To Vaccinate or Not---The Rat Flu Odyssey Continues

[yeahman]

The Bivariant's been out what a month and takes 2 weeks to fully engage..

Yep, that graphic appears to only includes the original booster, which for most was their 3rd shot. Still interesting that the original 2-shot vax is a clear difference maker and 3rd shot mostly inconsequential, at least in terms of hospitalization and death. There's more to it than that, of course.

[Mani_UT]

The safety study was done using Moderna with the original+BA.1 strains. Both vaccines have been updated to original+BA.4/5 for release.

Oh good. Thanks. Bad information from a major French paper of all places!

[schwerty]

Got the PFE bi yesterday. Seem a little tired today and the regular soreness around the injection site. No big deal. I would have loved to wait until Halloween but that shit is all around my kids at school. And…almost nobody is testing. Very different than a year ago. Free PCR tests 6 days a week had most people I know testing every time someone in their house sneezed. Now many parents I chat with just want to get their kids back in school. No test = couldn’t possibly be covid.

Hope this updated booster is solid.


Sent from my iPad using TGR Forums

[Danno]

Interesting graphic in the NYT this morning. Doesn't show the booster as making much difference.

Maybe I am misreading the chart (and as has been noted it just shows "with booster" without differentiation, some people have had 3 booster shots and some 1, and some have had booster shots within the last 3 months and some almost a year ago).

But on that graphic, if I am reading correctly, the only place where the booster hasn't seemed to make a difference is the 65+ hospitalizations. For hospitalizations of other cohorts, it seems to have halved the number (which is saying a lot when the number was already pretty low). And for deaths, it also has halved the number of deaths, including the 65+ group. Of course, it hasn't halved the number of deaths for the 30-49 group because you can't halve zero.

In what way would you say it hasn't made much of a difference? The numbers for vaccinated folks are pretty low, so the fact that it has actually made a dent in those numbers (except for hospitalizations of 65+), even considering we don't know the details behind each person's booster status, seems pretty noteworthy to me.

[funkendrenchman]

From Katelyn Jetelina


The FDA and CDC authorized the bivalent boosters based on a number of data sources. This was necessary to get ahead of the virus, like we do with the flu vaccine each year. Our hope is that a bivalent booster will help in three distinct ways:

Greater protection against infection and transmission, by boosting our first line of defense—neutralizing antibodies;
Longer protection against infection and severe disease, even just by a few months. (Unfortunately, we are at the mercy of time to know whether this will happen, but we are hopeful given data from our bivalent Beta vaccine clinical trials);
Broader protection or the ability to create antibodies that “see” more virus parts and “attach” more strongly compared to the antibodies we have right now.
We have two new studies with promising data.

The first preprint solidifies #1 and #3. Before now, we’ve relied on mice data to show that bivalent BA.4/5 vaccine increased neutralizing antibodies. But, now we have data on humans. Scientists measured antibodies in individuals who had three mRNA vaccines and a BA.4/5 breakthrough infection. (This can act as a proxy for the BA.4/5 booster.) They found antibodies were very high and were high against all Omicron subvariants studied. In other words, the bivalent booster will enhance protection against Omicron, which will help prevent infection and transmission. This is not surprising, but reassuring.


The second preprint points to #3. This is a study we’ve all been waiting for. Scientists studied B-cells—our antibody factories—and, particularly, whether we could make new B-cells (update the factory line after seeing another variant). This is important to study to ensure we don’t have original antigenic sin. (If you haven’t already, read this previous post on original antigenic sin where I attempt to explain this concept.) The current study showed that while we do have imprinting (which is normal and expected), we do make new B-cells after an updated Omicron vaccine. In fact, the authors stated, “immunization with an antigenically distant spike can overcome the antigenic imprinting by the primary vaccination series.” This means that an updated booster will increase the diversity of our antibodies and that memory will be retained by our immune systems.

Limitations

It’s important to note that, unfortunately, new subvariants of Omicron are already on the horizon with concerning mutations for antibody escape, like BA.2.75.2 or BQ.1.1. These new variants were not tested in the studies above. We’ve seen from another study that these new variants can substantially escape neutralizing antibodies from Coronavac (a Chinese vaccine using inactivated virus). But there are still a lot of unknowns: We don’t know how mRNA vaccines will hold up; we don’t know if these variants will take hold; and neutralizing antibodies are just one part of our complex immune system. Our safest bet is not through infection, but through vaccination. Our immune systems need updating and we need to be responsive to that, even if that updating is not perfect.

[yeahman]

Maybe I am misreading the chart (and as has been noted it just shows "with booster" without differentiation, some people have had 3 booster shots and some 1, and some have had booster shots within the last 3 months and some almost a year ago).

But on that graphic, if I am reading correctly, the only place where the booster hasn't seemed to make a difference is the 65+ hospitalizations. For hospitalizations of other cohorts, it seems to have halved the number (which is saying a lot when the number was already pretty low). And for deaths, it also has halved the number of deaths, including the 65+ group. Of course, it hasn't halved the number of deaths for the 30-49 group because you can't halve zero.

In what way would you say it hasn't made much of a difference? The numbers for vaccinated folks are pretty low, so the fact that it has actually made a dent in those numbers (except for hospitalizations of 65+), even considering we don't know the details behind each person's booster status, seems pretty noteworthy to me.

Yeah you're probably right. Even with no boosters, though, the original shots still provide great protection for the vast majority. You could halve it until the end of time with more boosters, I suppose.

[Dantheman]

For hospitalizations of other cohorts, it seems to have halved the number (which is saying a lot when the number was already pretty low).

Probably not saying a lot, actually. In general, smaller population sizes typically mean less meaningful statistics and relative risk reductions yield small changes in absolute risk. Greater Seattle metro has a population of ~4 million, so per those stats in the 50-64 cohort there are 16 vaxxed/unboosted people hospitalized and 8 vaxxed/boosted people hospitalized. Solidly into hair-splitting territory, IMVHO, especially without digging deeper into the data. A multivariate analysis that accounts for sex, more narrowly defined age ranges, smoking, obesity, etc. could find another variable that more strongly explains the delta between boosted/non-boosted.

[jono]

Probably not saying a lot, actually. In general, smaller population sizes typically mean less meaningful statistics and relative risk reductions yield small changes in absolute risk.

I had to read that a couple times. First time I thought you were saying population size drives different results in RR vs. AR rather than both things have an impact. I'm not seeing a disagreement here with Danno's reading of the data (such as it is), though.

A multivariate analysis that accounts for sex, more narrowly defined age ranges, smoking, obesity, etc. could find another variable that more strongly explains the delta between boosted/non-boosted.

Most likely the low delta in the one (too broad) older group gets explained as parsing reveals (once again) that people who thought they were at higher risk (and got boosted) were right about that.

Kinda nice to be into a place where a population of 4 million is too small to get strong stats on bad outcomes. Probably pushes us back two stages in statistical understanding but still nice.

[schindlerpiste]

The safety study was done using Moderna with the original+BA.1 strains. Both vaccines have been updated to original+BA.4/5 for release.

A couple weeks ago both my wife and I got shot #4. Both Ba-4-5. Mine was Moderna. Her's was Pfizer. I had a sore arm for 1 day. She was in bed for 2 days with 102 fever.

[yeahman]

Kinda nice to be into a place where a population of 4 million is too small to get strong stats on bad outcomes. Probably pushes us back two stages in statistical understanding but still nice.

Definitely. When hospitals were plugged and overflowing it was a very stressful time. We seem to be light years beyond that. Now the stress (mine anyway) has shifted to the economic after-effects of the pandemic, like inflation, stock market tanking, labor shortages, sky high real estate prices, the remote worker migration that will forever impact the Rocky Mountain West, etc. It's incredible how much that pandemic fucked up the balance of human civilization on earth, and how apparently tenuous that balance was in the first place.

We live in interesting times.

[::: :::]

I can report that our local hospital is full and understaffed.
A bit of a shock at how stressed it is in “back to normal” conditions. People waiting on assistance all over. Staff doing their best.
We are not prepared if we end up with a natural disaster like FL is going thru now.

[summit]

I can report that our local hospital is full and understaffed.
A bit of a shock at how stressed it is in “back to normal” conditions. People waiting on assistance all over. Staff doing their best.
We are not prepared if we end up with a natural disaster like FL is going thru now.

There are so many injured healthcare providers. I mean injured in the whole sense of the person and I mean severely injured. The culture is sick in most workplaces. An unbelievable amount of experience ran for the hills (away from the bedside). An unbelievable amount of new blood was put to trial by fire during the pandemic, and then crushed beneath the grindstone of stress and left or are actively leaving the bedside. The last 3 years was brutal and it wasn't just the COVID. It was the environment of care, the public discourse, the treatment by patients and visitors, the way the hospital corps treated staff, workloads, ratios, lack of mentorship, ethical and emotional conflicts... I could go on.

Nobody wants to staff that (ie regular employment), which led to high travel pay, which led to more staff leaving leaving to travel, which has now led to hospitals trying to refuse to hire travelers because they all went deep in the red (staffing is the #1 cost), but they still can't hire staff. I'm talking from CNAs to docs, but especially nurses and techs.

Nobody wants to staff. It is an ongoing crisis with no quick end in sight. Things are so far gone... management knows they can't solve it with free pizza party to so they try some resilience trainings as they add to the load, but these people are not at-risk, they are already seriously hurt. It will probably get worse before it gets better as the hospital corporations tighten their belts and increase patient ratios under the spectre of a sour economy which always portends less elective (and non-elective) healthcare usage.

[bagtagley]

Thing 1 tested positive several weeks ago. She isolated in her room, air purifiers strategically setup, masks when together. Made it ten days, and were starting to think we beat it when thing 2 tested positive. It was all downhill from there.

I don't know what flavor we had, but it was rough. Felt like a mix of a bad case of the flu and bad head cold with some stomach bug mixed in. Wife and I had a fever for about four days then slowly started to recover, but with the head cold sticking around. I'm just over two weeks since my first positive, and still don't feel great. My head is full of snot and I'm still coughing crud up. I imagine we have another week or two before we feel normal. I started exercising again around day 8, but nothing more than slow hikes, and I'm keeping things mellow as I still feel weak and fatigued. The only reason I've kept it up is because I feel a lot better afterwards, and sleep much better than if I don't. I'm certain a younger me would have overdone it and just made things worse.

I have a new appreciation for antigen tests. For all of us, as soon as we had symptoms, the positive line appeared as soon as the juice hit that part of the strip, basically instant. We continued to see bright red positives until about day 8 when the line started getting more faint, finally not appearing around day 15.

Pretty bummed we have to wait for the bivalent now. Get that thing if you can cause this shit blows.

[teledad]

Sounds similar to my family's experience (me, wife, adult kid) in late June except we all got it at the same time (probably exposed together). I somehow managed to walk the dog every day while I was sick but that was all I could manage. Wife has underlying conditions and went on Paxlovid, that helped with breathing but she had nausea instead and was basically in bed for 2 weeks. I tested positive until day 13 and was off the bike for a month.

[The Tortoise]

I am reading that the Bv Moderna target Ba.1 (omicron), who Pfizer targets Ba.4 and 5. Wouldn’t that suggest Pfizer is the better choice right now?

Since Canada is giving out the Moderna Ba.1 vaccine, I'd be curious to know the answer to this. Is it worth waiting for the Ba.4/5 vaccine?

[skiJ]

There are so many injured healthcare providers. I mean injured in the whole sense of the person and I mean severely injured. The culture is sick in most workplaces. An unbelievable amount of experience ran for the hills (away from the bedside). An unbelievable amount of new blood was put to trial by fire during the pandemic, and then crushed beneath the grindstone of stress and left or are actively leaving the bedside. The last 3 years was brutal and it wasn't just the COVID. It was the environment of care, the public discourse, the treatment by patients and visitors, the way the hospital corps treated staff, workloads, ratios, lack of mentorship, ethical and emotional conflicts... I could go on.

Nobody wants to staff that (ie regular employment), which led to high travel pay, which led to more staff leaving leaving to travel, which has now led to hospitals trying to refuse to hire travelers because they all went deep in the red (staffing is the #1 cost), but they still can't hire staff. I'm talking from CNAs to docs, but especially nurses and techs.

Nobody wants to staff. It is an ongoing crisis with no quick end in sight. Things are so far gone... management knows they can't solve it with free pizza party to so they try some resilience trainings as they add to the load, but these people are not at-risk, they are already seriously hurt. It will probably get worse before it gets better as the hospital corporations tighten their belts and increase patient ratios under the spectre of a sour economy which always portends less elective (and non-elective) healthcare usage.

This is an important post ^^^

Thank you. summit !


skiJ

[SumJongGuy]

Doctors and other hospital staff are also getting attacked in the workplace more and more often.

[Cono Este]

Covid still out there, despite everyone declaring victory.

Lost another client today. He was a beer vendor at Busch Stadium. Cool as fuck.

Went on a cruise. His brother said he a blast though.

Keep your parents home.

[SumJongGuy]

There's some interesting analysis recently released about the differing death rates between the reddest and bluest counties during the height of the pandemic. I'm not going to post it here but if anyone's interested it's out there..

[funkendrenchman]

Thing 1 tested positive several weeks ago. She isolated in her room, air purifiers strategically setup, masks when together. Made it ten days, and were starting to think we beat it when thing 2 tested positive. It was all downhill from there.

I don't know what flavor we had, but it was rough. Felt like a mix of a bad case of the flu and bad head cold with some stomach bug mixed in. Wife and I had a fever for about four days then slowly started to recover, but with the head cold sticking around. I'm just over two weeks since my first positive, and still don't feel great. My head is full of snot and I'm still coughing crud up. I imagine we have another week or two before we feel normal. I started exercising again around day 8, but nothing more than slow hikes, and I'm keeping things mellow as I still feel weak and fatigued. The only reason I've kept it up is because I feel a lot better afterwards, and sleep much better than if I don't. I'm certain a younger me would have overdone it and just made things worse.

I have a new appreciation for antigen tests. For all of us, as soon as we had symptoms, the positive line appeared as soon as the juice hit that part of the strip, basically instant. We continued to see bright red positives until about day 8 when the line started getting more faint, finally not appearing around day 15.

Pretty bummed we have to wait for the bivalent now. Get that thing if you can cause this shit blows.

Same experience with the antigens here. My family was still positive close to 2 weeks out. Even the kids who had minor symptoms for 3 days were still positive.

My wife and I had a fever for 3 days but neither of us is 100% at almost 3 weeks out. She’s still congested and my vision is slightly off. Luckily not bad enough that we can’t get back to high output activity. We both know a lot of active friends that weren’t 100% until at least a month.

[schindlerpiste]

Since Canada is giving out the Moderna Ba.1 vaccine, I'd be curious to know the answer to this. Is it worth waiting for the Ba.4/5 vaccine?

I received the Moderna Ba4/5 vaccine two weeks ago. Moderna certainly targets Ba4/5
https://eua.modernatx.com/covid19vac...-recipient.pdf

[Gcooker]

I received the Moderna Ba4/5 vaccine two weeks ago. Moderna certainly targets Ba4/5
https://eua.modernatx.com/covid19vac...-recipient.pdf

Sadly Health Canada hasn’t approved the Ba4/5 yet…

[old goat]

Sadly Health Canada hasn’t approved the Ba4/5 yet…

Let me guess--"out of an abundance of caution".

[Gcooker]

Let me guess--"out of an abundance of caution".

More likely that they bought too many of the other ones…

[riser4]

Seasonal Flu and bi-valent COVID onboard an hour ago. Doc said to get the Shingles vaxx on a different day.