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Cause for cautious optimism?


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The following is a link to a very recent article in the British Medical Journal, a highly respected independent of government publication. A very interesting read !

 

https://www.bmj.com/content/372/bmj.n326

 

The efficacy figures should put things in perspective somewhat.

 

The UK government took the view that 76% protection for 11.5 million (our current first dose vaccination figure, equating to well over 20% of all our adults ) was better than 82% protection for half that number. Generally, this is considered a sound and sensible position.

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49 minutes ago, SusieQft said:

With respect, I would rather focus on the first part first.  Get everyone who wants it vaccinated first, and then focus on the persuasion of the rest.

I understand that thought Susie - I just think we underestimate the impact the unvaccinated will have on the rest of us. And not just because they might be denied access to cruising / flying / restaurants - whatever.

There are so many more chapters of this to come....🙄☹️

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The data in this table illustrates why immunization in not an urgent necessity throughout the entire population.   Prioritizing herd immunity rather than full protection for those facing the greatest danger is hard to justify.

 

COVID-19 Hospitalization and Death by Age - (CDC data)

Age

 

Hospitalization

 

Death

 

0-4 years

9x lower

9x lower

5-17 years

9x lower

16x lower

18-29 years   

 

Comparison Group

 

Comparison Group

 

30-39 years

2x higher

4x higher

40-49 years

3x higher

10x higher

50-64 years

4x higher

30x higher

65-74 years

5x higher

90x higher

75-84 years

8x higher

220x higher

85+ years

13x higher

630x higher

Edited by Jim9310
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57 minutes ago, Jim9310 said:

Prioritizing herd immunity rather than full protection for those facing the greatest danger is hard to justify.

That is true, especially if you are in a group near the bottom of the table you just listed.  But the people making the decisions are mostly not in those groups.  What does that tell you?

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I'm afraid people now have a really negative connotation with the term herd immunity.  It's really unfortunate.

 

I think the news people have hijacked this term and is using it to describe the theoretical concept that if we let the disease run its course, those who survive will develop immunity and the disease might be controlled with acquired immunity among those who survive.  That is a very weird and limited definition of this concept.

 

Herd immunity is the concept to describe an observation that higher the prevalence of immunity against a pathogen (either acquired from actual infection OR FROM VACCINATION), more protected those who are not immune from getting sick from that same pathogen.

 

It might sound like a minor point, but herd immunity is a great benefit to individuals, and this concept applies to how we vaccinate a population.  UK has made a decision to cast a wider net by giving slightly less than optimal vaccination to twice as many people first, with an assumption that greater vaccination coverage of the population may be a good thing, especially when the vaccine supply and distribution infrastructure is less than adequate to give two doses 22 days apart.  The assumption is that by doing so, the vaccine is resulting in greater herd immunity compared to the scenario where 1/2 of the people are receiving both doses 22 days apart.

 

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18 minutes ago, SusieQft said:

That is true, especially if you are in a group near the bottom of the table you just listed.  But the people making the decisions are mostly not in those groups.  What does that tell you?

 

Not sure what it tells me???  I suspect many of those making the decisions have already received both doses.

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The South African mutation confirms that herd immunity from COVID must eventually be obtained on a worldwide basis to end the pandemic.

According to the RAPS Vaccine Tracker of 55 possible vaccines, there are nine vaccines currently authorized for use in various parts of the world, and an additional eight vaccines undergoing phase 3 testing.  

The global vaccine marketplace does appear to be constrained by “big phama” patent protections and nationalist chauvinism.  Thus, Russian, Chinese, and Indian products are ignored in much of the developed world.

With seventeen vaccine varieties in sight, only three of them have been given emergency clearances in the USA, Canada, UK, and EU.  This has led to slow implementation, heightened supply vs demand conflicts, and production bottlenecks. 

Time will tell how long these deficiencies persist.

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1 hour ago, Jim9310 said:

 

The data in this table illustrates why immunization in not an urgent necessity throughout the entire population.   Prioritizing herd immunity rather than full protection for those facing the greatest danger is hard to justify.

 

COVID-19 Hospitalization and Death by Age - (CDC data)

Age

 

Hospitalization

 

Death

 

0-4 years

9x lower

9x lower

5-17 years

9x lower

16x lower

18-29 years   

 

Comparison Group

 

Comparison Group

 

30-39 years

2x higher

4x higher

40-49 years

3x higher

10x higher

50-64 years

4x higher

30x higher

65-74 years

5x higher

90x higher

75-84 years

8x higher

220x higher

85+ years

13x higher

630x higher

There's nothing wrong with table, but what this table cannot account for is the hospitalizations and deaths secondary to virus being spread from low-risk groups to high-risk groups.  In other words, different age groups do not live in distinct bubbles, as far as the viral transmission is concerned.  So, ideally, immunization should have at least two overlapping and somewhat distinct goals...to immunize as many of those who are at high risk of being hospitalized and die from the disease AND to immunize as many of those who are effective spreaders of the virus.  Herd immunity from vaccination should play a big part in protecting everyone, and especially those who are more likely to get very sick from this disease.  So immunizing those who are likely to spread the virus more effectively, in my opinion, is a good thing.

Edited by Psoque
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6 minutes ago, Jim9310 said:

 

The South African mutation confirms that herd immunity from COVID must eventually be obtained on a worldwide basis to end the pandemic.

 

According to the RAPS Vaccine Tracker of 55 possible vaccines, there are nine vaccines currently authorized for use in various parts of the world, and an additional eight vaccines undergoing phase 3 testing.  

 

The global vaccine marketplace does appear to be constrained by “big phama” patent protections and nationalist chauvinism.  Thus, Russian, Chinese, and Indian products are ignored in much of the developed world.

 

With seventeen vaccine varieties in sight, only three of them have been given emergency clearances in the USA, Canada, UK, and EU.  This has led to slow implementation, heightened supply vs demand conflicts, and production bottlenecks. 

 

Time will tell how long these deficiencies persist.

 

I think when you say "herd immunity" you are meaning "naturally acquired immunity from widespread infection."  They don't mean the same.

 

Also, the potential appearance of various mutants that may evade the immunity from the previously prevalent strain suggest that a proactive vaccination program, similar to what is done for influenza might be more important than just letting everyone get infected and see who survives.

 

I agree that the business and politics of vaccine development and distribution is a real mess for many reasons, partly because a) it is not very profitable and b) the "treatment" is given to otherwise healthy individuals, so the real "benefit" is not readily felt by many, especially if the incidence of the disease is lower (we wish we get there soon!) c) it takes a long time to really know how to use a new vaccine for a new disease.  It takes years/decades to really answer all of the important questions, including comparative effectiveness of different products, duration of the effective immunity, what is the best order in which the vaccines are given to the population, etc.

 

However, I think the current speed at which three different vaccines from three different companies are being introduced less than a year after the identification of this new pathogen is a good sign, at least to me, that the system has worked much better than before.  I agree that it has to be even better in the future, though.

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30 minutes ago, Jim9310 said:

I suspect many of those making the decisions have already received both doses.

I think you are spot on with that.

 

11 minutes ago, Psoque said:

what this table cannot account for is the hospitalizations and deaths that is secondary to virus being spread from low-risk groups to high-risk groups. 

Which is going to slow down the hospitalizations and deaths faster, immunizing everyone in a high-risk group first, or using up a lot of the vaccines available to immunize a lot of low-risk people first and thereby slowing down the vaccination of the most vulnerable?

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1 minute ago, SusieQft said:

I think you are spot on with that.

 

Which is going to slow down the hospitalizations and deaths faster, immunizing everyone in a high-risk group first, or using up a lot of the vaccines available to immunize a lot of low-risk people first and thereby slowing down the vaccination of the most vulnerable?

Vaccines are known to work much better when the incidence of the infection is lower, so there should be a happy medium between using up all of the vaccines for the high risk group vs. using some of the vaccines for the lower risk/better spreader population.  I think we don't know exactly what this happy medium is at this tiime.  But in the UK, they are hedging their bet by giving more vaccines to more people (prioritizing the older people but still having some left for others), which I think might be closer to that happy medium.

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6 minutes ago, Psoque said:

I think when you say "herd immunity" you are meaning "naturally acquired immunity from widespread infection." 

I did not read it that way.  As you explained, vaccines should also be able to get us to herd immunity, and that should be strongly preferred over getting there without vaccines.  Hopefully we are beyond the point now that people still think that herd immunity automatically implies "naturally acquired immunity from widespread infection."   

 

However, it is also possible that some less developed parts of the world may be well along the path to naturally acquired herd immunity before they have the opportunity for widespread vaccination.  Hopefully soon we will be able to produce, distribute, and administer enough vaccine around the world that we can reduce that occurrence. 

 

Another problem is that vaccine resistance exists at a national level, not just a personal level.  I was recently reading recently about one African country where the government is adamantly opposed to making the vaccine available to its people.  They don't trust it and prefer recommending "natural" remedies.  Unless they change their mind, "natural" herd immunity will be the only option there.

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19 minutes ago, SusieQft said:

I did not read it that way.  As you explained, vaccines should also be able to get us to herd immunity, and that should be strongly preferred over getting there without vaccines.  Hopefully we are beyond the point now that people still think that herd immunity automatically implies "naturally acquired immunity from widespread infection."   

 

I"m sure you know the difference, but if you look at how people here as well as everywhere else use the term "herd immunity," you might be surprised what people think it means.  I don't want to be confrontational, but at least twice the term "herd immunity" was misused in two separate posts in the past 2 hours here.

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51 minutes ago, Psoque said:

I think when you say "herd immunity" you are meaning "naturally acquired immunity from widespread infection."  They don't mean the same.

 

 I recognize that "herd immunity " is loosely defined and is being used in many contexts.  I envision that it, ideally, resembles the type of nearly universal immunity achieved for smallpox.

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1 minute ago, Jim9310 said:

 

 I recognize that "herd immunity " is loosely defined and is being used in many contexts.  I envision that it, ideally, resembles the type of nearly universal immunity achieved for smallpox.

Speaking of smallpox, it took decades to reach that nearly universal immunity.  I can remember when it was announced that smallpox had been eradicated from the earth, and then a few years later some new cases were reported.  COVID-19 and its many mutant offspring are probably going to be with us forever, but hopefully in the near future we will be able to keep it to a manageable level by a regular vaccination program analogous to what we are doing for the flu.

 

Maybe the new vaccine technology can be applied to the flu as well, which seems like it might help with that problem in the long run.  Of course keeping COVID under control and benefitting from potentially better flu vaccines both depend on people being willing to be vaccinated.

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A big concern at the moment is also the effectivity of vaccines against mutations. From the New York Times : “South Africa halted use of the AstraZeneca-Oxford coronavirus vaccine on Sunday after evidence emerged that it did not protect against the more contagious variant found there.”

 

Ivi

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I am watching the Super Bowl now, and in an ideal world the virus would be KC and the antibodies are TB (those are  initials for the team and their QB) who are now totally demolishing KC team.

 

I don't really follow NFL yet I wanted KC to win due to geographic proximity. 

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9 minutes ago, mskatiemae said:

I am watching the Super Bowl now, and in an ideal world the virus would be KC and the antibodies are TB (those are  initials for the team and their QB) who are now totally demolishing KC team.

 

I don't really follow NFL yet I wanted KC to win due to geographic proximity. 

I remember watching the Super Bowl on board the Serenity a couple of years ago. It was lovely 😊 . I am missing cruising so much... I just hope that we are able to resume cruising this year. Maybe on the third quarter...

Ivi

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17 minutes ago, mskatiemae said:

I am watching the Super Bowl now, and in an ideal world the virus would be KC and the antibodies are TB (those are  initials for the team and their QB) who are now totally demolishing KC team.

 

I don't really follow NFL yet I wanted KC to win due to geographic proximity. 

 

TOM BRADY IS INVINCIBLE!  California boy, New England champion, discoverer  of "fountain of youth" in Florida!

Edited by Jim9310
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8 minutes ago, Jim9310 said:

 

TOM BRADY IS INVINCIBLE!  California boy, New England champion, discoverer  of "fountain of youth" in Florida!

 

Hate to admit it, but the "Tom Terrific" headline will run over the more accurate "defense wins championships" cliche.

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2 hours ago, KenzSailing said:

 

Hate to admit it, but the "Tom Terrific" headline will run over the more accurate "defense wins championships" cliche.

The commentators did credit the defense, but I am most fond of the observation that "experience topped youth". Cheers for the elders! And for  coming back to the thread here, it seems that our immune system can benefit from experience - so I applaud those who are getting the vaccines!

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6 hours ago, travelberlin said:

A big concern at the moment is also the effectivity of vaccines against mutations. From the New York Times : “South Africa halted use of the AstraZeneca-Oxford coronavirus vaccine on Sunday after evidence emerged that it did not protect against the more contagious variant found there.”

 

Ivi

Ivi, having read the article they do conclude that the number of people tested was small and of a younger age and what they are unsure of is it's effectiveness in preventing serious health issues.  It could be that it lowers the effectiveness to completely prevent the effects from the virus but if it keeps you from having severe reactions that would still be good.  They have more to study but looks like they will hold off using the vaccine they have received and give their health workers the J&J when it arrives.

 

The key is having large enough studies so they can evaluate effectiveness.

 

Similarly I watched an interview with Dr Fauci yesterday when he responded to a question about one expert recommending that in the USA we focus on giving one dose of Pfizer and Moderna rather than two in order to get more people vaccinated and Dr. Fauci said it was an interesting thought but the data was not there from the trials to make a solid scientific decision so he said the USA should proceed with both dosages.  The only change was one made a few weeks ago which was don't hold back inventory to guarantee everyone who gets the first dosage will have the second one precisely three and four weeks apart of Pfizer and Moderna respectively noting that waiting a little more time is not a problem.  

 

This is another reminder that we have to slow down the pace of spread to minimize variants and as Dr. Fauci said they knew variances would occur as it spreads.  We (the people of the world) cut very much cu down the spread if we would do what science has asked us to do.  Why people ignore this is beyond me.  

 

It's so simple to minimize spread (wear the mask, social distance, don't be inside with others who do not live under the roof, social distance and even with the mask on social distance, don't travel unless you have to, wash hands often and thoroughly).

 

One of my roommates from University wrote me the other day.  He and his wife saw his kids.  They have been very good but they messed up.  None wore masks.  Well guess what?  He got Covid as did his daughter and son in law.  The only reason the wife didn't was she is a nurse who works in a hospital and had both dosages and it worked.

 

His takeaway wear the mask.

 

What I couldn't say was of course we are the mask because you can't let your guard down for a moment.


The virus doesn't care how good we've been.  Rather it is looking for a vulnerability to spread.

 

I know this thread digressed to the Super Bowl.  Great game but a reminder to me.  How many people attended Super Bowl Parties and didn't wear masks and how many will become infected due to these spreader parties?  And how many people at the Tampa Bay stadium will get the virus from either being in the game or from events before and afterwards?  

 

We don't get it.  We just don't and to me that is very sad in addition to the virus mutating and all of the people who have gotten the virus and those who have died.

 

Too  many people are acting like children.

 

Keith

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1 hour ago, Keith1010 said:

Ivi, having read the article they do conclude that the number of people tested was small and of a younger age and what they are unsure of is it's effectiveness in preventing serious health issues.  It could be that it lowers the effectiveness to completely prevent the effects from the virus but if it keeps you from having severe reactions that would still be good.  They have more to study but looks like they will hold off using the vaccine they have received and give their health workers the J&J when it arrives.

This story is also breaking here. As you suggest, it is thought that the AZ vaccine is not as effective in preventing mild or moderate symptoms. However, it seems that it remains highly effective in preventing serious illness, hospitalisation and death. South Africa are obviously wise in choosing an alternative, if available and if it provides greater overall protection.

Incidentally, Oxford University are already working on a tweak to counter the mutations, which were not unexpected and we are told to expect the likelihood of an annual anti-covid booster jab. 

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There was an outbreak of COVID at a home of seniors who have received already two dosis of Pfizer/Biontech. It seems they were infected with the mutation first seen in the UK. Good news is that even though the vaccines did not stop the infection with the virus, they appeared to have diminish the severity of the disease. Every day we are learning more.

 

https://www.dw.com/en/coronavirus-digest-german-nursing-home-sees-outbreak-after-vaccines/a-56491823?fbclid=IwAR1AUCsg6W1TDLXAxK10mnpXz-5PqHBWyoQYpx7b2mhjZh-hteDee0FQePw

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The report of the AstraZeneca vaccine having just 10 % efficacy against the South Africa variant is based on what we call a "subset analysis" of the phase 3 study.  There are a few things we must know about this.

 

Subset analysis is an  unplanned analysis of a subset of study data to get an initial glimpse at trends that were not designed to be studied when the study was designed and opened.  So, by definition, it lacks statistical power to really make any reasonable conclusion.

 

However, a subset analysis can give enough provocative suggestions for a new study to be performed, to see if the results from the subset analysis actually hold true in an actual study.  The actual study may confirm what is being suggested in the subset analysis or not.

 

So, I think it is very interesting to know what kind of a study will be designed in the future to know which vaccines works well enough for which subtypes, and if we are actually headed into a situation where we are continually making new vaccines with a mixture of potential variants predicted to be prevalent at that time.

 

I am envisioning this will be a very expensive endeavor either way.

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