importance in regards to vaccines. Interestingly, we also found that a generic lineage B.1 isolate with E484K and N501T, and a rare B.1.1.7 (Alpha) isolate with E484K (also with the common N501Y mutation) have similar impacts on neutralization as B.1.351 and P.1. While the combinations of mutations in the B.1 and B.1.1.7 with E484K isolates likely do not increase transmissibility, the additive effects of these two mutations supports that surveillance programs should track all viruses with E484K and N501Y/T in addition to variants of concern/interest.

Kenya.

Science Magazine @ScienceMagazine | 3:45 AM · Oct 12, 2021
Waves of #SARSCOV2 infection in Kenya were driven not only by emerging variants, a new modeling study shows, but also by socio-economic circumstances. Understanding this is critical for forecasting hospitalization demand and planning interventions.

Graph-7-day moving av cases w/ govt policy actions
https://twitter.com/ScienceMagazine/status/1447830668340248576/photo/1
from https://fcld.ly/r3jlh04
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Samuel P. C. Brand et al. 2021. COVID-19 transmission dynamics underlying epidemic waves in Kenya. Science • 7 Oct 2021 • First Release • DOI: 10.1126/science.abk0414 https://www.science.org/doi/10.1126/science.abk0414

Abstract
Policy decisions on COVID-19 interventions should be informed by a local, regional and national understanding of SARS-CoV-2 transmission. Epidemic waves may result when restrictions are lifted or poorly adhered to, variants with new phenotypic properties successfully invade, or when infection spreads to susceptible sub-populations. Three COVID-19 epidemic waves have been observed in Kenya. Using a mechanistic mathematical model, we explain the first two distinct waves by differences in contact rates in high and low social-economic groups, and the third wave by the introduction of higher-transmissibility variants. Reopening schools led to a minor increase in transmission between the second and third waves. Socio-economic and urban/rural population structure are critical determinants of viral transmission in Kenya.

...The high population exposure suggests that a fourth COVID-19 wave in Kenya before the end of 2021 would only be likely if
(i) a variant arises with substantial further enhancement in transmissibility or immune escape, such as the B.1.617.2 Delta variant (30), or
(ii) significant waning of immunity in those previously exposed.

We predict that approximately 75% of the Kenyan population have been exposed to SARS-CoV-2 by June 2021. This will mitigate the death rate that might be expected in the future but taking together
a) the markedly increased transmissibility of Delta variant;
b) the potential for re-infection and
c) the experience of other countries despite prevalent vaccination,
this scenario is entirely consistent with a significant fourth wave in Kenya.

We conclude that our analysis which triangulates PCR test, seroprevalence, mobility and genomic data to develop a coherent explanation of the transmission dynamics of COVID-19, provides insight of public health importance in Kenya, including targeting health care capacity and pharmaceutical and non-pharmaceutical interventions.

Texas...

Greg Abbott (TX guv) @GregAbbott_TX | 7:00 PM · Oct 11, 2021:
I issued an Executive Order prohibiting vaccine mandates by ANY entity in Texas.
I also added the issue to the Special Session agenda.
The COVID-19 vaccine is safe, effective, & our best defense against the virus,
but should always remain voluntary & never forced.
Image- https://twitter.com/GregAbbott_TX/status/1447698649446854656/photo/1

https://twitter.com/jessicashortall/status/1447746618766381061/photo/1

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Texas: Where a virus has reproductive rights,...
But a woman does not.

- Roshan Rinaldi @Roshan_Rinaldi | 10:45 AM · Oct 10, 2021
---------------------------------------------------------

ETA
Texas Gov. Greg Abbott orders a ban on all COVID-19 vaccine mandates in the state
The Associated Press | October 11, 2021

...Abbott previously barred vaccine mandates by state and local government agencies, but until now had let private companies make their own rules for their workers. It was not immediately clear if Abbott's latest executive order would face a quick court challenge.

Abbott's new order also carries political implications. The two-term Republican is facing pressure from two candidates in next year's GOP primary, former state Sen. Don Huffines and former Florida Congressman and Texas state party chairman Allen West, have attacked Abbott's COVID-19 policies and have strongly opposed vaccine mandates...

https://www.npr.org/2021/10/11/1045142578/texas-governor-greg-abbott-ban-covid-v...

Could chicken eggs help end the COVID-19 pandemic?
Tom Mooney | 11 Oct 2021

...more than a billion safe and effective egg-based flu vaccine doses are made annually worldwide. So, could the egg-based approach be adapted to make a COVID-19 vaccine, and could existing flu vaccine factories be converted to augment the COVID-19 vaccine supply? CEPI is providing financial support of up to $2 million to PATH as the consortium aims to find out.

Renowned U.S. researchers from Icahn Mount Sinai, UT Austin, and PATH are working with manufacturers in Vietnam, Thailand, and Brazil to advance the development of an egg-based COVID-19 vaccine designed to be affordable and manufacturable at scale to increase equitable access. CEPI’s funding will support PATH in providing technical assistance to Instituto Butantan in Brazil, the Government Pharmaceutical Organization (GPO) in Thailand, and the Institute of Vaccines and Medical Biologicals (IVAC) in Vietnam – all established flu vaccine manufacturers – who will be suppliers of the vaccine if successful.

Expanding access to COVID-19 vaccines
Affordability and deliverability.
Untapped production capacity.
Greater supply control for countries.

Classic technology meets cutting-edge science
...The vaccine is based on a novel platform that brings together traditional egg-based technology with new, cutting-edge science—and uses another virus as a building block. Mount Sinai scientists genetically modify a Newcastle disease virus (NDV)—usually used in its live form, in vaccines for poultry—so that its surface presents the SARS-CoV-2 stabilized spike protein (known as HexaPro), developed by UT Austin. SARS-CoV-2 is the coronavirus responsible for causing COVID-19. The spike protein is what trains the immune system to recognize and fight COVID-19 infection. The NDV is grown in eggs, purified, inactivated (or killed), and formulated into an injectable vaccine....

An international collaboration

https://cepi.net/news_cepi/could-chicken-eggs-help-end-the-covid-19-pandemic/
https://www.path.org/articles/classic-tech-meets-new-science-how-chicken-egg-cou...

Alzheimer’s and COVID-19 severity: A genetic link?
Anna Guildford | October 11, 2021

In a new study, scientists have identified a genetic link between the development of Alzheimer’s and severe COVID-19 outcomes.
The study also identifies the same immune system changes in both diseases.
Targeting specific “risk” genes could lead to future treatments for Alzheimer’s disease and COVID-19...

...Scientists have also shown that OAS1, which regulates inflammatory proteins, contributes to the genetic riskTrusted Source associated with severe COVID-19 outcomes.

...“We see in … microglial cells that OAS1 is suppressing pro-inflammatory function of cells in response to elevated levels of interferon.”

......Dr. (Rosa Sancho, head of research at Alzheimer’s Research UK) points out that “we don’t know whether the effects of this risk gene could influence long-term neurological consequences of COVID-19 or whether COVID-19 … increases the risk of dementia later in life.”...

https://www.medicalnewstoday.com/articles/alzheimers-and-covid-19-severity-a-gen...
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Naciye Magusali et al. 2021. A genetic link between risk for Alzheimer's disease and severe COVID-19 outcomes via the OAS1 gene. Brain,Published: 07 October 2021, https://doi.org/10.1093/brain/awab337

Corrected proof

Abstract
Recently, we reported oligoadenylate synthetase 1 (OAS1) contributed to the risk of Alzheimer’s disease, by its enrichment in transcriptional networks expressed by microglia. However, the function of OAS1 within microglia was not known.

Using genotyping from 1313 individuals with sporadic Alzheimer’s disease and 1234 control individuals, we confirm the OAS1 variant, rs1131454, is associated with increased risk for Alzheimer’s disease. The same OAS1 locus has been recently associated with severe coronavirus disease 2019 (COVID-19) outcomes, linking risk for both diseases. The single nucleotide polymorphisms rs1131454(A) and rs4766676(T) are associated with Alzheimer’s disease, and rs10735079(A) and rs6489867(T) are associated with severe COVID-19, where the risk alleles are linked with decreased OAS1 expression. Analysing single-cell RNA-sequencing data of myeloid cells from Alzheimer’s disease and COVID-19 patients, we identify co-expression networks containing interferon (IFN)-responsive genes, including OAS1, which are significantly upregulated with age and both diseases. In human induced pluripotent stem cell-derived microglia with lowered OAS1 expression, we show exaggerated production of TNF-α with IFN-γ stimulation, indicating OAS1 is required to limit the pro-inflammatory response of myeloid cells.

Collectively, our data support a link between genetic risk for Alzheimer’s disease and susceptibility to critical illness with COVID-19 centred on OAS1, a finding with potential implications for future treatments of Alzheimer’s disease and COVID-19, and development of biomarkers to track disease progression.

------------------------------------------------------------

ETA: Related?

Alzheimer's: The heretical and hopeful role of infection
David Robson | 6th October 2021
https://www.bbc.com/future/article/20211006-what-if-dormant-microbes-trigger-alz...

New data suggests Canada's 'gamble' on delaying, mixing and matching COVID-19 vaccines paid off
Early data suggests strong protection against delta, no evidence for boosters in the general population yet
Adam Miller | Oct 09, 2021

New Canadian data suggests the bold strategy to delay and mix second doses of COVID-19 vaccines led to strong protection from infection, hospitalization and death — even against the highly contagious delta variant — that could provide lessons for the world.

Preliminary data from researchers at the British Columbia Centre for Disease Control (BCCDC) and the Quebec National Institute of Public Health (INSPQ) shows the decision to vaccinate more Canadians sooner by delaying second shots by up to four months saved lives.

The researchers excluded long-term care residents from the data, who are generally at increased risk of hospitalization and death from COVID-19, in order to get a better sense of vaccine effectiveness in the general population — and the results were exceptional.

The analysis of close to 250,000 people in B.C. from May 30 to Sept. 11 found two doses of any of the three available COVID-19 vaccines in Canada were close to 95 per cent effective against hospitalization — regardless of the approved vaccination combination.

That means for every 100 unvaccinated people severely ill in Canadian hospitals, 95 of them could have been prevented by receiving two doses of either the AstraZeneca-Oxford, Pfizer-BioNTech and Moderna vaccines, or some combination of the three.

...the research showed that protection against COVID-19 infection from two doses of the Pfizer vaccine rose dramatically when the first and second shots were spread out — from 82 per cent after three or four weeks, to 93 per cent after four months...

https://www.cbc.ca/news/health/canada-vaccine-effectiveness-data-delayed-doses-m...

Flu vaccination mitigates the risks of sepsis, stroke, deep vein thrombosis, emergency department & Intensive Care Unit admissions in people testing positive for SARS-CoV-2.

"...Pawlowski et al...retrospective review found that a history of eight different vaccines including Polio, H. influenzae type-B, measles-mumps-rubella, and Varicella, amongst others, within the past one, two, or five years is associated with decreased SARS-CoV-2 infection rates, even after cohort balancing. This suggests that the protective effect observed by our group and others against SARS-CoV-2 may not be unique to influenza vaccination..."

Taghioff SM, Slavin BR, Holton T, Singh D (2021) Examining the potential benefits of the influenza vaccine against SARS-CoV-2: A retrospective cohort analysis of 74,754 patients. PLoS ONE 16(8): e0255541. (August 3, 2021) https://doi.org/10.1371/journal.pone.0255541 https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0255541

Abstract
...Results
SARS-CoV-2-positive patients who received the influenza vaccine experienced decreased sepsis...and stroke...across all time points. ICU admissions were lower in SARS-CoV-2-positive patients receiving the influenza vaccine at 30, 90, and 120 days..., while approaching significance at 60 days...). Patients who received the influenza vaccine experienced fewer DVTs (deep vein thrombosis) 60–120 days after positive SARS-CoV-2 diagnosis...and experienced fewer emergency department (ED) visits 90–120 days post SARS-CoV-2-positive diagnosis...

Conclusion
Our analysis outlines the potential protective effect of influenza vaccination in SARS-CoV-2-positive patients against adverse outcomes within 30, 60, 90, and 120 days of a positive diagnosis. Significant findings favoring influenza vaccination mitigating the risks of sepsis, stroke, deep vein thrombosis (DVT), emergency department (ED) & Intensive Care Unit (ICU) admissions suggest a potential protective effect that could benefit populations without readily available access to SARS-CoV-2 vaccination. Thus further investigation with future prospective studies is warranted.

...Discussion
...Our study found no association between influenza vaccination and risk of death in SARS-CoV-2-positive patients...need for prospective randomized control studies to better define the potential protective effect of influenza vaccination against SARS-CoV-2.

...Expanding upon our prospective understanding of the relationship between influenza vaccination and protection against adverse outcomes during SARS-CoV-2 is the work of Pawlowski et al. This retrospective review found that a history of eight different vaccines including Polio, H. influenzae type-B, measles-mumps-rubella, and Varicella, amongst others, within the past one, two, or five years is associated with decreased SARS-CoV-2 infection rates, even after cohort balancing. This suggests that the protective effect observed by our group and others against SARS-CoV-2 may not be unique to influenza vaccination.

...The influenza vaccine may be a viable option to attenuate the adverse effects of SARS-CoV-2 worldwide, with a specific potential to benefit populations struggling with access to or distribution of SARS-CoV-2 vaccination. Even patients who have already received SARS-CoV-2 vaccination may stand to benefit given that the SARS-CoV-2 vaccine does not convey complete immunity, although further research into the relationship and potential interaction between influenza vaccination and SARS-CoV-2 vaccination should be performed...

>110 margd: But in the 3 months between when you would have gotten the 2nd shot under the initial regimen and when you get under the Canadian regimen aren't you more at risk?

>112 jjwilson61: Canada's vaxxes were late arriving so it was making a public health decision. Leaders calculated that more lives would be saved if they used initial shipments to give as many people 1st dose rather double vaxxing a smaller number. When more vaxxes finally came--remember US "loan"?--they used what they had on hand for 2nd dose so some mix, some match. Turns out to be not only good strategy from a public health perspective, there were benefits for individuals as well. I wonder if wait also contributed to better uptake? Except perhaps for Alberta, Cdns were pretty accepting of masks, shutdowns, border measures--as they waited for vaxxes, non-pharmaceutical measures were all they had.

The researchers excluded long-term care residents from the data, who are generally at increased risk of hospitalization and death from COVID-19, in order to get a better sense of vaccine effectiveness in the general population — and the results were exceptional.

The analysis of close to 250,000 people in B.C. from May 30 to Sept. 11 found two doses of any of the three available COVID-19 vaccines in Canada were close to 95 per cent effective against hospitalization — regardless of the approved vaccination combination.
https://sofadungtien.com/
https://sofadungtien.com/danh-muc-san-pham/sofa-goc/

Beyond bedbugs: a mechanical engineer analyzes ventilation in her hotel room. :0

Marwa Zaatari (Mechanical engineer) @marwa_zaatari | 10:36 PM · Oct 13, 2021:
https://twitter.com/marwa_zaatari/status/1448477797714890754

The search for ventilation.
Hotel & COVID-19 Edition.
I stayed yesterday at brand name hotel. Here are some observations about shared air, outdoor air, and maintenance issues.

The room I stayed in does not have shared air. This is typical for hotel rooms. Air in your room gets recirculated and conditioned within your room only - by design.

Pic for unit in my room: window unit with fan and cooling/heating coil.
https://twitter.com/marwa_zaatari/status/1448477737077952513/photo/1

Indoor air gets recirculated on the side, conditioned and then blown from the top - as shown by my infrared camera.
Blue = cold air. orange = "hot" air. https://twitter.com/marwa_zaatari/status/1448477748385681408/photo/1
Hint: to know the intake of air on the unit, look where there is dust.

This unit only provides recirculated indoor air - NO outdoor air. I double checked with the brand name manufacturer.

Ok. Where is outdoor air coming from?
Typically, you will see a supply air in the corridor like the picture here.
https://twitter.com/marwa_zaatari/status/1448477755918651393/photo/1

In the hotel I stayed in, no outdoor air unit is found on the hotel premises and no sign of any supply of outdoor air in the room.
Image https://twitter.com/marwa_zaatari/status/1448477765146132483/photo/1

Other method to get outside air is to supply it to the corridor and then get outside air from the door to the room. However, the door is this room was sealed shut and I verified (three different methods) there was no air coming from the corridor.

The only other way is outside air brought in from the windows. However, I could not open them as there were sealed shut. I called the operator and asked her "how do I open these lovely windows", she said she worked at the hotel for a long time and never got asked this question.

In the bathroom, there was exhaust fan (fan taking air from bathroom and room and exhausting to the outside) continuously.
(it does not look pretty as it is never cleaned).
https://twitter.com/marwa_zaatari/status/1448477783437496322/photo/1
https://twitter.com/marwa_zaatari/status/1448477783437496322/photo/2

Because of the exhaust fan, taking air from room to outside, room pressure is less than 0. Meaning that air is being sucked in from corridor or adjacent room. For this room, there was air (small quantity) coming from an ill-sealed door from adjacent room.
My go-to-solution is duct tape. https://twitter.com/marwa_zaatari/status/1448477793344438275/photo/1

(unrelated to this thread, if you ever watched forensic files, you would know to always check that this door between two rooms to be always closed)...

I noticed that the air conditioning system in my room has back mold. Unfortunately this is typical as the model is "design and forget".
I took bio-sampling and will be sending the sample to a lab to get the results of what I was breathing. (will share the results).
https://twitter.com/marwa_zaatari/status/1448477806678220801/photo/1
https://twitter.com/marwa_zaatari/status/1448477806678220801/photo/2

I also took CO2 data and particulate matter samples from 0.3 um to 10 um in size (will share the results when i graph the data and compare to other environment).
https://twitter.com/marwa_zaatari/status/1448477818082533376/photo/1

#111-114 contd. Mix and matching mRNA vaxx and J&J.

NYT: "...researchers found that those who got a Johnson & Johnson shot followed by a Moderna booster saw their antibody levels rise 76-fold within 15 days, whereas those who received another dose of Johnson & Johnson saw only a fourfold rise in the same period. A Pfizer-BioNTech booster shot raised antibody levels in Johnson & Johnson recipients 35-fold..."

Eric Topol (Scripps) @EricTopol | 1:35 PM · Oct 13, 2021
A big mix and match vaccine report in 458 participants with Pfizer, Moderna, J&J, then getting another vaccine 12 weeks later:
markedly increased neutralizing antibody response by mixing (up to 76-fold) w/ these 9 combinations (Figure)
https://medrxiv.org/content/10.1101/2021.10.10.21264827v1
(not Delta strain)
Image ( https://twitter.com/EricTopol/status/1448341734807654401/photo/1 )

The big takeaway from this dataset is the response to J&J vaccine with a Moderna or Pfizer booster, taking that vaccine with low levels of neutralizing antibodies to close to parity with the mRNAs (also worked in reverse, J&J boost to mRNA, middle panel)
Image ( https://twitter.com/EricTopol/status/1448353685965131779/photo/1 )

A few add’l points: 1. 100 μg dose of Moderna booster used here is not (2X) 50 μg proposed by their EUA for FDA tomorrow 2. In prior reports, Astra Zeneca 1st, then mRNA had superior levels of nAbs over mRNA 2 doses, not seen here w/ J&J 3. Assessments were w/ D614G, not Delta

Here are data for neutralization with AZ, then Pfizer, showing that was superior vs 2 AZ or 2 Pfizer doses for Alpha & Beta variants
https://thelancet.com/journals/lanres/article/PIIS2213-2600(21)00357-X/fulltext
Preprint today: look at neutralization not binding Abs; yes Moderna -> more boost than Pfizer to J&J, but w/ 100 μg dose
Image ( https://twitter.com/EricTopol/status/1448490704645214209/photo/1 )

The new mix and match study makes the headline for tomorrow
https://nytimes.com/2021/10/13/health/johnson-vaccine-booster-fda.html
by @carlzimmer @noahweiland
Image-NYT ( https://twitter.com/EricTopol/status/1448535098274373633/photo/1 )

----------------------------------------------------------------------------------
Robert L Atmar et al. 2021. Heterologous SARS-CoV-2 Booster Vaccinations: Preliminary Report. MedRxiv
doi: https://doi.org/10.1101/2021.10.10.21264827 https://www.medrxiv.org/content/10.1101/2021.10.10.21264827v1

This article is a preprint and has not been certified by peer review

Abstract
...Results: 458 individuals were enrolled: 154 received mRNA-1273 (Moderna), 150 received Ad26.CoV2.S (J&J), and 154 received BNT162b2 9Pfizer) booster vaccines. Reactogenicity was similar to that reported for the primary series. Injection site pain, malaise, headache, and myalgia occurred in more than half the participants. Booster vaccines increased the neutralizing activity against a D614G (important mutation in COVID variants) pseudovirus (4.2-76-fold) and binding antibody titers (4.6-56-fold) for all combinations; homologous boost increased neutralizing antibody titers 4.2-20-fold whereas heterologous boost increased titers 6.2-76-fold. Day 15 neutralizing and binding antibody titers varied by 28.7-fold and 20.9-fold, respectively, across the nine prime-boost combinations.

Conclusion: Homologous and heterologous booster vaccinations were well-tolerated and immunogenic in adults who completed a primary Covid-19 vaccine regimen at least 12 weeks earlier.
-----------------------------------------------------------------------------------

David Hillus et al. 2021. Safety, reactogenicity, and immunogenicity of homologous and heterologous prime-boost immunisation with ChAdOx1 nCoV-19 and BNT162b2: a prospective cohort study. Published:August 12, 2021 DOI:https://doi.org/10.1016/S2213-2600(21)00357-X https://thelancet.com/journals/lanres/article/PIIS2213-2600(21)00357-X/fulltext

Summary
...Interpretation
The heterologous ChAdOx1 (Astrazeneca) nCov-19–BNT162b2 (Pfizer) immunisation with 10–12-week interval, recommended in Germany, is well tolerated and improves immunogenicity compared with homologous ChAdOx1 nCov-19 vaccination with 10–12-week interval and BNT162b2 vaccination with 3-week interval. Heterologous prime-boost immunisation strategies for COVID-19 might be generally applicable.

-----------------------------------------------------------------------------------

People who received a J.&J. vaccine may be better off with a Moderna or Pfizer booster, a study finds.
Carl Zimmer and Noah Weiland | Oct. 13, 2021

...researchers found that those who got a Johnson & Johnson shot followed by a Moderna booster saw their antibody levels rise 76-fold within 15 days, whereas those who received another dose of Johnson & Johnson saw only a fourfold rise in the same period. A Pfizer-BioNTech booster shot raised antibody levels in Johnson & Johnson recipients 35-fold...

https://www.nytimes.com/2021/10/13/health/johnson-vaccine-booster-fda.html

Chilling: Mississippi is just 100 deaths away from COVID having killed 1 out of every 300 residents of the state.

- Charles Ghoul-ba Ghost (healthcare policy analyst) @charles_gaba | 11:38 PM · Oct 12, 2021
https://twitter.com/charles_gaba/status/1448130959463886852

_______________________________________________________

Central Florida school district sees 17 employee deaths from COVID-19
Gail Paschall-Brown | Oct 13, 2021

...At least 17 Polk County staff members have died from COVID-19 since the start of the school year.

The school district says 12 have died since returning to school in August and five passed away before returning. It's not known where the employees were exposed to the virus.

"It's a terrible tragedy it really is. Our hands are tied. The reality is you can't enforce a mask policy. A lot of folks wanted a mask policy. I think the real key was allowing a virtual option. We couldn't do that either," Polk County School Board member Lynn Wilson said.

Stephanie Yocum, Polk Education Association president, agrees. "Our state has been kind of laissez-faire with it — as far as the mitigation strategy and being very restrictive to local governments and local school boards in what we can and cannot do," Yocum said.

To help prevent the spread of COVID-19, the Polk County School District is installing 50,000 desk shields in classrooms in grades K-5 over the next month. Air purifiers are also in every classroom...

https://www.wesh.com/article/best-subscription-services/32961516

>107 margd: TX ban on vaxx mandates

IBM is rebuffing Greg Abbott's order banning private employers in Texas from mandating COVID vaccines, instead choosing to follow President Biden's directive for the shots.

IBM says, as a federal contractor, it "must comply with federal requirements."

-Kyle Griffin (MSNBC) @kylegriffin1 | 9:00 AM · Oct 14, 2021
______________________________________________________

Texas-based airlines brush off Gov. Abbott’s ban on vaccine mandate
Annabelle Timsit and Andrew Jeong | Oct 13, 2021

...Dallas-based Southwest Airlines said it will still seek to meet the Biden administration’s demand that contractors of the federal government get their workforce vaccinated.

Fort Worth-based American Airlines, which employed 102,700 people at the end of last year, said in a statement that Abbott’s order “does not change anything for American.”..

https://www.washingtonpost.com/transportation/2021/10/13/southwest-american-airl...

>113 margd: I got that. But from an individual perspective it's not clear that the longer period between doses is better if the person is less protected during that period.

>119 jjwilson61: it may be one of those serendipitous discoveries resulting from no better options, that may turn out to be of large scale public health benefit. But as you say, may not be better for given individuals

zeynep tufekci (UNC) zeynep | 8:56 AM · Oct 15, 2021:
For some, fear of needles reaches phobia-levels and can cause them to faint or have a panic attack.
Research suggests about one in ten adults avoid vaccines because of this.
Canada, UK etc. reach out, offer support and privacy rooms. What do we do? Everything to make it worse.
Image ( https://twitter.com/zeynep/status/1448996193212710934/photo/1 )
https://www.nytimes.com/2021/10/15/opinion/covid-vaccines-unvaccinated.html

Eric Topol (Scripps) @EricTopol | 9:01 AM · Oct 15, 2021·Twitter Web App
Just published @NEJM*
Neutralizing antibody levels and T cells response out to 8 months for Pfizer, Moderna and J&J vaccines
Moderna highest antibody response;
J&J while lower doesn't fall off and best CD8 T-cell response at 8 months

Figure 1. Kinetics of Humoral and Cellular Immune Responses Elicited by the BNT162b2, mRNA-1273, and Ad26.COV2.S Vaccines.
https://twitter.com/EricTopol/status/1448997468117426182/photo/1
------------------------------------------------

* Ai-ris Y. Collier et al. 2021. Differential Kinetics of Immune Responses Elicited by Covid-19 Vaccines (Letter to Editor). NEJM October 15, 2021 DOI: 10.1056/NEJMc2115596 http://nejm.org/doi/full/10.1056/NEJMc2115596

...These data show differential kinetics of immune responses induced by the mRNA and Ad26.COV2.S vaccines over an 8-month follow-up period. As shown in previous studies,1,2 the BNT162b2 (Pfizer) and mRNA-1273 (Moderna) vaccines were characterized by high peak antibody responses that declined sharply by 6 months; these responses declined further by 8 months. Antibody titers in recipients of the mRNA-1273 vaccine were generally higher than those in recipients of the BNT162b2 vaccine. The Ad26.COV2.S (J&J) vaccine induced lower initial antibody responses, but these responses were relatively stable over the 8-month follow-up period, with minimal-to-no evidence of decline. These findings have important implications for waning vaccine immunity, although correlates of protection from SARS-CoV-2 are not yet defined.

zeynep tufekci (UNC) zeynep | 8:42 AM · Oct 15, 2021
72% of the unvaccinated said they'd quit after a mandate. In real life, few do.
Studies show older people are vulnerable to misinformation and Fox News, and yet almost all are vaccinated. What explains this? My piece of the sociology of the unvaccinated.*

Excerpt text ( https://twitter.com/zeynep/status/1448992640343674881/photo/1 )
-------------------------------------------------------------------

* The Unvaccinated May Not Be Who You Think
Zeynep Tufekci | Oct. 15, 2021

...The remarkable success of vaccine mandates shows that for many, it is not firm ideological commitments that have kept everyone from getting vaccinated, and that the stubborn, unpersuadable holdouts may be much smaller than we imagine...

https://www.nytimes.com/2021/10/15/opinion/covid-vaccines-unvaccinated.html

If my math is correct,
Africa is still doing better (.04?) than the US (.36?) in cases per capita.

Africa: est. 59,000,000 cases (WHO, Oct 2021) with a population of ~1,381,583,154.
US: est. 120,200,000 cases (CDC, May 2021) with a population of ~330,000,000.
--------------------------------------------------------------

6 in 7 coronavirus cases in Africa are not being detected, WHO study suggests
Continent's estimated infection level may be 59 million people
The Associated Press · Posted: Oct 14, 2021
https://www.cbc.ca/news/world/who-africa-covid-detection-1.6211629

#111, 116 mix and match contd.

Eric Topol (Scripps) @EricTopol | 10:24 AM · Oct 15, 2021:
New data from NIH mix and match study:
strong antibody response induced vs Delta for all additional vaccine (Pfizer, Moderna, J&J) shots

Image ( https://twitter.com/EricTopol/status/1449018441449365510 )

Meeting Presentation (37p)
to FDA's Vaccines and Related Biological Products Advisory Committee
October 14-15, 2021

DMID 21-0012 - Heterologous Platform Boost Study Mix and Match
Kirsten E. Lyke, MD representing Mix and Match Study Team University of Maryland, School of Medicine
Center for Vaccine Development and Global Health
https://fda.gov/media/153128/download

COVID super-immunity: one of the pandemic’s great puzzles
People who have previously recovered from COVID-19 have a stronger immune response after being vaccinated than those who have never been infected. Scientists are trying to find out why.
Ewen Callaway | 14 October 2021

...Not long after countries began rolling out vaccines, researchers started noticing unique properties of the vaccine responses of people who had previously caught and recovered from COVID-19. “We saw that the antibodies come up to these astronomical levels that outpace what you get from two doses of vaccine alone,” says Rishi Goel, an immunologist at the University of Pennsylvania in Philadelphia who is part of a team studying super-immunity — or ‘hybrid immunity’, as most scientists call it...

...at least partly, due to immune players called memory B cells

...A third vaccine dose might allow people who haven't been infected to achieve the benefits of hybrid immunity, says Matthieu Mahévas, an immunologist at the Necker Institute for Sick Children in Paris.

...whatever the potential benefits — the risks of a SARS-CoV-2 infection mean that it should be avoided...

https://www.nature.com/articles/d41586-021-02795-x

New CDC data shows the risk of dying from Covid-19 is 11 times higher for unvaccinated adults than for fully vaccinated adults
Deidre McPhillips | October 15, 2021

(CNN)Throughout August, the risk of dying from Covid-19 was 11 times higher for unvaccinated adults than for fully vaccinated adults in the United States*...Unvaccinated adults faced a six times higher risk of testing positive for Covid-19 throughout the month, and In the last week of August, the risk of being hospitalized was nearly 19 times higher for unvaccinated adults than fully vaccinated adults...

...The CDC data shows that the risk of death from Covid-19 for unvaccinated adults has dipped in recent weeks as the pace of new cases drops across the country...

But since April, the risk for fully vaccinated adults has never been higher than 1.2 deaths per 100,000 people.

...While the risk of cases and deaths have dropped, the CDC data also shows that the rate of hospitalizations among unvaccinated adults has continued to climb, up more than 80% from the first week in August to the last.

Risk ratios vary by age group. For example, the rate of Covid-19 hospitalizations among adults under the age of 50 is about 15 times higher for unvaccinated people than for fully vaccinated people. For those age 50 to 64, the hospitalization rate is 31 times higher for unvaccinated people, and for those age 65 and older, the hospitalization rate is 16 times higher for unvaccinated people...

After falling to the seventh leading cause of death in July, Covid-19 surged back to the second leading cause of death in September...

https://www.cnn.com/2021/10/15/health/cdc-covid-risk-higher-unvaccinated/index.h...
----------------------------------------------------------------------

* Scobie HM, Johnson AG, Suthar AB, et al. Monitoring Incidence of COVID-19 Cases, Hospitalizations, and Deaths, by Vaccination Status — 13 U.S. Jurisdictions, April 4–July 17, 2021. MMWR Morb Mortal Wkly Rep 2021;70:1284–1290. DOI: http://dx.doi.org/10.15585/mmwr.mm7037e1 https://www.cdc.gov/mmwr/volumes/70/wr/mm7037e1.htm?s_cid=mm7037e1_w

Summary
What is already known about this topic?
The incidence of SARS-CoV-2 infection, hospitalization, and death is higher in unvaccinated than vaccinated persons, and the incidence rate ratios are related to vaccine effectiveness.

What is added by this report?
Across 13 U.S. jurisdictions, incidence rate ratios for hospitalization and death changed relatively little after the SARS-CoV-2 B.1.617.2 (Delta) variant reached predominance, suggesting high, continued vaccine effectiveness against severe COVID-19. Case IRRs decreased, suggesting reduced vaccine effectiveness for prevention of SARS-CoV-2 infections.

What are the implications for public health practice?
Getting vaccinated protects against severe illness from COVID-19, including the Delta variant. Monitoring COVID-19 incidence by vaccination status might provide early signals of potential changes in vaccine effectiveness that can be confirmed through robust controlled studies.
________________________________________________________

Holiday Celebrations
Updated Oct. 15, 2021
Safer Ways to Celebrate Holidays
https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/holidays/celebration...

Delta reinfected 27% of recovered Alpha patients in Delhi, India...
"No severe illness or hospitalization was reported in reinfections."

Mahesh S. Dhar et al. 2021. Genomic characterization and epidemiology of an emerging SARS-CoV-2 variant in Delhi, India. Science • 14 Oct 2021 • First Release • DOI: 10.1126/science.abj9932 https://www.science.org/doi/10.1126/science.abj9932

Abstract
Delhi, the national capital of India, has experienced multiple SARS-CoV-2 outbreaks in 2020 and reached population seropositivity of over 50% by 2021. During April 2021, the city became overwhelmed by COVID-19 cases and fatalities, as a new variant B.1.617.2 (Delta) replaced B.1.1.7 (Alpha). A Bayesian model explains the growth advantage of Delta through a combination of increased transmissibility and reduced sensitivity to immune responses generated against earlier variants (median estimates; ×1.5-fold, 20% reduction). Seropositivity of an employee and family cohort increased from 42% to 87.5% between March and July 2021, with 27% reinfections, as judged by increased antibody concentration after a previous decline. The likely high transmissibility and partial evasion of immunity by the Delta variant contributed to an overwhelming surge in Delhi.

>4 jjwilson61: I would have to agree. I was fully vaccinated back in January/February 2021 and in August 2021 I was unlucky enough to be standing next to someone in a store who was coughing and a week later I was admitted to the hospital for 13 days with COVID-19 pneumonia. I’ve been home for six weeks and my lungs are still not healed up. I’ve never smoked btw. Still on oxygen. Still not back at work. But my case was so severe they said if I hadn’t been vaccinated I would have most likely died. I will definitely be getting that booster. It’s a wicked disease.

Hundreds of samples from Ontario grocery stores examined for coronavirus; all test negative
Marlene Leung | October 15, 2021

A new study* tested more than 900 samples from high-touch surfaces in Ontario grocery stores for SARS-CoV-2 and found zero positive results, suggesting the risk of exposure to the virus in grocery stores is low....

https://www.ctvnews.ca/health/coronavirus/hundreds-of-samples-from-ontario-groce...
----------------------------------------------------------------

* Maleeka Singha et al. 2021. Detection of SARS-CoV-2 on surfaces in food retailers in Ontario. Current Research in Food Science
Volume 4, 2021, Pages 598-602 https://doi.org/10.1016/j.crfs.2021.08.009 https://www.sciencedirect.com/science/article/pii/S2665927121000629?via%3Dihub

Abstract
The COVID-19 pandemic has generated increased interest in potential transmission routes. In food retail settings, transmission from infected customers and workers and customers through surfaces has been deemed plausible. However, limited information exists on the presence and survival of SARS-CoV-2 on surfaces, particularly outside laboratory settings. Therefore, the purpose of this project was to assess the presence of the virus at commonly found surfaces at food retail stores and the potential role that these spaces play in virus transmission.

Samples (n=957) were collected twice a week for a month in food-retail stores within Ontario, Canada. High-touch surfaces were identified and surveyed in 4 zones within the store (payment stations, deli counters, refrigerated food section and carts and baskets). The samples were analyzed using a molecular method, i.e., reverse transcriptase quantitative Polymerase Chain Reaction (RT-qPCR).

Regardless of the store's location, the sampling day or time, the location of the surface within the store or the surface material, all samples tested negative for SARS-CoV-2. These results suggest that the risk of exposure from contaminated high-touch surfaces within a food retailer store is low if preventive measures and recommended sanitizing routines are maintained.

"We've known about (J&J) lapses in antibody levels and reduced protection vs hospitalization for some time, but left these people (who typically had no choice and were told all vaccines were equivalent) susceptible over a prolonged period"

Eric Topol @EricTopol | 12:57 PM · Oct 16, 2021
Yesterday the FDA Advisory committee recommended that the 15 million Americans who have had J&J vaccines, more than 2 months out, get a 2nd shot.
There are some significant issues with this that could have been prevented /1
Image ( https://twitter.com/EricTopol/status/1449419195456704513/photo/1 )
Our World in Data

By May 1, there were over 8 million people 5.5 months out
By June 1, the number rose to nearly 11 million people 4.5 months out
Yet data have consistently been showing attrition of protection vs infections for this vaccine, this week in 620,000 US Veterans /2
Image ( https://twitter.com/EricTopol/status/1449419198334078978/photo/1 )

This is the only Covid vaccine that was positioned as "one and done." J&J is the largest healthcare company in the world, yet research to back that up was undone until recently.
Single dose: 70% protection vs symptomatic infection
2-dose: 94% protection /3
https://fda.gov/media/153129/download
Image ( https://twitter.com/EricTopol/status/1449419204218613762/photo/1 )

To start with, the 1-shot 70% efficacy vs. symptomatic infections was considerably lower than the mRNA vaccines (95%), the primary endpoint of all Covid vaccine trials, and a proxy for protection vs hospitalizations and deaths
2-shots brought it to parity in the US at 94% /4
Image ( https://twitter.com/EricTopol/status/1449419210342293511/photo/1 )

A grand total of 17 people were studied for impact on spike protein binding antibody levels (not even neutralization Abs) at 6 months /5
Image ( https://twitter.com/EricTopol/status/1449419212833755142/photo/1 )

Parenthetically, the antibody level increase from the 2nd J&J shot at 2 months were small relative to a booster with an mRNA vaccine (50-70 fold, 1 month)/6
Image ( https://twitter.com/EricTopol/status/1449419217996898305/photo/2 )

How could this happen? 15 million Americans potentially left vulnerable and still no formal approval for a 2nd shot
1. J&J did insufficient and late in coming research to backup their "one and done" assertion
2. The poor US tracking of data obscured detection of this issue /7

We've known about the lapses in antibody levels and reduced protection vs hospitalization for some time, but left these people (who typically had no choice and were told all vaccines were equivalent) susceptible over a prolonged period
Image ( https://twitter.com/EricTopol/status/1449454401949601792/photo/1 )
Image ( https://twitter.com/EricTopol/status/1449454401949601792/photo/2 )

Eric Topol @EricTopol | 2:09 PM · Oct 16, 2021:
Just published at Cell CellPress*
The pivotal importance of vaccine dose spacing.
Comparison of a median 3.3 week vs 10.1 week spacing for the Pfizer vaccine shows
longer lag yields much higher neutralizing antibody and CD4+ T cell response
Delta example ( https://twitter.com/EricTopol/status/1449437421754404864/photo/1 )
------------------------------------------------

* Rebecca P. Payne et al. 2021. Immunogenicity of standard and extended dosing intervals of BNT162b2 mRNA vaccine. Cell. Published:October 15, 2021 DOI:https://doi.org/10.1016/j.cell.2021.10.011 https://cell.com/cell/fulltext/S0092-8674(21)01221-6#relatedArticles

Highlights
BNT162b2 vaccine with an extended interval between doses is highly protective
Antibody levels were higher after the extended regimen compared to the short regimen
The extended regimen enriches for virus-specific CD4+ T cells expressing IL-2
Antibody levels wane after each dose but B and T cell pools are maintained

Summary
Extension of the interval between vaccine doses for the BNT162b2 mRNA (Pfizer) vaccine was introduced in the UK to accelerate population coverage with a single dose. At this time, trial data was lacking, and we addressed this in a study of UK healthcare workers. The first vaccine dose induced protection from infection from the circulating alpha (B.1.1.7) variant over several weeks. In a sub-study of 589 individuals, we show that this single dose induces SARS-CoV-2 neutralizing antibody (NAb) responses and a sustained B and T cell response to spike protein. NAb levels were higher after the extended dosing interval (6-14 weeks) compared to the conventional 3-4 week regimen, accompanied by enrichment of CD4+ T cells expressing IL2. Prior SARS-CoV-2 infection amplified and accelerated the response. These data on dynamic cellular and humoral responses indicate that extension of the dosing interval is an effective, immunogenic protocol.

...Discussion
...In conclusion, the immunogenicity of longer regimens appears robust, and indeed for antibody measurements, improved over the conventional 3-4 week regimen. We provide evidence that T cells are induced and sustained during the longer period between doses in the 6-14 week regimen, but there is an impact of dosing interval on the relative proportion of T cell subsets. Ongoing studies in this cohort will monitor the durability of antibody and T cell responses 6 months after a 2nd vaccine dose delivered in an extended dosing interval, and response to 3rd “booster” doses where given. For policy makers, optimal dosing intervals may depend on community prevalence, population immunity from natural infection, circulating variants of concern and vaccine supply. A short dosing interval gives early protection, whereas an increased interval appears to improve peak neutralizing antibody levels.

Immune Responses From 3 Different COVID-19 Vaccines Compared Over 8 Months
Beth Israel Deaconess Medical Center | October 17, 2021

...In a paper published in the New England Journal of Medicine, a team of experts at Beth Israel Deaconess Medical Center (BIDMC) compared immune responses induced by the three vaccines over an eight-month follow-up period. The investigators evaluated the 61 participants’ levels of various antibodies, T cells, and other immune products at two to four weeks following complete immunization – the time of peak immunity – to eight months after vaccination. Thirty-one participants received the BNT162b2 (Pfizer) vaccine, 22 received the mRNA-1273 (Moderna) vaccine and eight received the Ad26.COV2.S (J&J) vaccine.

“The mRNA vaccines were characterized by high peak antibody responses that declined sharply by month six and declined further by month eight,” said corresponding author Dan H. Barouch, MD, PhD, director of the Center for Virology and Vaccine Research at BIDMC, who helped develop the Ad26 platform in collaboration with Johnson & Johnson. “The single-shot Ad26 vaccine induced lower initial antibody responses, but these responses were generally stable over time with minimal to no evidence of decline.”

The team also found that mRNA-1273 elicited antibody responses which were generally higher and more durable than BNT162b2. All three vaccines demonstrated broad cross-reactivity to variants of SARS-CoV-2, the virus that causes COVID-19. The findings have important implications for understanding how vaccine immunity may wane over time; however, the precise immune responses necessary to confer protection against SARS-CoV-2 has not yet been determined, the researchers point out.

“Even though neutralizing antibody levels decline, stable T cell responses and non-neutralizing antibody functions at 8 months may explain how the vaccines continue to provide robust protection against severe COVID-19,” said lead author Ai-ris Y. Collier, MD, a maternal-fetal medicine specialist at BIDMC. “Getting vaccinated (even during pregnancy) is still the best tool we have to end the COVID-19 pandemic.”

https://scitechdaily.com/immune-responses-from-3-different-covid-19-vaccines-com...

Reference: “Differential Kinetics of Immune Responses Elicited by Covid-19 Vaccines” by Ai-ris Y. Collier, M.D.; Jingyou Yu, Ph.D.; Katherine McMahan, M.S.; Jinyan Liu, Ph.D.; Abishek Chandrashekar, M.S.; Jenny S. Maron, B.S.; Caroline Atyeo, M.S.; David R. Martinez, Ph.D.; Jessica L. Ansel, N.P.; Ricardo Aguayo, B.S.; Marjorie Rowe, B.S.; Catherine Jacob-Dolan, B.S.; Daniel Sellers, B.S.; Julia Barrett, B.S.; Kunza Ahmad, M.S.; Tochi Anioke, B.S.; Haley VanWyk, B.S.; Sarah Gardner, B.S.; Olivia Powers, B.S.; Esther A. Bondzie, B.A.; Huahua Wan, M.S.; Ralph S. Baric, Ph.D.; Galit Alter, Ph.D.; Michele R. Hacker, Sc.D. and Dan H. Barouch, M.D., Ph.D., 15 October 2021, New England Journal of Medicine. DOI: 10.1056/NEJMc2115596 https://www.nejm.org/doi/full/10.1056/NEJMc2115596

Breakthrough SARS-CoV-2 infections in 620,000 U.S. Veterans, February 1, 2021 to August 13, 2021...
- Moderna 92% -> 64%
- Pfizer 91% -> 50%
- Janssen vaccine 88% -> 3%
So much for J&J one and done!

- Roland Baker RolandBakerIII | :24 PM · Oct 17, 2021

Barbara A. Cohn et al. 2021. Breakthrough SARS-CoV-2 infections in 620,000 U.S. Veterans, February 1, 2021 to August 13, 2021. MedRxiv (Oct 14, 2021) doi: https://doi.org/10.1101/2021.10.13.21264966 https://medrxiv.org/content/10.1101/2021.10.13.21264966v1

This article is a preprint and has not been certified by peer review

Abstract
National data on COVID-19 vaccine breakthrough infections is inadequate but urgently needed to determine U.S. policy during the emergence of the Delta variant. We address this gap by comparing SARS CoV-2 infection by vaccination status from February 1, 2021 to August 13, 2021 in the Veterans Health Administration, covering 2.7% of the U.S. population. Vaccine protection declined by mid-August 2021, decreasing from 91.9% in March to 53.9% (p

John Burn-Murdoch (Financial Times) @jburnmurdoch | 2:17 PM · Oct 17, 2021|
https://twitter.com/jburnmurdoch/status/1449801652207239176

NEW: there’s been a lot of chatter about why cases, hospitalisations and deaths are much higher in the UK than elsewhere in Western Europe.

I think a lot of the commentary has been overly simplistic, politicised and at-times flat-out wrong.

Let’s see if we can do better.

Yesterday we published a story comparing the situation in the UK vs a selection of Western Europe peers:
https://ft.com/content/34582534-4510-4d45-bcba-2f9e04005309

Here are the top-line stats:
• Cases among older people are 7x higher in UK
• Hospital admissions are 6x higher
• Deaths are 3x higher

Not great!

...So I hope we can now see that:
• Yes, mask-wearing has plummeted in England and reversing that would help
• But higher rates of crowded indoor mixing are likely a bigger issue
• And both are almost certainly dwarfed by UK’s much more acute (vaccine) waning problem (as seen in Israel)

Oh, and two brief related additions as a reminder that we shouldn’t forget about structural issues either:

UK has far worse sick pay than other Western European countries, making it much harder for people who do get sick to stay home and protect others

Older people are far more likely to be in poverty in the UK than elsewhere, which can increase their risk of both catching and dying from the disease.

Couple more bits based on common feedback:
• UK — and in particular England — late vaccination of children definitely a factor too (we addressed this in the story FWIW). Not so much because of direct risk to kids, but kids spread to older groups

• Some saying weather/climate could be a factor if it leads to more time indoors in UK (and esp Scotland) than FR/ES/DE/IT. Agreed.

• ...and to pre-empt the "if it’s weather/climate, then why no surge in Nordics?"
a) I don’t know
b) but my guess would be that the same structural factors that have kept most of the Nordics relatively low-Covid for 18 months are still doing their thing

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Lyman Stone 石來民 BisonBisonBison @lymanstoneky | 8:51 AM · Sep 1, 2021

This is arguably the most important single piece of epidemiological research of the entire pandemic.

A MASSIVE randomized trial launched a pro-mask campaign in some Bangladeshi villages, but not others.

The result: masking villages got less COVID.
https://poverty-action.org/sites/default/files/publications/Mask_RCT____Symptoma...

...acceleration (in the post-COVID-19 population) of ...+5.25 years above the range of normality...some epigenetic alterations are associated with the post-COVID-19 condition, particularly in younger patients (less than 60 years)...

Alessia Mongelli et al. 2021. Evidence for Biological Age Acceleration and Telomere Shortening in COVID-19 Survivors. Int J Mol Sci. 2021 Jun; 22(11): 6151. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8201243/

Abstract
The SARS-CoV-2 infection determines the COVID-19 syndrome characterized, in the worst cases, by severe respiratory distress, pulmonary and cardiac fibrosis, inflammatory cytokine release, and immunosuppression. This condition has led to the death of about 2.15% of the total infected world population so far. Among survivors, the presence of the so-called persistent post-COVID-19 syndrome (PPCS) is a common finding. In COVID-19 survivors, PPCS presents one or more symptoms: fatigue, dyspnea, memory loss, sleep disorders, and difficulty concentrating. In this study, a cohort of 117 COVID-19 survivors (post-COVID-19) and 144 non-infected volunteers (COVID-19-free) was analyzed using pyrosequencing of defined CpG islands previously identified as suitable for biological age determination.* The results show a consistent biological age increase in the post-COVID-19 population, determining a DeltaAge acceleration of 10.45 ± 7.29 years (+5.25 years above the range of normality) compared with 3.68 ± 8.17 years for the COVID-19-free population... A significant telomere shortening parallels this finding in the post-COVID-19 cohort compared with COVID-19-free subjects... Additionally, ACE2 expression was decreased in post-COVID-19 patients, compared with the COVID-19-free population, while DPP-4 did not change. In light of these observations, we hypothesize that some epigenetic alterations are associated with the post-COVID-19 condition, particularly in younger patients (less than 60 years).

* https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4789590/

F.D.A. to Allow ‘Mix and Match’ Approach for Covid Booster Shots
Sharon LaFraniere and Noah Weiland | Oct. 18, 2021

WASHINGTON — The Food and Drug Administration is planning to allow Americans to receive a different Covid-19 vaccine as a booster than the one they initially received, a move that could reduce the appeal of the Johnson & Johnson vaccine and provide flexibility to doctors and other vaccinators.

The government would not recommend one shot over another, and it might note that using the same vaccine as a booster when possible is preferable, people familiar with the agency’s planning said. But vaccine providers could use their discretion to offer a different brand, a freedom that state health officials have been requesting for weeks...

https://www.nytimes.com/2021/10/18/us/politics/fda-mix-and-match-boosters.html

Eric Topol (Scripps) @EricTopol | 9:42 PM · Oct 14, 2021:
For the 1st time, the @CDCgov is now posting national data on vaccination status
for hospitalization and death, and by age
https://covid.cdc.gov/covid-data-tracker/#rates-by-vaccine-status

Here are data for death during the Delta wave
Unvaccinated (11.3) -fold risk of dying (margd: 6.1 risk of infection)

Image-incidence of infection, 4 vaxxes April-May 2021 ( https://twitter.com/EricTopol/status/1448826680043212802/photo/1 )

There May Be People Who Are Genetically Resistant to COVID-19, Scientists Say
JACINTA BOWLER | 19 OCTOBER 2021

..."We propose a strategy for identifying, recruiting, and genetically analyzing individuals who are naturally resistant to SARS-CoV-2 infection," the team writes.

"We first focus on uninfected household contacts of people with symptomatic COVID-19. We then consider individuals exposed to an index case without personal protection equipment, for at least 1 hour per day, and during the first 3-5 days of symptoms in the index case."

This would then be checked with negative PCR tests and negative blood work four weeks after the exposure, particularly looking for T cells to confirm that the person hasn't been infected in the past.

If this sounds like you – good news! The researchers are still looking for participants for their research. (apply: https://www.covidhge.com/ )

"We have already enrolled more than 400 individuals meeting the criteria for inclusion in a dedicated resistance study cohort," the researchers wrote.

"The collaborative enrolment of study participants is continuing (link here), and subjects from all over the world are welcome."

...This perspective was published in Nature Immunology. (margd: DOI link not yet active?)

https://www.sciencealert.com/scientists-think-that-there-are-people-out-there-wh...

"Reinfection by SARS-CoV-2 under endemic conditions would likely occur between 3 months and 5·1 years after peak antibody response, with a median of 16 months."

Coronavirus reinfection: How long might 'natural immunity' last?
Hannah Flynn, MS on October 18, 2021

Having COVID-19 should confer some immunity against developing the disease again, but health experts do not know how long this immunity lasts.

Scientists know that some people have developed COVID-19 more than once, but there are not enough data for scientists to be able to analyze how long “natural” immunity lasts.

Having studied the genome of SARS-CoV-2, researchers suggest that, among unvaccinated people, reinfection could happen as soon as 3 months (up to 61 months, median 16 months) after contracting the virus...

https://www.medicalnewstoday.com/articles/coronavirus-reinfection-how-long-might...
-----------------------------------------------

Jeffrey P Townsend et al. 2021. The durability of immunity against reinfection by SARS-CoV-2: a comparative evolutionary study. The Lancet Microbe (Published:October 01, 2021) DOI:https://doi.org/10.1016/S2666-5247(21)00219-6 https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(21)00219-6/fullt...

Summary
...Findings
...Reinfection by SARS-CoV-2 under endemic conditions would likely occur between 3 months and 5·1 years after peak antibody response, with a median of 16 months...

Japan baffled amid sudden virus cases drop
Mari Yamaguchi | October 18, 2021 3:51PM

...Daily new COVID-19 cases have plummeted from a mid-August peak of nearly 6000 in Tokyo, with caseloads in the densely populated capital now routinely below 100 - an 11-month low.

The bars are packed, the trains are crowded and the mood is celebratory, despite a general bafflement over what, exactly, is behind the sharp drop.

Japan, unlike other places in Europe and Asia, has never had anything close to a lockdown, just a series of relatively toothless states of emergency.

Some possible factors in Japan's success include a belated but remarkably rapid vaccination campaign, an emptying out of many nightlife areas as fears spread during the recent surge in cases, a widespread practice of wearing masks and bad weather in late August that kept people home.

But with vaccine efficacy gradually waning and winter approaching, experts worry that without knowing exactly why cases have dropped so drastically, Japan could face another wave like this summer, when hospitals overflowed with serious cases and deaths soared - though the numbers were lower than pre-vaccination levels.

Many credit the vaccination campaign, especially among younger people, for bringing infections down.

Nearly 70 per cent of the population is fully vaccinated...

https://www.perthnow.com.au/news/coronavirus/japan-baffled-amid-sudden-virus-cas...

If I read this correctly,
1. Pregnant and lactating women require second dose (mRNA) vaccine to benefit as much as non-pregnant women.
2. Male-expectant mothers and their sons may not benefit as much from SARS-CoV-2 (exposure? vaccination?), as female-expectant mothers and their daughters.

Eric Topol (Scripps) @EricTopol | 10:54 AM · Oct 19, 2021
Just published @ScienceTM

With blunting of the immune response, why it is so important for pregnant women to get a Covid vaccine

Image-Ovies et al. https://twitter.com/EricTopol/status/1450475410328850435/photo/1
Image-Atyeo et al. https://twitter.com/EricTopol/status/1450475410328850435/photo/2
Image-Bordt et al. https://twitter.com/EricTopol/status/1450475410328850435/photo/3
Image-figure https://twitter.com/EricTopol/status/1450475410328850435/photo/4
-----------------------------------------------------

Cristian Ovies et al. 2021. Pregnancy Influences Immune Responses to SARS-CoV-2. Science Translational Medicine • 19 Oct 2021 •
DOI: 10.1126/scitranslmed.abm2070 https://science.org/doi/10.1126/scitranslmed.abm2070

...(Atyeo et al.) Compared to immunized non-pregnant women, pregnant and lactating women exhibited overall lower SARS-CoV-2 antibody titers, restricted IgG subclass responses, and a decreased FcR binding capacity following the first dose (“prime”) of vaccination. However, following the second dose (“boost”), there were minimal differences between pregnant and lactating versus non-pregnant women, indicating that boosting could overcome the attenuated immune responses to the first dose during pregnancy, supporting the importance of vaccine boosting...results imply that vaccination earlier in pregnancy and boosting later in pregnancy will help to maximize transplacental and breastmilk antibody transfer and show that immunization across different stages of gestation results in unique antibody profiles.

...(Bordt et al.) mothers carrying male fetuses had lower maternal titers of IgG antibodies against all specific SARS-CoV-2 antigens tested. This finding of dampened immune responses to SARS-CoV-2 in mothers with male fetuses suggests that fetal sex modifies maternal antibody responses to infection during pregnancy. Additionally, the transfer ratio of SARS-CoV-2 antibodies into cord blood was lower in male versus female pregnancies. Mothers with male fetuses had lower SARS-CoV-2 antibody titers with differential FcR binding and glycosylation following infection and lower rates of anti-SARS-CoV-2 IgG transfer across the placenta. These observations have important implications for SARS-CoV-2 vaccination in male- versus female-expectant mothers and, following parturition, the care of at-risk male children. It is essential that we continue to study these dichotomous fetal sex responses to infection in pregnancy across gestation.

Eric Topol (Scripps) @EricTopol | 1:58 PM · Oct 19, 2021:
Vaccinations for teens is remarkably effective and safe, as determined by a new @CDCMMWR report *
https://cdc.gov/mmwr/volumes/70/wr/mm7042e1.htm?s_cid=mm7042e1_w

Please help get teenagers vaccinated
Image-graphic ( https://twitter.com/EricTopol/status/1450521688576167938/photo/1 )
Image-table ( https://twitter.com/EricTopol/status/1450521688576167938/photo/2 )

---------------------------------------------
* Olson SM, Newhams MM, Halasa NB, et al. Effectiveness of Pfizer-BioNTech mRNA Vaccination Against COVID-19 Hospitalization Among Persons Aged 12–18 Years — United States, June–September 2021. MMWR Morb Mortal Wkly Rep. ePub: 19 October 2021. DOI: http://dx.doi.org/10.15585/mmwr.mm7042e1external icon . https://cdc.gov/mmwr/volumes/70/wr/mm7042e1.htm

Eric Topol (Scripps) @EricTopol | 8:52 PM · Oct 19, 2021:

Considerable neutralizing antibody decline after both Pfizer and Astra Zeneca vaccines over 3-7 months in over 500 healthcare workers, but much less so in those with prior Covid *

Graphs-neutralizing capacity, prior Covid, Pfizer, Astrazeneca v Wild Type (Wuhan), Delta
https://twitter.com/EricTopol/status/1450626040091471872/photo/1

Table- https://twitter.com/EricTopol/status/1450626040091471872/photo/2

To be clear: All were vaccinated, but hybrid immunity—prior covid plus vaccination—had a more durable neutralizing antibody response

...as the authors concluded, reinforces the role of 3rd shots in people at increased risk
----------------------------------------------------------

Artyelt @artyelt · 8h
How about neutralizing antibodies in a vaccinated person after a breakthrough?
----------------------------------------------------------

* Sebastian Havervall et al. 2021. Impact of SARS-CoV-2 infection on longitudinal vaccine immune responses. MedRxiv (Oct 19, 2021) doi: https://doi.org/10.1101/2021.10.16.21264948 https://medrxiv.org/content/10.1101/2021.10.16.21264948v1

This article is a preprint and has not been certified by peer review

Abstract
...Results
Vaccination (BNT162b2 (Pfizer) and ChAdOx1 (Astrazeneca) ncov-19) following SARS-CoV-2 infection resulted in higher wild-type BAU/ml geometric mean titers (GMTs) at all sampling time points when compared to SARS-CoV-2 naive vaccinees... GMTs were 1875 BAU/ml in convalescent and 981 BAU/ml in naive BNT162b2 vaccinees 6 weeks post vaccination. 29 weeks post vaccination, GMTs had decreased to 524 BAU/ml in convalescent and 148 BAU/ml in naive vaccinees. GMT differences between convalescents and naive following ChAdOx1 ncov-19 mirrored those after BNT162b2, but the titers were considerably lower. Finally, at all time points, neutralizing antibody titers against all ten tested SARS-CoV-2 variants were at least 2 respectively 3-fold higher in SARS-CoV-2 recovered as compared to naive vaccinees following BNT162b2 and ChAdOx1 ncov-19, respectively...

Conclusions
These findings of substantially more robust serological responses to vaccine after natural infection imply that prior infection may be taken into consideration when planning booster doses and design of current and future SARS-CoV-2 vaccine programs...

...DISCUSSION
...In summary, our findings of a considerable antibody decline over 3-7 months, paralleled with reports of waning vaccine effectiveness within the same time frame, supports the administration of a third vaccine dose, particularly in individuals with risk
factors for severe COVID-19. However, the striking and sustained increased titres and neutralizing breadth of antibodies in previously SARS-CoV-2 infected vaccinees as compared to SARS-CoV-2 naive vaccinees highlights the strong impact of infection prior to vaccination. These findings suggest that prior infection should be taken into consideration when planning booster doses and design of current and future SARS-CoV-2 vaccine programs.

It’s cheap, easy to make and in demand overseas. So why can’t this Texas-born COVID-19 vaccine break into the U.S. market?

A Houston vaccine team would like a U.S. distributor but for now focuses its efforts abroad to inoculate those in countries where COVID-19 variants surface more quickly.

Karen Brooks Harper | Oct. 19, 2021

...(at (the National School of Tropical Medicine) at Texas Children's Hospital Center for Vaccine Development in Houston where Peter Hotez is dean and Maria Bottazzi is associate dean), the Houston team’s vaccine, called Corbevax by its maker in India, is cheap, has no patent, can be made by many vaccine producers globally — including those in low- and middle-income countries — and is poised to receive approval for widespread global use.

The Indian government has promised the biopharmaceutical company Biological E Limited, which is making the vaccine in that country, that it will buy 300 million doses with the potential for more.

A halal version of the vaccine, for use in Islamic countries because it doesn’t contain animal-based ingredients, is also about to start clinical trials in Indonesia.

And later this year, the company hopes the vaccine will be endorsed by the World Health Organization for use globally, which could open the doors to quicker authorization in several countries that need it...

https://www.texastribune.org/2021/10/19/texas-covid-19-vaccine-peter-hotez/

Opinion: Finally, an answer for Johnson & Johnson vaccine recipients. Here’s what I chose.
Leana S. Wen* | 10/20/2021

...I would rather not receive a second dose of the J&J vaccine because of the blood-clotting disorder, thrombosis with thrombocytopenia syndrome (TTS), associated with this vaccine. TTS is extremely rare, but it has caused severe illness — and death — in a handful of cases. The group most prone to TTS seems to be women under 50. As a 38-year-old woman, I opted for an mRNA booster because the Pfizer and Moderna vaccines are not linked to TTS.

There are others who might prefer J&J. The mRNA vaccines are associated with another rare condition, myocarditis (inflammation of the heart muscle), that’s most commonly seen in men under 30. It would be reasonable for someone in this group, in consultation with his doctor, to opt for a J&J booster. Similarly, if an individual had a severe allergic reaction to Pfizer or Moderna, a second dose of J&J could be more suitable.

Should people mix and match because it might be more protective than a booster of the same vaccine? Here, the data are less clear. Several research groups have found that mixing one dose of AstraZeneca (a similar vaccine to J&J) with either one dose of Pfizer or Moderna induces a stronger immune response than two doses of the same vaccine. In addition, preliminary results from a National Institutes of Health study showed that while J&J recipients had a fourfold increase in neutralizing antibodies after a second J&J shot, their antibody levels rose 35-fold after a Pfizer booster and 76-fold after Moderna.

As extraordinary as these numbers are, antibody levels are not the only measure of immunity. Moreover, these are limited laboratory studies that are not yet confirmed by real-life comparisons of how well mixing vaccines protects against disease.

My choosing an mRNA second dose is not because it’s necessarily more effective, but because I wish to avoid TTS. My getting Pfizer is purely a practical decision; the Moderna booster is not yet available, and I was not willing to wait any longer...

https://www.washingtonpost.com/opinions/2021/10/20/leana-wen-johnson-johnson-boo...

* Leana Wen, M.D. @DrLeanaWen
Public health professor @GWPublicHealth. Author of Lifelines. Emergency physician. Contributing columnist @WashingtonPost. CNN medical analyst. Mom.

Study of 1 million people finds lower risk of death from COVID-19 in statin users
Annie Lennon | October 20, 2021

Researchers have investigated the link between statin use and COVID-19 mortality in around 1 million people.

They found that statin use was associated with a slightly lower risk of COVID-19 mortality, regardless of age, sex, and COVID-19 risk factors.

The team notes that further research is needed to confirm whether statins protect against COVID-19; however, those prescribed statins should continue taking their medication...

https://www.medicalnewstoday.com/articles/study-of-1-million-people-finds-lower-...
-------------------------------------------------

Rita Bergqvist et al. 2021. HMG-CoA reductase inhibitors and COVID-19 mortality in Stockholm, Sweden: A registry-based cohort study. PLOS Medicine. Published: October 14, 2021. https://doi.org/10.1371/journal.pmed.1003820 https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003820

Abstract
...Methods and findings
This cohort study included all Stockholm residents aged 45 or older (N = 963,876), followed up from 1 March 2020 until 11 November 2020. The exposure was statin treatment initiated before the COVID-19-pandemic, defined as recorded statin dispensation in the Swedish Prescribed Drug Register between 1 March 2019 and 29 February 2020. COVID-19-specific mortality was ascertained from the Swedish Cause of Death Registry. Hazard ratios (HRs) were calculated using multivariable Cox regression models. We further performed a target trial emulation restricted to initiators of statins.

In the cohort (51.6% female), 169,642 individuals (17.6%) were statin users. Statin users were older (71.0 versus 58.0 years), more likely to be male (53.3% versus 46.7%), more often diagnosed with comorbidities (for example, ischemic heart disease 23.3% versus 1.6%), more frequently on anticoagulant and antihypertensive treatments, less likely to have a university-level education (34.5% versus 45.4%), and more likely to have a low disposable income (20.6% versus 25.2%), but less likely to reside in crowded housing (6.1% versus 10.3%).

A total of 2,545 individuals died from COVID-19 during follow-up, including 765 (0.5%) of the statin users and 1,780 (0.2%) of the nonusers. Statin treatment was associated with a lowered COVID-19 mortality (adjusted HR, 0.88...), and this association did not vary appreciably across age groups, sexes, or COVID-19 risk groups. The confounder adjusted HR for statin treatment initiators was 0.78...in the emulated target trial. Limitations of this study include the observational design, reliance on dispensation data, and the inability to study specific drug regimens.

Conclusions
Statin treatment had a modest negative association with COVID-19 mortality. While this finding needs confirmation from randomized clinical trials, it supports the continued use of statin treatment for medical prevention according to current recommendations also during the COVID-19 pandemic.

BNO Newsroom @BNODesk | 10:04 AM · Oct 21, 2021:
Moscow orders non-essential companies, venues and services to close
from October 28 until November 7 amid surge in coronavirus cases

Pay heed, police and firemen fighting vaxx...and this is pre-vaxx, pre Delta...

Katherine D. Ellingson et al. 2021. Incidence of SARS-CoV-2 Infection Among Health Care Personnel, First Responders, and Other Essential Workers During a Prevaccination COVID-19 Surge in Arizona. JAMA Health Forum. Oct 22, 2021;2(10):e213318. doi:10.1001/jamahealthforum.2021.3318 https://jamanetwork.com/journals/jama-health-forum/fullarticle/2785400

Key Points
...Findings This prospective cohort study of 1766 unvaccinated seronegative Arizona workers using self-administered reverse-transcription polymerase chain reaction testing found that first responders had a significantly higher incidence of SARS-CoV-2 infection than health care personnel, even after controlling for sociodemographic characteristics and underlying health and exposure indicators.

Meaning The findings of this cohort study indicate that first responders warrant greater public health attention in context of the COVID-19 pandemic given their higher rates of SARS-CoV-2 infection.

Abstract
...Results The study cohort comprised 1766 Arizona workers (mean age...43.8...years; 1093 (61.9%) female; 401 (22.7%) were Hispanic and 1530 (86.6%) were White individuals) of whom 44.2% were health care personnel, 22.4% first responders, and 33.4% other essential workers. The cohort was followed up for 23 393 person-weeks. Crude incidence of SARS-CoV-2 infection was 6.7, 13.2, and 7.4 per 1000 person-weeks at risk for health care personnel, first responders, and other essential workers, respectively. In unadjusted models, first responders had twice the incidence of infection as health care personnel (IRRs, 2.01...). While attenuated, this risk remained elevated in adjusted LASSO-optimized models (IRR, 1.60...). Risk of infection among other essential workers was no different than for health care personnel in unadjusted or adjusted models.

Conclusions and Relevance This prospective cohort study found that first responders had a higher incidence of SARS-CoV-2 infection than health care personnel, even after adjusting for potential confounding factors. Given their frequent contact with each other and with the public and their high rates of SARS-CoV-2 infection, the safety challenges for first responders warrant greater public health attention and research.

Eric Feigl-Ding @DrEricDing | 1:23 AM · Oct 22, 2021
BEST BOOSTER? Mix it up — but depends which you had first. Switching vaccine for the booster seems to be the best—
Pfizer to Moderna booster,
Moderna to Pfizer for booster, and
J&J should switch to Moderna / Pfizer booster.
Image-table ( https://twitter.com/DrEricDing/status/1451418802416197633/photo/1 )

2) Vaccine efficacy and booster eligibility summarized here by @MedicalLetter.
https://secure.medicalletter.org/downloads/1621g_table.pdf
Image- table ( https://twitter.com/DrEricDing/status/1451421023698571281/photo/1 )

4) Here are the official eligibility criteria for boosters.
Note that Moderna as a booster is a modified 50 mcg. Normal first 2 shots of Moderna is 100 mcg.
FDA: https://twitter.com/DrEricDing/status/1450931622484787205/photo/1

5) that said, if you have a cancer or immunocompromised like #MultipleMyeloma,
then you should go with the Moderna full dose 100 mcg two shots. Ask your doctor if still possible.
(Pfizer is 30 mcg)

6) Moderna 2 shots (2x 100 mcg) yielded 6x greater antibody response than 2 shots of Pfizer. Might be too late to change; but just FYI for those not vaccinated yet.

Interesting history/analysis of US's five waves:

What Previous Covid-19 Waves Tell Us About the Virus Now
Lauren Leatherby | Oct. 23, 2021

...The country has suffered through five waves of the pandemic now, depending on how you count. “Each of these waves has a different complexity and pattern,” said Alessandro Vespignani, the director of the Network Science Institute at Northeastern University in Boston.

...“The difference between the Michigan Alpha wave in Spring 2021 and the Delta wave is really telling you that the wall that you’ve built might work for one variant, but it might not be enough for the next one,” Mr. Vespignani said. “There might be another variant that is more transmissible and with more immune evasion. That’s why we need to build the wall as high as possible.”

https://www.nytimes.com/interactive/2021/10/23/us/covid-surges.html