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What is Going on With the AstraZeneca/Oxford Vaccine?

Update: more on this in a later post here.

Everyone will have heard of the situation in Europe right now, with a whole list of countries suspending dosing of the AstraZeneca/Oxford vaccine. Sweden and Latvia joined that list today .But getting clarity on this is another thing entirely.

I have not been the biggest fan of the vaccine, because its initial rollout was (frankly) botched. It was difficult to figure out how efficacious it was, and that confusion persisted after further attempts to clear things up. The last figure I’ve seen is that the European Medicines Agency estimates the vaccine to be about 60% effective, and at the same time the EMA does not see safety concerns with it. But there are many member states of the EU who apparently disagree, citing reports of blood clotting problems and/or thrombocytopenia after dosing.

I think that there are several distinct levels to this problem. The first, obviously, is medical. The big question is, are the reports of vascular problems greater than one would expect in the vaccinated population as a whole? It’s not clear to me what the answer is, and it may very well be “No, they aren’t”. That CNBC link above quotes Michael Head at Southampton as saying that the data so far look like the problems show up at at least the same levels, and may even be lower in the vaccinated group. AstraZeneca has said that they’re aware of 15 events of deep vein thrombosis and 22 events pulmonary embolisms, but that’s in 17 million people who have had at least one shot – and they say that is indeed “much lower than would be expected to occur naturally in a general population of this size“. It also appears to be similar to what’s been seen with the other coronavirus vaccines, which rather than meaning “they’re all bad” looks like they’re all showing the same baseline signal of such events across a broad population, without adding to it.

In that case, this could be an example of what I warned about back in December (and many others have warned about as well), the post hoc ergo propter hoc “false side effects” problem. I’ve been looking this morning, and so far have not found anyone clearly stating that the problems seen are running higher in the vaccinated patients, anyway (if someone does come across such numbers or such a statement, I’ll amend this post immediately with a link). I realize that there’s a possibility (not a likely one, though) that some particular batch of vaccine is more problematic, but I haven’t seen any solid evidence of that, either

The second half of the medical problem is naturally what happens when you suspend dosing of what is, in many cases in the EU, the only vaccine available. We’ve been seeing cases falling here in the US ever since a peak on the first week of January – many of us were worried about what might have been a rise in February but which now just seems to have been a plateau, with cases continuing to drop since then. But many European countries are definitely seeing another wave of infections, and the EU case numbers as a whole are going in the opposite direction to the US ones. There are surely a lot of reasons for this, with new viral variants being one, slow vaccine rollouts being another, and now complete vaccination halts set to add even more. Put as bluntly as possible, even if the AZ/Oxford vaccine has these side effects (which again, I don’t see any evidence for yet), you are still very likely to kill more people by not giving it.

The next problem is a regulatory one. The EMA and the World Health Organization continue to endorse the vaccine, but that seems to mean little or nothing as one European country after another shuts down its use. I understand that the EMA does not have supranational authority in these matters, but there must be people there wondering what good their recommendations and regulatory approvals do, if this is how they can be dealt with. The EMA itself is meeting on Thursday for what should be some stressful discussions. Meanwhile, there are other countries (such as Belgium) whose authorities (so far) say that they see no need to stop using the vaccine at all.

It’s a mess. And it’s a mess that leads us right into the third problem, which is public confidence. The AZ/Oxford vaccine has been in trouble there since the day the first data came out. The efficacy numbers looked lower than the other vaccines that had reported by then, and as mentioned, the presentation of the data was really poorly handled and continued to be so for weeks. Now with these dosing suspensions, I have to wonder if this vaccine is ever going to lose the dark cloud it’s currently sitting under. Even if EU countries start dosing again in a few days, what are people going to think? And this fear and uncertainty can spill over into hesitancy for all the vaccines, of course, and that’s the last thing we need.

We’re about to get another batch of data, for better or worse. Reports are that the US trial of the vaccine has reached its events threshold, so we’ll be seeing completely new clinical efficacy numbers for this vaccine soon. That will be very interesting indeed – and while most of us were waiting to see what those efficacy figures would look like, now everyone will be looking at the safety numbers as well. I do not expect the vaccine to show any bad safety signals at all, let me say up front (I mean, it’s already been dosed 17 million times; that’s a bigger data set than any trial could ever give you). But will that matter to people who are scheduled to get it? Will it matter to the countries who have suspended dosing?

Let’s say that the efficacy numbers come in at a solid, inarguable 60%. You would want to see a higher number in a better world, but 60% is a damn sight better than not getting vaccinated at all. Which is effectively what a number of European countries have chosen to do instead. If I were living in one of those countries where the cases are heading right back up, I would bare my arm immediately for a 60% effective vaccine and hope that as many other people as possible did the same.

304 comments on “What is Going on With the AstraZeneca/Oxford Vaccine?”

  1. The data I’ve seen so far would equally well support media headlines like “Vaccine may be protective against blood clots”.

    1. P says:

      The data reported don’t seem to show much of anything, and the Norwegian cases don’t make any sense statistically. Norway has given 700,000 vaccines so far – I don’t know how many are AZ, but even if it were 100% then an adverse event this common (and unusual) would have been seen hundreds of times in the UK and elsewhere. I suppose it’s possible that Norway received a bad batch of vaccine which somehow caused this side effect, but it doesn’t make any sense that if this was an AZ-specific effect it would only have been seen there.

      Never mind that anything and everything that could be described by a layperson as a ‘clot’ seems to be being reported as potentially linked. A thrombocytopaenic haemorrage, perhaps associated with DIC or ITP, is not the same as a cerebral sinus thrombosis or a DVT/PE, and bundling them all into a single entity just increases the odds of confirmation bias. I suspect that rates of cerebral sinus thrombosis and DVT/PE are sensitive to testing rates, too – if everyone who walks into an ED with shortness of breath, chest pain or calf pain after receiving the AZ vaccine is now being investigated then we would expect to see the numbers artificially inflated.

      1. TT says:

        126000 az doses administered – 6 cases 2 deaths.

        1. Philip Vitale says:

          When these types of statements are made please provide sources. Otherwise why should it be believed.

    2. Dr. Victor Frankenstein says:

      One of the key differences may be that in continental European countries people are advise to take Paracetamol BEFORE the vaccination to ameliorate any expected side effects (pains, fever).

      Here in the UK, no such advice is given. It only says that Paracetamol can be taken AFTER the vaccination IF there are side effects.

      I wonder whether the continental European countries are seeing the side-effects of the Paracetamol, rather than the vaccine itself …

      1. Some idiot says:

        Not in Denmark… instead, we are told that if we get aches/pains/fever, then Panadol can be used to lessen the symptoms.

        No idea what the advice is in other countries…

      2. WST says:

        Any source of this information, not the case of Italy, Sweden & France.

        1. Dr. Victor Frankenstein says:

          In Germany.

          Recommendation from the Robert Koch Institute: 1 g Paracetamol before the vaccination

          https://www.rki.de/DE/Content/Infekt/EpidBull/Archiv/2021/Ausgaben/02_21.pdf?__blob=publicationFile

          1. Arno Nym says:

            > Recommendation from the Robert Koch Institute: 1 g Paracetamol before the vaccination

            That would be news to me. Its certainly not in the linked article. That one only mentions paracetamol in the context of describing the AstraZeneca trial where it was given to some of the participants.

      3. Stanslav Radl says:

        No such advice in the Czech republic and Slovakia.

        1. Keano says:

          Nothing in Italy like this either

    3. Kim Zenad says:

      What is the difference between Relative Risk Reduction and Absolute Risk Reduction when providing the efficacy of this vaccine?

      1. neil says:

        Very different. Event rate between A and B, 5% vs 4%. The ARR is 1%, the RRR is 20%.

        1. Micha Elyi says:

          Wouldn’t that be an absolute risk reduction (ARR) of one percentage point, not 1%?

  2. sgcox says:

    EU is so pissed off with Brexit that it would rather let its own people die than admit UK is doing something better.
    Just IMHO.

    1. Some idiot says:

      Nope, not in this case. It has actually been pretty clear that this has been popping up on more or less a country-by-country basis, with the EMA saying clearly at every juncture that the vaccine is safe. And the other countries that have also put in a pause have done so slowly, and not in a coordinated fashion. This is definitely not an “EU” thing.

      Actually, as someone living in Denmark (one of the first countries to put in a pause), the reaction has been more “Damn, this is going to slow down the rollout”, as opposed to “Damn, that vaccine is unsafe.” I would also like to point out (as Adrian also pointed out), the AZ vaccine has only been a smaller player in the EU market, in part at least to AZ’s production problems. The actual amount delivered has been significantly less than expected (like around 20-30 %). So yes, this will impact the rollout in (eg) Denmark, but not to nearly the same extent as it would have in (eg) UK. And the pause is for two weeks… I will be very interested to see what happens then, and the reasons given for that action.

      Is there anything in it? I am really on the fence now… To start off with, I was clearly in the “ok, someone had to have a stroke shortly after being vaccinated” group, because that’s where I figured it was. But now I am not so sure. Partially because the clinician that raised the alarm (here in Denmark, I think) was concerned due to the atypical nature of the event. Apparently (and I am not an expert in the area, just repeating what was reported) there were multiple blood clots in multiple organs, with (apart from other things) depleted levels of blood platelets. Again, it could still be “just one of those coincidences”, where a person with atypical symptoms (for completely unrelated reasons) just happens to have been vaccinated beforehand.

      Having said that, on the other hand, there are so many that have been vaccinated with it in the UK now, that I would have expected a signal to pop up there, as well. But one thing is certain: I have confidence in the relevant persons to dig into it and sort it out. Will be interesting to follow…

      1. stewart says:

        COVID-19 is known to result in coagulopathy, and coagulopathy can result in thrombocytopenia (by soaking up all the platelets). This leads me to wonder whether these were people who were infected by SARS-COV-2 shortly before or after vaccination, and the symptoms were caused by the infection rather than the vaccination.

        Questions to ask: Were the individuals involved tested for COVID-19? (And what were the results?) What is the rate of these events in COVID-19 patients as opposed to the general population?

        1. Some idiot says:

          No idea, but very relevant questions. Very many of here get tested once a week (twice a week if you are eg a teacher), so I am sure that those who are investigating would know. I will be _very_ interested to hear the results of the investigations. I hope they will be made public (or at least an anonymised version of it).

          1. Lilian Calò says:

            What about someone who had already has DVT and has been taking blood thinners since the episode. Is that person at risk to take the AZ vaccine?

        2. ochenta says:

          “COVID-19 is known to result in coagulopathy, and coagulopathy can result in thrombocytopenia (by soaking up all the platelets).” Good point!
          I wonder even if these people were not infected by SARS-COV-2.
          What is the rate of this COVID-trombo incidence? Do the vaccination reduced it?
          If that is the case, the vaccine suspension is risen again that risk by exposition to COVID.
          Some body know the numbers? (COVID-trombo rates)

          1. M. Sweet, M.D. says:

            That was my thought too-history of past (or present asymptomatic) COVID-19, contributed to clotting or coagulopathy?
            I’ve seen several patients soon after COVID-19 present this way.

        3. Zoë Gallagher says:

          Excellent point. I’ve been wondering the same thing. Were you able to find any information related to this?

      2. sgcox says:

        Yes, you are right, I was generalising about EU instead of particular politicians.
        And indeed the decisions are heavily influenced by the recent spat with AZ
        Here is what French politician said to BBC. Sorry, no direct link, it was from rolling news feed:
        ——————————————————————————————————————————————-

        Véronique Trillet-Lenoir, who is a French oncologist and an MEP, is asked by BBC News why the AstraZeneca vaccine is coming under more scrutiny than other authorised vaccines such as the Pfizer vaccine.

        “We have maybe a specific regard on AstraZeneca. As you know, the firm did probably not fulfil all the commitments [it] made in the contracts with the EU. The vaccine is not that effective on the South African variant, so there are some warnings on these vaccines, which probably led the governments to be even more cautious on it.”

        1. WST says:

          Sorry sgcox , you are taking noise for a signal. So many people have opinions on this and other covid related subjects that you will always find someone that will confirm your biases.
          You could have easily found a French medicine professor that would the an opposite view.

          The French top medical authority HAS not changed its positive evaluation published 26/2.
          The decision to suspend the vaccination is purely political. As it was in other European countries (Italy, Denmark), against their medical authorities advice.

          1. sgcox says:

            Unfortunately, Politics is not Science and noise can easily outweigh the signal, aka Fake News phenomena.
            People in position of authority should really care what they said – does not apply to to Macron or BoJo The Clown..

      3. Dr Roger Higgs says:

        “But one thing is certain: I have confidence in the relevant persons to dig into it and sort it out”

        I suggest that your confidence is misplaced. Scientists, politicians and journalists have been corrupted by money. Believe nothing.

        https://www.researchgate.net/publication/345778067_IPCC_Cover-up_of_Sun%27s_Obvious_Control_of_Climate

        1. Daniel Correia says:

          Dear Dr. Higgs,

          The suggestion somewhat central to your paper, that cosmic rays affect cloud patterns, is very interesting. In fact, your paper as a whole draws on very fascinating mechanisms. However, to provide an accurate picture to readers, so that they may come to an informed conclusion, science demands that dissenting views be considered and discussed – just as you suggest the IPCC et al do a better job of.

          A cursory search for this seeding hypothesis yielded, e.g. Laken, J. Space Weather Space Clim. 2 (2012), who come to the conclusion that cosmic rays and magnetic flux have little correlation with clouds, and therefore albedo. Note that I know nothing of the topic, and therefore rely on you to paint an accurate picture of the shortcomings of these (and other) works.

          You state in bold that “CO2 is irrelevant”. Knowing the absorption spectrum of CO2 (easily measured with little equipment), and with the directly measured CO2 concentrations in the atmosphere (similarly so), the simplest first-principles equation will give you a very good indication of just how relevant varying concentrations of CO2 are in the earth’s thermal system. As a doctor and apparently a distinguished geologist, I’m sure you know that making such definitive, sweeping statements – in this case, simply dismissing fundamental physical concepts – is not a good way to instill confidence, especially when you wish to overturn an existing, rigidly established concept.

          1. WST says:

            …also prof H. Svensmark formulated this hypothesis well before you…and CERN created a CLOUD project running for 10 years; the result was that the cosmic rays have a marginal impact on aerosol formation.

        2. Deborah says:

          Yes! I completely agree….thank you. . ER RN

        3. Deborah says:

          Yes! I completely agree with you. Thank you. ER RN

      4. E Moeller says:

        Two cases of stroke reported in vaccinated health care personnel in the capital region this morning, one fatal.

    2. Chris Fagg says:

      This idiotic comment has no place in a serious magazine.

    3. doublea says:

      Can we stop peddling this nonsense? The only EU institution involved here, the EMA, is actually endorsing the vaccine.

  3. Jiří Hudeček says:

    The particular combination of brain thromboses and reduced thrombocytes seen in several cases normally comes up 2-5 times a year in a million people, but they have already seen 7 cases in about a month in the 1.6 million Germans vaccinated with AstraZeneca.

    Clemens Wendtner, head of infectious diseases and tropical medicine at Munich clinic Schwabing, said the background incidence, or normally expected risk, for this condition was two to five cases per 1 million individuals per year.

    “This should be the reason to suspend the vaccination in Germany until all cases, including suspected cases in Germany and Europe, have been completely cleared up,” he added.

    https://www.reuters.com/article/instant-article/idINKBN2B71UM

    1. Nicholas Marshall says:

      The Reuters link you posted has an important distinction.

      “Spahn said there have been seven reported cases after vaccination that could be related to cerebral vein thrombosis out of 1.6 million vaccinations in Germany.”

      That’s not the same as confirmed cases of CVT, and in a noisy dataset where (as Lowe points out) they’re trying to distinguish it from background noise, it’s important not to overstate what’s been observed even a little bit.

    2. Oudeis says:

      I think Derek’s right to point out that the comparison here isn’t between the vaccine and perfect safety; it’s between a vaccine and an epidemic. The doctor here is complaining about a one-month period with maybe six extra thromboses, but in the last month something like six thousand Germans have died of the coronavirus.

    3. Nigel says:

      And, of course, both cerebral vein thrombosis and thrombocytopenia (along with other blood complications) are known to be associated with Covid.

      There is an outside possibility of a ‘bad batch’, but as far as the overall vaccine safety is concerned, the UK figures on safety are rock solid, especially given the centralised health system. It’s inconceivable that they would have missed such a safety signal with ten times as many vaccinated.

      The precautionary principle, given the risk of death from the virus in older people, really does not justify suspension of the vaccine on the current evidence.

      1. Adrian says:

        It is less than 2 weeks that the Oxford vaccine was approved for people over the age of 65 in Germany, while the UK has used it in a relatively strict oldest-first order for all ages.

        This gives quite different vaccinated groups with little overlap.

        I have heard (unconfirmed!) rumours that the cases in Germany are mainly among women using contraceptive pills. That’s a significant part of the vaccinated people in Germany, but outside the age groups vaccinated so far in the UK.

        1. Chris Phillips says:

          Of course vaccination in the UK hasn’t been done in order of age. Health and care workers of all ages were among the highest priorities. Presumably that is why these younger people were vaccinated in Germany.

          1. A Nonny Mouse says:

            Healthcare workers were mainly given the Pfizer vaccine as it was easier to do it in the hospital situation (my son recently had his second dose after 9 weeks).

          2. Adrian says:

            “Of course vaccination in the UK hasn’t been done in order of age.”

            The UK has been comparably strict in going by age group, while Germany has already started to vaccinate school and kindergarten teachers of all ages.

            As of 2 weeks ago, 100% of the people who received a dose of the Oxford vaccine in Germany were under the age of 65. It is safe to say that the majority of people who received a dose of the Oxford vaccine in Germany are women under the age of 65.

            How many percent of the people who received a dose of the Oxford vaccine in the UK as of 2 weeks ago are women under the age of 65?

            How many percent of the people who received a dose of the Oxford vaccine in the UK are women under the age of 40?
            Less than 25% ?

          3. Chris Phillips says:

            Healthcare workers have been given both vaccines. More may have been given Pfizer than AstraZeneca, but – for example – in the recent SIREN preprint about a quarter of the participants had received AZ, not Pfizer.

            It’s simply not true that young and middle-aged people haven’t yet been given AZ in the UK.

          4. Adrian says:

            “It’s simply not true that young and middle-aged people haven’t yet been given AZ in the UK.”

            It’s simply not true that anyone claimed that.

            What is true is that the distribution of the people who received the Oxford vaccine is very different in different countries.

            Any problems that affect only young people would be expected to be very visible in Germany but hardly visible in the UK.
            And the same is also true for related statistical problems, like oversampling of women of reproductive age in the German data.

          5. Chris Phillips says:

            Adrian

            What you said was that there was “little overlap” between those given AZ in the UK and Germany.

            That’s obviously not true. But what you were claiming was actually that too few under-65s would have been vaccinated with AZ here to pick up problems in that age group, compared with Germany, which is even more ridiculous.

            If you look at the priority groups in the UK and add up the numbers, you’ll see that something like half of the 25m vaccinated so far must be in either under-65 categories or one of the categories that aren’t age-based (health workers, social workers, at severe risk, at risk). And AZ accounts for the majority of the vaccines given here. And you’re trying to say that because 1.6m have been given AZ in Germany, they have vaccinated more under-65s with it than we have? Many more, even? It’s absurd.

          6. Adrian says:

            Chris, you are confusing absolute numbers with distribution.

            How many percent of the people who received a dose of the Oxford vaccine in the UK are women under the age of 40?
            Less than 25% ?

          7. Jonathan B says:

            We can actually put numbers on that, since the UK Office for National Statistics publishes vaccination figures on a weekly basis, as an Excel spreadsheet which breaks them down by various categories.

            So for last weeks figures, out of some 20 million odd total vaccinations just under 7 million were of people under 60. Around 1.7 million were frontline health or care workers.

            There are likely to have been a lot of females on oral contraceptives for whom adverse effects would have been reported.

          8. Chris Phillips says:

            I’m confusing nothing. You said women using contraception were “outside the age groups vaccinated so far in the UK”!

            Absurd. Almost certainly more women using contraception will have been vaccinated in the UK than in Germany.

        2. Sarah Rainsford says:

          I keep hearing this, and I would not be at all surprised if it’s a factor, I personally have never felt comfortable using hormonal contraceptive for that reason. But I also have to point out that in the UK, women are advised to stay on their contraception until 55 or 2 years after their last period, whichever comes soonest. We are not all dried up old crones at 45 you know! Plus many women 50-65 who will have stopped using the pill in the last 5-10 years – possibly after having been on it for 30+ years. Does the increased risk really stop as soon as you stop taking it after being on it for so long?

          Also, where I am in the UK, and many other parts, they have now finished vaccinating all the initial Group 1-9 priority groups – so down to 50 years olds and up. So there are now many women who are 50-55 that have been vaccinated with the AZ vaccine and are now more that a week or 2 out (myself included) without any serious side-effects. Bear in mind also that many younger women have also been vaccinated in the UK for a lot longer, some with 2 doses, because they work in health or social care.

          If there is something fundamental about this vaccine and blood clotting surely it would have shown up in the UK by now – where something like 20 million doses have been given?

      2. Brian Petuch says:

        When I heat “bad batch” I have to wonder of what. The virus construct isn’t going to change, so is it the excipients? They are:

        L-Histidine
        L-Histidine hydrochloride monohydrate
        Magnesium chloride hexahydrate
        Polysorbate 80
        Ethanol
        Sucrose
        Sodium chloride
        Disodium edetate dihydrate
        Water for injections

        I do hope they report the COVID-19 test status for those with severe adverse events, but is it being determined and will privacy prevent release.

        1. JIm Mayes says:

          The clustering is very suspicious in EU manufactured vaccines. UK and India VAERs with more doses and less effects. BTW these are not just “blood clots” :
          https://www.pei.de/SharedDocs/Downloads/EN/newsroom-en/hp-news/faq-temporary-suspension-astrazeneca.pdf?__blob=publicationFile&v=5
          Two more in Spain, three in Norway. Political vs Medical pressures clearly in play as dropping a “batch” is $$$$.

          1. Some idiot says:

            Just a couple of comments here… I am involved in late-stage process development (having said that, small molecule, not biologics/vaccines), and I, for one, would be incredibly surprised if there was a problem with the excipients etc. That sort of thing is _so_ much controlled by GMP etc, the chances of anything sneaking through there would be basically zero, in my book.

            As regards “dropping a batch”: Those guys are going to have specifications, and there is no way in the world they are going to let through a batch that doesn’t make specs. Seriously no way… And there would have to be not only “a person or two” but quite decent parts of completely differing departments that would have to agree to letting a not-in-spec batch through. Even an in-spec but out-of-trend batch tends to raise eyebrows all over the place (which is also the way it should be). So, the short version is that I just don’t see it happening, for all sorts of reasons, only one of them being that _so_ many different people would have to be in on it, and I don’t see that happening without many different whistles being blown. Plus, an inspection that picked up this sort of thing would be Very Bad News for the site and the company in general. I really, seriously can’t see it happening…

            I will also say that I am skeptical about it being an issue with a particular manufacturing site, although that may perhaps be more plausible than (eg) problems with excipients. If there was something unexpected that cropped up that escaped detection (and thereby “ok” on specifications), also bearing mind that this site has been having sever production hassles, well, maybe. Perhaps. But my impression is that (despite production hassles) these guys know what they are doing. So I am still very skeptical there. Mammalian Scale Up Person would be far more qualified to comment on that one.

    4. Jenny69 says:

      There are >50 cases of idiopatic thrombocytopenia in US after Pfizer or Moderna. All after dose 1. We didn’t suspend vaccination for that. We learned how to treat them and no one has died after case 1.
      https://onlinelibrary.wiley.com/doi/10.1002/ajh.26132?af=R

      1. primary care person says:

        To me this seems like one of the most underrated comments of the discussion. Thanks for the practical info! The policy/ethical discussion on this issue is fascinating but ultimately out of my sphere of influence (I assume most people commenting here are not policy-makers over nations). However, as a health care provider, I find your linked article valuable because it is actionable and would probably help assuage many peoples’ hesitations in my daily conversation.

      2. Harvey 6'3.5" says:

        If you read the paper cited by Jenny56, it is clear that the rate of ITP is lower in the vaccinated population than the expected rate of ITP per million. So it reads as coincidence, not causation. As per the XKCD cartoon on M&Ms and significance, if you look at enough different conditions, you will find something that is “statistically significant” at the 0.05 level with vaccination, even if that condition is being hit by a car, liking raw eggs, or being a Cowboys fan (shudders).

        1. Gmac says:

          Rate implies measurement over time. The history of all deaths over all time suggests that covid is a minor killer and not worthy of any worry or restrictions! Now for the apples and apples comparison – Recent deaths vs. Recent Vaccine administrations have resulted in independent suspensions by a dozen plus national medicinal regulatory agencies. 6 foot 3.5 and not a brain cell in sight?

          1. Chris Phillips says:

            If COVID-19 – which so far has killed 1 in 500 of the entire UK population – is a “minor killer” in your loopy view, I wonder what that makes the 1-in-a-million events that have caused this mess in Europe.

  4. Skeptical scientist says:

    I honestly think this is a political decision by the European countries. the UK is far ahead with vaccinations (mainly because of this vaccine), and from the earlier hooha between the Eu and AZ, it is clear that there isn’t going to be enough vaccine available for the EU for some time. Combine this with the French President’s comments about the vaccine being “quasi effective” and the early leaks in the German papers saying the vaccine does not work in over 65s.

    The real world data from Scotland shows performance that is as good as the Pfizer vaccine https://www.bmj.com/content/372/bmj.n523

    So pretty despicable behaviour by politicians here I think, based more on not looking bad when compared to Brexit Britain, which has vaccinated far more of its population than the EU have.

    1. Some idiot says:

      Nope, I humbly disagree… This does not “feel” like a political thing, but rather a case of cautiousness (or overcautiousness, depending on your point of view) of clinicians and the health bodies in the various countries. Particularly since the EMA has been saying all along that they believe the AZ is ok (which I am inclined to believe).

      1. colintd says:

        The statements: “8% effective in over 65s” from the German press, “quasi-ineffective in over 65s” from Macron, and “I’m not going to take it because I’m 67” from Merkel, all suggest a very political, anti AZ attitude.

        I respectfully suspect it is against that background which we need to judge the current decisions…

        1. Jim Grant says:

          I know right. Foolish germans claiming it was only 8% effective in over 65 year olds when the AstraZeneca data clearly stated it was 6% effective in over 65s durring the phase 3 clinical trials.
          Disgusting that those nazis would try and scare people like that.

          1. sgcox says:

            Jimmy,
            That trial says 8% of enrolled participants were over 65%. Not the effect size.
            The outraging headlines came from one German tabloid citing unnamed German minister.
            German government rejected it outright as a fake.
            But the fake still lives and propagates and here is another proof of that.
            I sometimes lose hope in humanity.

        2. Some idiot says:

          I understand where you are coming from there, but (a) it didn’t start from France or Germany, and (b) the whole feel of it has been something that started from the clinical “grass roots” and worked its way up, not the other way around…

          Don’t get me wrong… I have seen (and am pretty disappointed, but not surprised about) far too much political stupidity regarding the different vaccines, but to me this case just feels wrong to fall into that category. As someone else mentioned, the (I think) German health minister ridiculed the pauses in (apart from others) Denmark, but later on they quietly (sort of…) started their own pause… To me a good sign that this isn’t political…

          But whatever it is, I hope it is sorted out soon. What we need is vaccinations…!

    2. ChevLK says:

      I have to agree. There were a lot more deaths in Norway in January from after taking the Pfizer vaccine. Those were found to be unrelated too. Plus it’s looking more likely the surplus AZ vaccine after the UK have had both doses, will be distributed or at least shared with less developed countries in the Commonwealth for example rather than the EU bloc.

      1. Gmac says:

        “Found to be unrelated” by what metric and by whom? Vaccine escape over time is an absolute certainty. Find fault with that statement

        1. confused says:

          Then why wasn’t vaccine escape seen with smallpox? Why does measles vaccine still work? What about polio?

          1. Gmac says:

            Not respiratory viruses are they boss?

          2. confused says:

            I believe measles is generally spread through the air… I don’t see how the fact that the lungs aren’t the primary thing affected is terribly relevant here.

            Flu vaccine has to be changed annually, sure, but flu is a very special case in a number of ways (antigenic shift, evolving through a bunch of different species, etc.) – that’s not really the normal case for a vaccine.

          3. confused says:

            In any case, your statement was a generic absolute that “vaccine escape over time” was “an absolute certainty”, without any qualifiers about type of virus, type of vaccine, etc. A claim of absolute certainty can be disproved by one counterexample, which the example of smallpox eradication provides. (Also rinderpest, though the latter wasn’t in humans.)

          4. D Barr says:

            Don’t know about smallpox, but measles works out of sheer luck. The part of the virus that antibodies target can’t evolve to escape because any changes make the virus non-viable.

            That was demonstrated by an elegant experiment where researchers randomly mutated the virus and monitored three key proteins in the subset of viruses which grew in culture after mutation. Two of them showed a lot of variation. One showed very little variation from the original form, implying that those mutants died out. That happened to be the one targeted by vaccines.

            Mutational analysis of measles virus suggests constraints on antigenic variation of the glycoproteins. Cell Rep. 2015 June 9; 11(9): 1331–1338. doi:10.1016/j.celrep.2015.04.054.

          5. Gmac says:

            https://www.sciencedirect.com/topics/immunology-and-microbiology/respiratory-virus
            sort of knowledgeable (keep working on it!) and confused referring to respiratory viruses in the classic sense (see link) and in particular to COVID as per topic.

        2. sgcox says:

          OK, I am confused here. Are you suggesting that thrombosis cases in Norway were caused by virus escaping AZ vaccine ?
          Plausible.

          1. Gmac says:

            Confused – covid-19 virus variants are already capable of escaping these vaccines that are in emergency use (well the ones not suspended anyway). How can these variants be contained? Impossible to contain them even when we are locking up people … so the companies involved are all rushing to make boosters against these variants… I believe this is a losing strategy (constantly trying to hit a moving target when development time and logistics are insurmountable delays). The risks involved in mass vaccination without any long term safety data are unknown. VAERD or ADE… are plausible in that they have been seen in preclinical models of coronavirus vaccines. The initial vaccine efficacy could backfire (possible with waning immunity or when covid classic antibodies from the vaccine meet mutated spikes on variants – which they inevitably will). I am very concerned that these vaccines are now being tested in children where the risks posed by covid are quantified as being extremely low (less than influenza). In the long term what are the risks or benefits of these vaccines?

          2. Derek Lowe says:

            Why would you say that the current variants are already capable of escaping the current vaccines? The numbers argue otherwise.

          3. sgcox says:

            No, absolutely not.
            I was simply trying to be sarcastic but is almost impossible online. 🙁

          4. Gmac says:

            Hi Derek,
            This SA variant is circulating in most countries albeit at very low levels…. due to massive restrictions on movement of people and crippling economic sanctions. Vaccine doesn’t work against the variants
            https://www.nejm.org/doi/full/10.1056/NEJMoa2102214?query=featured_home
            Also the previous SA clinical trial data where the country decided not to use 1.5M doses of AZ vaccine! Points to the futility of these vaccination campaigns, especially when as a reward governments are talking about vaccine passports etc. Why? To blow up the whole situation again is the only result that I can see happening. CDC go and hug each other without masks if you’ve had you jab. Madness, the whole thing is mass vaccination hysteria

          5. Chris Phillips says:

            Gmac

            I’m afraid your brand of anti-vaccine propaganda is too transparently dishonest to achieve much in this forum.

            You claimed COVID-19 could escape the vaccines that are “not suspended” (presumably meaning all the vaccines except AstraZeneca). But then when asked why you say that, all you are able to come up with is an AstraZeneca trial! Probably you’re well aware that Johnson and Johnson and Novavax have demonstrated efficacy against the South African variant in trials, and that the manufacturers of the mRNA vaccines have expressed confidence based on in vitro studies that they will be effective against it.

            As for the AstraZeneca trial you cited, it’s true that it fails to demonstrate efficacy. But it also fails to demonstrate a lack of efficacy. The confidence interval for efficacy against the South African variant is -76.8% to 54.8%. The statistical power is insufficient to say whether it has no efficacy, or whether it halves the number of cases. We need more data.

            (Incidentally, the same is actually true of the efficacy of AstraZeneca in the larger trials in the UK and Brazil when the doses were given less than 6 weeks apart. In that case the confidence interval for efficacy was −2·5% to 78·8%. Obviously that is entirely consistent with the performance in the South African trial, where the doses were separated by 21-35 days.)

            Of course, that is efficacy for mild to moderate COVID-19. We are even more in the dark about the efficacy of AstraZeneca against severe disease and death caused by the South African variant.

          6. Gmac says:

            Chris, I’m afraid that 60-64% reported efficacy vs. SA variant in tiny samples is a pretty poor showing and one that’s only going to decrease IMO. If you can honestly answer me these questions I’d be much grateful:
            Do you think the virus will stop mutating? Do you think that vaccines can realistically keep up? Do you think that there’s an increased or decreased probability of variant escape mutations emerging in extremely large populations vaccinated with non-sterilising protection?
            According to Worldometer there are currently approx. 21m active cases that have been confirmed by PCR. 90k cases are classified as severe/critical. So just being alive and any age gives you higher than 99.6% protection from severe disease or death. Some vaccines claim 100% but none have long term safety data and all have an unknown long term risk profile.

          7. Chris Phillips says:

            Gmac

            I think everyone can see that you’re just trying to mislead. I’m not going to play your game.

    3. WST says:

      It’s obvious that this was a political decision but not for the rather infantile reasons you put forward. More likely is that if there is a correlation and if there any new deaths related to the vaccine (..or even if there is no correlation), these deaths will be a made to a symbol and weight heavily in the next election. And opposition will paint the current decision makers as inhuman. The public does understand the “principle of precaution” but will not forgive any risk taking, even if it’s the most rational and most empathic alternative.

  5. Greg says:

    For me, it is the longer term effect all this negative publicity will have on the roll-out of the Oxford/AZ vaccine outside Europe in countries that can neither afford or store/distribute the mRNA vaccines. With this ‘dark cloud’ sitting over it, the motto ‘none of us are safe until we are all safe’ will be even more difficult to achieve than it already is.

  6. Oudeis says:

    As an admittedly chastened patriot, I’d like to take this as evidence that, though the United States has done plenty of dumb things in the last year, every country has its own idiocies and its own problem scenarios it is ill equipped to handle.

    And even we Americans (knock on wood) do occasionally manage to get things right. Fingers crossed that our vaccine rollout keeps succeeding, and new variants don’t make it useless.

  7. Arno Nym says:

    Only in German, but https://www.pei.de/SharedDocs/Downloads/DE/newsroom/meldungen/faq-temporaere-aussetzung-astrazeneca.pdf?__blob=publicationFile&v=2
    has a more detailed explanation. Rough translation of the relevant sentences: “Approximately one case would have been expected, seven cases have been reported” (1 (4), last sentence) and “… affected population of younger and middle age is not the population which is at high risk of severe or fatal Covid-19” (1 (5)).

    1. Chris Phillips says:

      I’m not quite sure what they are getting at with that last comment. Surely not that the risk of fatality for COVID-19 is lower than 2 in a million for young to middle-aged people?

    2. A Nonny Mouse says:

      “That [the thrombosis] is very likely due to the vaccine. Otherwise, you see that 50 times a year in the population in Germany. There are seven cases in the 1.6 million people who’ve been vaccinated. So the connection makes physiological sense.”

      This is a statement from the German institute; on that basis, we ought to have seen 50 cases in the UK when we have about 30 for all types of clot and none, it seems of this type.

  8. Andrew Haslett says:

    The efficacy data on AZ and Biontech vaccines from UK rollout suggest that AZ is marginally more effective after first dose; you might be better mixing and matching to avoid the vector immunity problem that Sputnik avoids in its design.

    There is a plausible mechanism for thrombosis combined with thrombocytopenia in people who are antiphospholipid positive, but this is likely to be similar in all vaccines that present the spike protein as antigen.

    The combination of these two observations is consistent with the very slightly higher number of events in trials as between AZ and Biontech. It’s very unclear why the level of thrombosis in vaccinated persons is significantly lower than the background population figure.

    There are other vaccines that cause immune mediated thrombocytopenia – it’s a known but not fully understood phenomenon.

    1. Mandark says:

      Hi Andrew,

      Could you explain what that mechanism is and how it’s related to the spike protein?

  9. TallDave says:

    looking at the CDC numbers, it would appear the pandemic is largely already over in the US

    we won’t know for sure for a few more weeks but trends are pretty clearly reverting to baseline

    which makes sense, vaccinating just the at-risk alone should reduce mortality by 90%

    who had March 2021 in the pool?

    just another few months to stamp it out entirely

    still a bit of drama left in the peptide vaccine results — much better, cheaper, faster option for 3W markets, possibly safer as well

    1. TallDave says:

      https://clinicaltrials.gov/ct2/show/NCT04545749

      tracker for UB-612 Phase One if anyone is interested

    2. Charles H says:

      I dispute your definition of the pandemic. I’ve always been more concerned with long term disabilities than with death, and we don’t have numbers to say that that has been decreasing. And probably won’t, since the statistics are quite hard to gather. (For months people were even denying that it was happening in the teeth of clear evidence.)

      I’ll grant that the only reliable statistic that’s been generated for COVID is excess deaths, but that’s not a good measure, and it certainly doesn’t measure the number of active infections or transmissions.

      1. TallDave says:

        serious illnesses are correlated to excess deaths

        there is no “excess hospitalizations” figure that I am aware of but hospital utilization is also returning to baseline

        e.g. technically speaking CMV is also pandemic in the human population but we don’t usually refer to “the CMV pandemic” because it rarely affects anyone who is otherwise healthy

  10. Sue says:

    And so it becomes a big issue of socio-psychology. I’m fully convinced the current AZ vaccine situation is a consequence of incompetence rather than malevolence, but, once the collective psyche is spiked, there are then the really bad (if probably only stupid-bad, not movie-villain-bad) actors that can ride the wave and create immense damage for the other vaccines too (with relevant if unrelated social media trends of the last 5-6 years as supporting evidence).

  11. A Nonny Mouse says:

    As pointed out today, the incidence of blood clots due to contraceptive tablets is 1 in 1000.

    The current data from the UK to the end of February is just over 3 clots per 1m doses for each of the A-Z and Pfizer vaccines (about 10m of each). Death rates slightly higher post injection with the A-Z vaccine, but this tends to be used much more in nursing homes and sicker patients who cannot visit centres or GPs.

  12. Adrian says:

    “The second half of the medical problem is naturally what happens when you suspend dosing of what is, in many cases in the EU, the only vaccine available.”

    This is not true for any of the 27 EU countries.

    The EU is doing a joined procurement with 4 vaccines currently approved, J&J was just approved but in addition to the Oxford vaccine the Pfitzer and Moderna vaccine are already in widespread use.

    Despite the EMA having approved the Oxford vaccine for all adults many EU countries (e.g. Germany) do or did restrict it for not being used for elderly people. In practice this means that in many countries the at-risk elderly people have received the Pfitzer (and Moderna) vaccines while care personnel received the Oxford vaccine.

    Detailed numbers of vaccine doses distributed and administered for every product/country combination are at
    https://vaccinetracker.ecdc.europa.eu/public/extensions/COVID-19/vaccine-tracker.html#distribution-tab

  13. Tobias says:

    Statistically, it may be the right choice to “sacrifice” 7 people per million and save hundreds, but politically, it is a hard sell. You are asking healthy people to play a game of chance with non-zero odds of a lethal outcome, and many people may believe that they personally can get by with other precautions, waiting for their turn with one of the (supposedly) better options. So you may deride the pols as hapless and panicky fools, but given the evidence, spurious as it may be, as well as the distrust stemming from the botched roll-out and the failure to deliver, politicians’ hands are effectively tied.

    1. Adrian says:

      “Statistically, it may be the right choice to “sacrifice” 7 people per million and save hundreds”

      It is a horrible idea to discuss vaccine safety this way, without any clue what is going on and why. Your “7 people per million” might be a statistical fluke, or the short-term tip of a huge iceberg of deaths.

      “So you may deride the pols as hapless and panicky fools”

      The opposite happened in countries like Germany, where the health minister just Friday ridiculed countries that suspended use of the Oxford vaccines – and then the health authority in his country did the same 3 days later.

      1. Tobias says:

        “It is a horrible idea to discuss vaccine safety this way, without any clue what is going on and why. Your “7 people per million” might be a statistical fluke, or the short-term tip of a huge iceberg of deaths.”

        And that is precisely why I am saying it is a choice that is hard to sell politically. No doubt that the argument that it is foolish to interrupt the vaccination drive because, in this way, more people will die from covid (Derek’s point) is statistically sound. However, as everybody is already queasy about AZ, not even Spahn can just soldier through.

        The pandemic is also about democracy and getting people on board, not only about stats and technocratically “right” choices.

        1. Adrian says:

          Any discussion about “sacrificing people” is too early before there is an understanding what is going on.

          Derek’s point was based on a mistaken assumption that the Oxford vaccine would be the only one in some EU countries, while in reality every single EU country is already administering at least 3 different vaccines.

          1. Bill says:

            It’s not a question of whether there are alternative vaccines in your country. It’s a matter of when can you as a person at risk get one?

            If you are delayed a day or a month…your risk of death or morbidity is inevitably increased.

            And there absolutely will be additional unnecessary deaths likely in large numbers as a result of schedule slip.

          2. Adrian says:

            Right now vaccinations with one of the three vaccines in use are suspended for a short amount of time. Which is reasonable based on the data available. Derek was wrongly assuming this would be the only vaccine in use in some EU countries, but it isn’t in any of the 27 EU countries.

            Your risk of death or morbidity is also inevitably increased when using a piece of cloth instead of a proper FFP2 (N95) respirator.

            In parts of Germany it is illegal to enter public transport or a supermarket without wearing an FFP2 (N95) respirator.

            There are additional unnecessary deaths likely in large numbers as a result if reckless people wear a piece of cloth instead of a proper respirator.

            Worst are people who wear only a piece of cloth but accuse other peoples actions as causing additional unnecessary deaths.

      2. Andy says:

        Adrian, you’re constantly posting anti-vaccine comments. Why?

    2. Chris Phoenix says:

      IIRC the measles vaccine I took to travel internationally has a 1 in a million chance of death.

      Given the reports I’ve seen about “long covid” in 25% of mild cases in healthy people – I’m taking that vaccine as soon as I’m eligible. Not to mention a high chance of heart damage, lung damage, CNS damage, and maybe reproductive system damage as well.

      Talk about overall expected health outcomes rather than focusing on the worst-case-anecdotes, and sensible people will line up around the block.

  14. Richard H says:

    Does anyone here have any informed knowledge about a gentleman called Geert Vander Bossche?
    I just received a sky-is-falling link to some dire predictions from him of global doom if we don’t halt global vaccination and do it his way instead. I won’t repost the links here but would be curious to know if there’s any truth in his theories.

    1. Fraud Guy says:

      Based on the sites that cite him, no.

    2. stewart says:

      His open letter is accessible. An immunologist could tell us whether it makes any sense. I find the claim that in the event of immune escape vaccination leaves you more susceptible than an immunologically naive person counterintuitive (absent antibody dependent enhancement), but I have a limited knowledge of the workings of the immune system. (Also, if he’s right why isn’t there a chorus of voices in support from virologists, immunologists and epidemiologists.)

      1. Gmac says:

        He is an immunologist, seems he would know quite a bit about vaccines too… have a read of his profile (also potentially conflicted as he appears to be working on a new vaccine modality).
        https://be.linkedin.com/in/geertvandenbossche
        I don’t believe that his assessment is implausible. It makes sense, more so than mass vaccination against a viral relic that is COVID-19, a virus evolved far beyond what the vaccines were designed to combat.
        People want to believe in these vaccines as the answer and who could break rank? Are people being silenced? Governments want to appear like they are doing something – vaccine this, vaccine that – fighting and squabbling over vaccine supplies and the global inequality in distribution would be reprehensible except for the futility of this drive to save humanity. As I’ve stated before take a look at the history of vaccination against respiratory viruses – RSV, ‘flu and history is in motion as regards COVID-19. The legacy left by the last rushed pandemic vaccine for swine ‘flu is inglorious to say the least – that one came much later into that pandemic and warp speed and global insane group thinking has now given the world an experiment of unprecedented scale. All we can do is pray that something doesn’t go horribly wrong (like ADE). Having said all that the known risk-benefit is justifiable for those people deemed at major risk of complications/death due to the virus but now the indemnified manufacturers are testing these vaccines in infants and kids who have a statistically greater chance of being hit by lightening than dying of COVID. Vaccine passports are another carrot about to be dangled in front of big people to coerce them into this experiment. Only time will tell how well these vaccines work against a rapidly evolving virus or if they carry any more ominous longer term risks. The short term risks of immune thrombocytopenia seem to have been swept under the carpet and even subjected to recent media blackouts in the democratic republic of Europe (curiously reports of a recent death in Spain the day before EMA decision were only picked up by the New York Post). There is no confirmed association between the vaccine and these deaths (we are told), yet if someone with asymptomatic COVID falls off a ladder and dies while cleaning out their gutters it’s recorded as a COVID-19 death! Consistency lacking. As per documented EMA and FDA risk analysis literature why don’t we let the public know that there are indeed unknown risks associated with these vaccines? I think that herd immunity through vaccination is an absolute impossibility and this is the message that the public are constantly being mis-sold. If people are worried about COVID or statistically at risk, by all means go for the shot. I would if I was genuinely at risk. As there is no proven effect on transmission I don’t believe that I’m endangering anyone by passing on the ‘opportunity’ to participate in a clinical trial.

  15. Jens says:

    As posted above by Arno:
    Only in German, but https://www.pei.de/SharedDocs/Downloads/DE/newsroom/meldungen/faq-temporaere-aussetzung-astrazeneca.pdf?__blob=publicationFile&v=2
    also states that
    a) it was a mandatory act by law that vaccination with AZ be stopped in Germany and the PEI (Federal Institute for vaccination) and the German Federal Ministery of Health had to inform the EMA to start a legally-required evaluation process.
    b) they point to a legal act requiring (if it turns out that there a causal relationship between the jab and a CVT is concluded ) that any person has to be informed prior to vaccination about the risk of very rare but potentially severe side effects as the CVT and that the corresponding “labelling text” on the vaccine dose has to note that “rare side effect”.

  16. Jonas says:

    If there is an increased risk of this particular clotting condition, it needs to be investigated against all vaccines. The UK dataset on possible adverse reactions following vaccinations is good in that it has vaccinated approx 11m people with EACH Pfizer/BioNtec and Oxford/AZ.

    As fas as I can tell, 19 thrombotic events reported for AZ, 18 for Pfizer:
    See for yourselves: page 60 for Pfizer: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/968413/COVID-19_mRNA_Pfizer-_BioNTech_Vaccine_Analysis_Print__2_.pdf

    Pages 62 for AZ: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/968414/COVID-19_AstraZeneca_Vaccine_Analysis_Print.pdf

    Very old people more likely to have had received AZ due to being easier to use in care home settings.

    Also note, J&J did report 2 thrombotic events in its vaccinated people. -but as others have pointed out, it’s at a lower risk level than the contraceptive pill even if these events (in one vaccine or more) were to be attributed to it/them.

    1. Jiří Hudeček says:

      A problem with the UK dataset is that they also report a substantial number of deaths (e.g. 144 for AZ out of total 278) without any explanation of preceding symptoms. 9 of them “sudden deaths”. It would be easy to miss the thrombotic events in elderly people living alone as opposed to active young people.

  17. Jenny56 says:

    Idopatic trobocyotopenia happens amd sometimes (rarely) COULD be vaccine induced (see MMR vaccines). There are >50 cases of trombocytopenia in US after Moderna/Pfizer vaccination.
    US response was not stop vaccinating, but immediately develop treatment model. After case 1, everyone recovered. This is what EU should do.

    Here link to US Cases
    https://onlinelibrary.wiley.com/doi/10.1002/ajh.26132?af=R

    1. hardnox fort says:

      It is getting a lot closer to the point, thank you sir!

      But the particular issue is related to the combination of idiopathic (so far) thrombocytopenia and blood clots. As far as I understand thrombocytopenia and clots are correlated and thus you may experience more clots with the condition. It is not usually a larger problem since blood thinners are a common treatment against clots and ITC is acting as a such. An illness as a treatment for an illness it induces. 3D chess to be sure!

      The exact issue reported: In a number of cases with both ITC and clots, both issues getting noticed in a 14 days window after vaccination, the combination seems to hit a lot harder than you would usually expect!
      It is a “rare combination of disorders with an unusual progression”. It can be completely unrelated, but untill investigated, we wont know what is going on!

      And yes, Norway has a couple of unrelated clot-deaths within 14 days of vaccination, that aren’t counted and are characterized as unrelated for a reason. Again the clots-argument is a red herring! Then again, for anti-vaxxers, the vaccine is front and center. But the vaccine is a sideshow in these cases. I doubt any decent regulatory organ would ban the vaccine even for this 1:10.000 or rarer complication you can somewhat mitigate in other ways.

      Halting the vaccine seems to me to be an overreaction, but don’t shit-talk the “rare and unusual ailment” just because it gets caught in the media shitstorming and the political fight between anti-vaxxers and AZ/medical authorities. The condition is real and it could be helpful to recognize.

  18. Felipe P. says:

    English statement of the PEI in Germany
    “the experts of the Paul-Ehrlich-Institut now see a striking accumulation of a special form of very rare cerebral vein thrombosis (sinus vein thrombosis) in connection with a deficiency of blood platelets (thrombocytopenia) and bleeding in temporal proximity to vaccinations with the COVID-19 vaccine AstraZeneca.”

    https://www.pei.de/EN/newsroom/hp-news/2021/210315-pei-informs-temporary-suspension-vaccination-astra-zeneca.html

  19. Jens says:

    The German Newspaper FAZ:
    https://www.faz.net/aktuell/wissen/nebenwirkung-bei-astrazeneca-impfstoff-spurensuche-bei-der-ema-17247571.html

    (Translation by deepl.com)

    Paul Hunter from the Norwich School of Medicine at the University of East Anglia, for example, is not convinced by the PEI’s calculation. He cites at least two clinical – pre-pandemic – studies since 2012, one Australian and one Dutch, that indicate a higher incidence of the specific sinus vein thrombosis in the general population: The two to five cases per million population per year is an outdated figure, he said. “It underestimates the incidence by a factor of four to eight.” The Australian study assumes 15.7 cases per million and year, the Dutch study 13.2 cases per million inhabitants and year. And these studies also showed that the incidence was even higher in people under 50, he said. Hunter: “With that, we would expect one to two cases per month. So sinus vein thrombosis is likely to be at least more common in Europe than previously expected.”

    1. Chris Phillips says:

      “It underestimates the incidence by a factor of four to eight.”

      That would imply that when PEI said they would expect one and have seen about seven, in fact they have seen almost precisely what they should have expected!

    2. Patrick says:

      I think the wide range of prevalence rates is a result of difference in CT scanning rates. Cerebral vein thrombosis is a relatively rare cause of headache and is often not detected without a specific CT protocol (CT venogram). Many mild cases will thus go undiagnosed if not specifically investigated for. So it makes sense to see an increasing incidence in newer studies, as more and more CT scans are being performed across the board.

      Along the same lines, expect an increase in diagnosis rates in the coming months, as many people presenting to an ED with a headache after receiving the AZ vaccine will now get a CT venogram.

      The same is also true of DVT and PE, with many small clots routinely undiagnosed when marginal scans aren’t performed.

      1. Janet says:

        That all makes sense- but do these ‘usual’ CSVT associate with disseminated clotting and thrombocytopenia as a rule? It seems to have been the combination that has them looking for an effective therapy, as opposed to the more typical PE and DVT which they already know how to treat, if detected in time.
        They found antibodies to platelets in all samples from patients in Norway and their idea would be that this particular pathology is vaccine triggered as they could find no other explanation/trigger in their histories.
        Of course it is better if the vaccine continues to be used- apart from the obvious reasons, more cases appearing, or not, will clear it up sooner and allow better targeting of particular vaccines according to statistical risk groups if there is a mechanism found. Ideally they need to start to stratify any severe potential AEs by e.g age and sex and ethnicity which would go some way to preventing blanket hesitancy emerging every tim esomething like this happens.
        I heard on the radio today in the Uk people saying they are waiting as there isn’t much data on vaccination in their ethnicity as yet- how to get by that other than through weekly published updates by CMO etc I don’t know.

  20. E H Moeller says:

    To me, an overlooked aspect of this discussion is the “why”. It seems that this could be caused by vaccine-induced immunologic thrombocytopenia. Different picture than background blood clots. It may be okay (happens with flu vaccines as well), but deaths due to a vaccine in a healthy population are not to be overlooked, IMHO.

    The regulatory agencies in the Scandinavian countries who play a large role in this evaluation have a history of being cautious, both when it comes to patient safety and when it comes to the public perception of vaccine safety. This is not politics.

  21. Isidore says:

    It is quite obvious to me that all these decisions are political. The health authorities in the various countries that have suspended use of the AZ vaccine are asserting their authority vis-a-vis the EMA, which they like to do periodically. This way they try to show to to their respective national audiences to be putting their interests first rather than the interests of a pharmaceutical company, which is also British. In addition, they are also demonstarting to vaccine sceptics (and there are many) that they take all adverse effects reports very seriously and that they are not part of some global conspiracy to subjugate the population through these vaccines. In a week to ten days I predict that in most of the countries the suspensions will be lifted.

    1. Some idiot says:

      With respect, I disagree… At least, in regards to here in Denmark (I won’t try to second-guess the other countries). Here, at least, the health authorities are generally really, really good at playing the ball, not the man. When you see the way the story came out here, it is (in my opinion) clear that it came the right way, following procedures (and if there is one thing that Danes are good at, it is following procedures, believe me…!). There was a genuine concern about the atypical nature of the (fatal) event that meant that the procedural pause was started.

      And trust me: the last thing the authorities here want to do is slow down vaccinations. Denmark has been one of the better EU countries regarding rollout, but every time there are delayed (or reduced) deliveries to Denmark, the authorities cop flak over the longer timelines, even though it isn’t their fault…! So no way they would be happier with more delays…!

      But yes, I believe (hope!) that the pause will be lifted after the end of the 14 day pause.

      1. Derek Lowe says:

        Denmark is indeed a country that I take very seriously in its public health decisions – I’m going to be interested to see what they do in the coming days.

      2. Draken says:

        I agree with S. idiot (what a screen name!) that the Danish decision most certainly wasn’t a middle finger to the EMA. The prime minister has directed sharp criticism at the EU precisely for being too little, too late.

        I think her concern is more vaccine skepticism, which, while manageable, is not zero in Denmark and seems to be relatively high under healthcare personnel.

  22. exGlaxoid says:

    I am in the AZ trial along with a neighbor. We were both recently unblinded due to the availability of vaccine in our area, and both of us got the real vaccine, not placebo. Neither of us had as much as a sore arm, and both have been covid free for months despite working full time in the public, while many of our coworkers and friends have had it.

    So it appears to be safe and effective in my small world, and I agree that while it may not be as effective as Pfizer or Moderna vaccine, it is a useful vaccine, especially in the areas without refrigeration and easy transport and cold storage. I think 60-70% is not as good as 95%, but in a pandemic, you can’t be choosy.

    I do think that for the people getting the current AZ and J&J vaccine, it might be ideal to get a booster of the mRNA vaccines once they are designed for the newest variants, I would think that should provide even more protection. That is the question I have for the vector vaccine.

    1. Bash says:

      60% is a headline efficacy number. In terms of keeping you out of hospital / severe disease, the efficacy is dramatically higher

    2. Marc Mac says:

      I’m in the AZ US trial as well. I will be eligible to be unblinded when vaccinations open up to all adults in my state (about 3 weeks away).

      I’m very curious to see what the study results are. I think I got the real vaccine (2/3 people did), but the mild side effects I had could have all been in my head.

  23. Health care IS politics says:

    “It’s a mess.”
    Welcome to European politics, my friend! It’s like American, only we can’t understand each other.

    1. Vader says:

      That might actually be to your advantage.

  24. Not a Doctor says:

    I am not a medical practitioner and while I understand why efficacy is important isn’t the number of people who have severe disease or death after vaccination more important? I understand that in the clinical trials for Oxford/AZ reported to date, none of the vaccinated participants had severe disease or died. If the vaccine reduces illness to the level of a bad cold or flu without the need for any medical intervention, isn’t that a victory, efficacy aside? It just seems to me there should be a greater focus on those numbers but perhaps I am missing something.

  25. Richard Miles says:

    This may come as a shock to you scientists, but in the case of the EU & many European countries, don’t underestimate the importance of politics, blame deflection, or just pure spite – any of which are quite capable of overriding scientific considerations.

    1. Jens says:

      Oh please,
      don’t bring the whole Brexit fake news bull crap into this forum.
      I could cite you dozens of examples of Brits being completely disingenuous when it comes to the EU, just in the past, say, 12 hours?
      So let’s keep this about science and science only

      A proudly European scientist

      1. Sebastien says:

        Yet your honest opinion is biased. It lacks an understanding of what is going on in the continent.
        In France 40% of daily inoculations are from AZ jabs, just as the Gvt is trying to speed up vaccinations (slowed down in part due to AZ’s inability to keep its productions promises…)
        No one is happy about this, if you spoke any other EU language and opened any newspaper you would read about how health ministers and presidents/prime ministers are fuming at having to slow this down. They are juggling defiance towards this vaccine because of its botched clinical trials.
        Despite all the issues Gvts have been betting and relying on AZ jabs to push forward with vaccinations.

        So no, Brexit is not the central focus. EU states have other political concerns, such as the health of their populations and being able to vaccinate as quickly as possible.

        Please get over yourself.

  26. Lane Simonian says:

    Many (but probably not all) hematologists believe there is a connection between the coronavirus vaccines and immune thrombocytopenia.

    https://www.nytimes.com/2021/02/08/health/immune-thrombocytopenia-covid-vaccine-blood.html

    This problem has been seen in several other vaccines. In the case of the measles, mumps, and rubella vaccine, the case numbers are between 1 in 25,000 and 1 in 40,000 . Perhaps the more important question is what are the numbers for those who already have or are prone to imnune thrombocytopenia.

    The mRNA vaccines (Moderna and Pfizer) don’t appear to be exempt from this problem.

    https://www.bmj.com/content/372/bmj.n699/rr-6

    This may be an issue for people with Celiac disease (such as myself) where there is a considerable overlap with immune thrombocytopenia (perhaps because both conditions may be triggered by pesticides). I will keep double-masking, keep my distance, and closely watch the Johnson and Johnson resutls, because what we know so far may be only the tip of an at least a small iceberg.

    1. Chris Phillips says:

      The trouble is that – as with the current AZ kerfuffle in Europe – the article and letter you link to contain nothing in the way of statistical evidence that there is any association with the vaccines, but only speculation that there might be.

      You talk about a 1 in 25,000 risk for mumps and rubella vaccine. I tracked down the sources for this. It’s worth noting that the evidence for any increased risk at all is barely statistically significant – a relative risk factor of “6.3 (95% CI 1.3, 30.1)” – and that the events in question are described as generally mild and short term:
      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1884189/

  27. Bill says:

    So far, it appears that numerous people in important positions are just bag of crap stupid.

    Is there a different way of viewing the scientifically valid facts that supports their decisions and justifies the obvious exacerbation of seemingly unnecessary additional deaths that have to amount to extra tens of thousands ultimately? Please tell me I’m missing something. Maybe I’m the stupid one.

    The closest I can imagine is extreme over-reaction for the purpose of soothing the vax hesitant. Hoping that that results in least loss of life, net.

    1. Adrian says:

      Read about the history of Thalidomide in Germany compared to the US if you want a lesson about the difference between taking slight worries about safety serious or not.

      1. confused says:

        That is not remotely comparable, for a lot of reasons.

        One simply can’t compare biological/medical knowledge in 1962 to knowledge in 2021.

        The problematic use of thalidomide was for morning sickness, not a pandemic – there was no need to move quickly in that case – no lives were at stake.

        Also, even if this effect is real, it is too rare to matter. That’s another critical difference.

      2. Arno Nym says:

        Actually, the more relevant precedent is Pandemrix (2009 swine flu vaccine). In particular the official reactions show a remarkable similarity, i.e. the Scandinavians reacting immediately (IIRC Sweden and Finland were most affected back then), the Germans with some delay and the EMA never saw a problem. 10 years later there seems to be general agreement there _was_ a connection between Pandemrix and the increase of narcolepsy in adolescents. Well, almost everyone agrees – except EMA and the manufacturer of the vaccine (GSK, IIRC).

        1. WST says:

          simply not true, Pandermix was never suspended or EMA did not cancel the license, the license just expired couple of years ago.
          Narcolepsy was a complication of both infection with the active virus and the inactive one (vaccination), the accepted hypothesis is that it was a rare autoimmune reaction to one of the virus proteins.
          This time Denmark was one of the first countries to react, Sweden the last one and Finland still vaccinates with AZ.

          1. Arno Nym says:

            > Pandermix was never suspended
            The THL (National Health Institute in Finland) recommended the suspension of Pandemrix “pending further investigation” on August 25, 2010 (https://web.archive.org/web/20100827075134/http://www.thl.fi/en_US/web/en/pressrelease?id=22930), the Swedish MPA recommended against its use on March 29, 2011. Quote: ” the MPA concluded that vaccination of children and adolescents with Pandemrix for the time being should not be recommended.” (https://web.archive.org/web/20190911170137/https://lakemedelsverket.se/english/All-news/NYHETER-2011/A-Swedish-registry-based-cohort-study-provides-strengthened-evidence-of-an-association-between-vaccination-with-Pandemrix-and-narcolepsy-in-children-and-adolescents-/)

            > EMA did not cancel the license
            Of course not – the EMA never accepted that there was an issue.

            > the license just expired couple of years ago.
            In 2015, IIRC.

        2. WST says:

          “Scandinavians reacting immediately ”
          You mean 2 years and 6.1 million injections and a year after first reports in Sweden? ? And recommendation was no to use under 18 years and vaccination continued.

          Finish THL recommended suspension of vaccination “because there was no epidemic” in the country but still kept possibility of vaccinating people travelling to countries with an epidemic.

          It’s easier to say, ‘oops I’m sorry ” or not to say anything at all.

  28. wilson says:

    German experts talk about CVST being noted multiple times, yet looking through EU adverse reports database of the AZ vaccine only one suspected CVST case in conjunction with ITP is currently listed. What is the explanation?

  29. johnnyboy says:

    This is a diabolical mess. The authorities of various european countries stopping vaccinations while saying “there is no proven link yet” – this is exactly what you’d do if you wanted to scare a population already unhealthily skeptical about vaccines. The uptake of the Oxford/AZ vaccine was already ridiculously low (GP practices in France are having a tough time recruiting the measly 10 patients per week for their allocated vaccines – yes you read that right), even if after all this the authorities come out and say “sorry it was just a precaution, there is no safety issue”, the uptake will never recover. Meanwhile the third wave is taking hold in these countries, and hundred die every day in France, Italy, Germany… I’m a big believer in Europe in general, but in this case they’ve royally f*cked it up.

    1. Adrian says:

      The University of Oxford and AstraZeneca are to blame for a large part of the distrust in their vaccine, the way they mishandled the trials and trial data did not generate confidence.

      Politicians telling lies the Oxford vaccine would be as good as the other vaccines didn’t help in generating trust.

      Not acting when there are indications of additional safety issues causing deaths would only serve to further undermine trust in vaccines.

      1. Chris Phillips says:

        Do you feel you are more on top of the relevant facts than the World Health Organisation and the European Medicines Agency?

        I have to say that hasn’t been coming across in your comments.

    2. WST says:

      True, except that in France GPs are not vaccinating against covid with AZ or any other. Pharmacies were planned to start AZ this week ( roughly 10 a week) and their list are fully booked.
      The demand is much higher then vaccines’ availability, except for the lower healthcare personnel, only 40% accepted to be vaccinated…. which is a problem. Their vaccines (roughly 400,000 doses) were now given to the general public.

  30. Daren Austin says:

    “60% effective vaccine”
    Actually 100% effective in preventing hospitalisations. It’s not symptomatic infections that are keeping us locked down to prevent spread. I’ve long viewed the vaccine as first protection from morbidity when we eventually catch SARS-CoV-2. And I believe that eventually, everyone will catch this soon-to-become endemic coronavirus. It is simply a matter of time.

    1. Mandark says:

      Daren, none of the vaccine trials were powered to estimate efficacy in preventing hospitalization. The number of events for that outcome was too small to make any reasonable estimate.

      And I think what most people were really interested in was preventing infection and transmission, which was the narrative around vaccines until the recent SARS-CoV-2 appeared and the vaccines turned out to be less effective against them. At that point, public figures started talking about preventing severe disease and hospitalization as all that we wanted from vaccines.

      1. confused says:

        Eh, we were also told (in the US) that 50% efficacy would be good enough for FDA approval (though that probably would not be enough for herd immunity, especially given limited uptake). In reality, the trials showed vastly better efficacy (94% or 95% for Moderna and Pfizer).

        I don’t really think the vaccine efficacy has been “walked back” – if anything, I think it’s consistently being undersold (what real data there is on efficacy against the variants seems significantly better than media discussion would imply).

        But then, I think severe disease/hospitalization/deaths really should have been the only thing of concern all along – cases are useful only as a leading indicator, IMO.

        If vaccination breaks the correlation between cases and severe disease, then cases need be of no more concern than for colds, flu, etc.

        (Sure, theoretically it gives the virus more space to evolve – but why don’t the other four human coronaviruses, or any of the other circulating respiratory viruses, evolve to deadlier forms? There seem to be strong constraints in practice, even if we don’t know what they are…)

  31. MTK says:

    The 17M denominator, meaning the number of total AZ/Oxford vaccine doses administered, may not be the right number. The story I read a few days ago pointed to two specific batches, ABV2856 and ABV5811, being the source of the concern. The story said that the ABV2856 was 1M doses. No idea if the other batch was the same size.

    Even at the batch level this may be nothing. TIFWIW.

    1. Some idiot says:

      Just curious, where do you read that? I’m interested in reading stuff about this…! 🙂

      1. MTK says:

        It was a Reuters story about the halt in Italy where a couple of people received doses from the same batch (of course that doesn’t prove anything). Romania evidently halted shots using one of those batches also.

        Unclear what batches Norway, Denmark and other countries have been using.

        1. Some idiot says:

          Thx! 🙂

  32. George Wilson says:

    You could give 17 million people a spearmint flavored Tic Tac and there would be strokes, hemorrhages, clots, and deaths associated with it. Why? Because people have strokes, hemorrhages, clots, and die every day. Its important to get into these cases very deeply and very fast to rule out vaccine adverse effects so we can move on getting the population vaccinated.

    1. confused says:

      >> Its important to get into these cases very deeply and very fast to rule out vaccine adverse effects so we can move on

      I think it’s actually wrong to condition “moving on” on finding out what’s happening.

      As long as the side effect, even if real, is vastly rarer than (risk of catching covid x risk of serious complications from covid) … the risk balance is still vastly in favor of the vaccine.

  33. Marko says:

    Continuing to vaccinate the elderly and severely at-risk groups seems to me the sensible way to proceed, and do so immediately, as this gets sorted out. The benefit/risk ratio for those groups is off the charts, and side effects in the numbers seen won’t change that. If over-65s in Europe are finding their access to vaccines curtailed as a result of this, something is seriously wrong with the decision-making process in the health ministries.

    1. Bill says:

      Vax the elderly with AZ? Why would you want to treat them with something “quasi-ineffective”?

      Source: well, you know the source.

  34. Doug H MD says:

    Derek: can you comment on the Spike protein make up of the different vaccines? Are they all nearly identical? Pfizer is RBD only not full spike, right? Is that true of Moderna and AZ and J and J too?

    1. Doug H MD says:

      ANYONE care to comment?

      1. Mandark says:

        Doug, all vaccines currently used in the US, UK and EU are based on a full-length spike protein.

        1. Doug H MD says:

          didnt Pfizer test two originally, one with only the RBG?

          1. Alex Beribisky says:

            Yes, the original construct (bnt162b1) was encoding just for Spike’s RBD. However following the phase 1 trial, Pfizer and BioNTech have chosen to proceed with a construct that codes for the entire Spike protein (bnt162b2) with a number of stabilizing mutations as this construct gave rise to a more robust T-cell immune response:

            https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-choose-lead-mrna-vaccine-candidate-0

          2. Rob Sutherland says:

            BioNTech initially trialed 4 different mRNA vaccine candidates but either threw them all out after early data was not good and made a new full-length Spike version, or one of the original 4 that used a full length version was selected for Phase III trials. I cannot recall which scenario at this point.
            But critically, they altered the mRNA sequence so that ‘stabilized’ spikes, i.e., spikes that retain the pre-fusion conformation, would be made by the vaccine.
            Moderna had taken a similar approach, and I believe J&J did the same thing to the spike made by their Ad26-vectored DNA vaccine.
            As far as I know, only Oxford-AZ uses a DNA insert that did not encode a stabilized spike in the Chimp Ad virus vector that they use. I wonder if this may explain some of the lower vaccine efficacies against one or two of the emerging variants?

    2. B says:

      Yes the comment below by Rob is a good point. All current vaccines use a prefusion stabilized (2-proline mutations in both, also a furin cleavage mutation in J&J) variant of the spike, except for Astrazeneca. Since the spike is presented on the cell, it could be possible that the wildtype spike used in the AZ vaccine allows for cell fusion, except instead of with a virus to a cell it is between cells that are expressing this spike. There seems to be similar amount of these cases between vaccines, although I wonder if there’s differences in the rates of these events happening.

  35. Oleg says:

    Isn’t ineffectiveness against B.1.351 going to be problem?

    https://www.nejm.org/doi/full/10.1056/NEJMoa2102214?query=featured_home

    1. Mariner says:

      It rather depends on how well the vaccine protects against serious illness with B.1.351. In this trial, there were no hospitalisations in either the placebo or vaccine group.

      I do also wonder if the AZ vaccine will provide greater efficacy against B.1.351 with the greater, 12 week spacing of doses in operation in the UK now. It seems that spacing the doses in this manner improves the level of immune response so perhaps it will help a little against the South African variant as well?

      I speak as an interested observer, having received my first dose of the AZ vaccine at the weekend!

  36. Ms Scandinavia says:

    The problem is not on a group level, but on an individual level. What the Norwegians doctors are saying is that 4 young, previously healty, persons, have gotten seriously ill, (one died) suffering from blood clots combined with a very low level of blood platelets and bleeding. And the Norwegian doctors say that that is an unusal combination and a very fatal one. And the same goes for the person aged 60 who died in Denmark. So no one is saying that blood clots are more common in vaccinated people than in non vaccinated people. But on an individual level some people had gotten really ill, and the working hypothesis from Norwegian doctors is that their patients’ condition is vaccineinduced ITP.
    As the head of the Norwegian Medical Agency pointed out,, the benefit/risk discussion is always on a group level, but their job is also to look into severe side effects for individuals, even if those individuals are rather few and would pass unseen in statistics on a group level.

    1. Bill says:

      Worldometer Data says 3500 Europeans died of Covid today, 2500 yesterday, 2000 the day before that. Most would agree that if those 8000 had vax immunity, nearly all would be alive today. That’s three days. It’s hard to do rigorous math, but one could estimate what a 14 day suspension will cost in near-future deaths.

      And on the other side of that scale we have a handful of people who died of suspicious causes and who had been vaccinated. No known correlation. And this side of the scale won.

      As I said, none of the above is rigorous. But not fake news either. Precise numbers aside, the decisions will cost thousands of “extra” deaths.

      1. Ms Scandinavia says:

        I was not arguing for or against pausing the AZ vaccine. I was arguing against the the « logic » from people who claim that this condition could not be vaccine related since it is happening to such a small amount of people.

        1. confused says:

          The small number of people doesn’t prove it can’t be vaccine related.

          But it does mean

          – it is not evidence that it *is* related, since one-in-a-million people have all sorts of weird health events all the time

          – even if it is related, it’s rare enough to be insignificant relative to the reduction in COVID risk the vaccine provides, so ultimately what difference does it make? 1 in a million risks just aren’t that significant.

          1. Mandark says:

            If it is vaccine-related then it is important to understand exactly why it happens.

          2. confused says:

            Understanding would be good – but at this low rate, not a justification to pause vaccination now.

            If you told me that the vaccine had a 1 in 1 million chance of killing me the instant it was injected, I’d still take it without a second thought – and I’m considered pretty low-risk. (My risk of death if infected given my age, health, and gender is probably on the order of 1 in 2,000 or 1 in 3,000 – so even if my chance of infection was as low as 1% it’d be a clear win).

            (I already got the first Moderna shot, and AZ isn’t available in the US, so it’s academic for me personally. But still…)

          3. Chris Phillips says:

            Another way of looking at it is that on average someone aged thirty in the UK would normally have a 0.0038% chance of dying in any given fortnight (the period considered in the PEI calculation).

            Even if these three deaths in the PEI calculation were attributable to the vaccine, the effect would be to raise that chance to 0.004%, by my reckoning.

            Given that there are consequences of not being vaccinated – either inconvenience to oneself or potentially fatal risks to others – I don’t think a decision not to be vaccinated can be described as rational, on those numbers.

    2. WST says:

      “As the head of the Norwegian Medical Agency pointed out,, the benefit/risk discussion is always on a group level, but their job is also to look into severe side effects for individuals, even if those individuals are rather few and would pass unseen in statistics on a group level.”

      The logic of this argument is flawed.
      Looking at a group level is also looking at the effects on a group of individuals, which is undoubtedly more important. 641 Norwegians died in covid and roughly one still dies a day.
      There is a ‘low probability high damage event’ (death in covid in Norway) against ‘order of magnitude lower probability of high damage’ (death in a vaccine AE), you don’t compromise a mitigation effort of the former in order to mitigate the later. You “just” create (or copy FDA’s) treatment plan.
      A death of a young person is such a dramatic event that people lose their minds.

      1. hardnox fort says:

        The argument is a bit pointless. The pause on vaccination is likely an overreaction. But, you kind of have to understand cases on an individual level before you can group them! The investigations are the main priority.

        In this case, the severity seems high from ITC + clots (the combination, which is harder to catch in a pure statistical setting!). Determining if it is related to the vaccine will be harder to prove. The clots alone and ITC alone doesn’t seem more common (actually some have teased the vaccine as a preventative treatment against clots on account of the statistical numbers), but if you mess with the [b]severity[/b] of a condition in the statistics, it may be another issue!

        In this case, expect the result to be a specific group taking extra precautions when vaccinated (The group of more likely to have/get clots and more likely to have/get ITC or a subgroup thereof) and give extra pointers to them about seeking doctor for purpura-like markings, excessive gum-bleeds. Those potential ITC-indicative symptoms, so the early treatment hopefully can prevent the addition of clots.

        To those spouting COVID-19 numbers, keep in mind that most countries are in vaccine-supply constraint. The delay caused by the pause would likely be caught up pretty fast and the overall delay woud be very low from the pause. Particularly after AZs delivery-expectation was cut to 70 million doses from 180 mllion doses in EU for the second quarter…
        https://www.ctvnews.ca/health/coronavirus/eu-chief-says-astrazeneca-shortfalls-slow-covid-19-vaccine-campaign-1.5350593

        1. confused says:

          Overall delay may be small, but it doesn’t take much at all to override a one-in-a-million effect. Expected IFR in people who would have been vaccinated but weren’t will probably be at least 1% (given that this population is skewed older than the general population), if even 0.1% more of the population is infected before being vaccinated, that’s 10x greater. (0.1% x 1% = 1 in 100,000)

          Frankly, this effect strikes me as rare enough that whether it is caused by the vaccine is of purely scientific interest – it’s just far too rare to matter regardless.

          1. Chris Phillips says:

            How inconsiderate of you to “spout numbers”!

            I think it’s sufficient to look at daily death rates to see that – in Germany, for example – a 1-in-a-million fatal side effect would lead to a much smaller number of deaths than a single day’s delay in the vaccination programme.

            But I’d be more concerned by the consequences for vaccine hesitancy, which will surely have a permanent effect on uptake. No doubt the anti-vaccine propagandists will now be pushing the line that “it’s not just AstraZeneca, but all of them”.

          2. Chris Phillips says:

            By sheer coincidence, I came across this preprint examining the effect of the AZ extension on vaccine acceptance:
            https://psyarxiv.com/uh4y6/

            It shows a significant decrease in acceptance of all approved vaccines in countries where AZ was suspended. If I understand correctly the meaning of the parameter b (undefined by the authors), the total decrease in vaccine acceptance in these counties after 10 March was 14%. No decrease in acceptance in countries where there was no suspension.

  37. Mariner says:

    I realise that vaccine production is an extremely carefully-controlled process, but is it actually feasible that there are minor differences between the AZ vaccines given in the UK and those given in the EU? We’ve heard lots of commentary about how the UK isn’t exporting any vaccines and the AZ vaccines used in the UK thus far are produced here.

    Is it possible that minor differences between the production processes in different countries could lead to batches of vaccines more likely to cause these reported problems?

  38. Vjoe says:

    Times

    France and Italy prepared to drop their suspension of the AstraZeneca vaccine last night after the European regulator said it was “firmly convinced” that the benefits outweighed any risks.

    President Macron and Mario Draghi, the Italian prime minister, said that they would “promptly restart the administration of the AstraZeneca vaccine” if it was cleared by the European Medicines Agency tomorrow.

  39. ssjpabs says:

    Good run down. I’m on day 10 after Moderna #1 so it doesn’t apply to me but a couple things.

    First: 60% is approaching flu shot levels of bad. I always get the flu shot don’t get me wrong but 60% is almost a coin flip.

    Second: once the urgency goes down from doing it fast and okay to getting it right, can an AZ take a booster from pfizer or moderna? What about non mRNA Johnson&Johnson?

    1. Mariner says:

      I don’t quite get your logic here. Covid-19 is not the flu. If you’re talking about the more transmissible and more deadly B.1.1.7 variant which is currently rapidly spreading in many western countries, CFR is somewhere around 2.5%. OK, as with most illnesses, the risk of dying is greater if you’re elderly, but the thing we know about Covid-19 is that it can also be deadly for younger, otherwise healthy people. And this doesn’t even consider the large numbers of people struggling with the effects of ‘Long Covid’ after infection.

      With all this taken into consideration, 60% efficacy is very good, especially as it appears to be almost 100% effective against severe illness. And, you’d hope, drastically reduce the likelihood of developing ‘Long Covid’ in the event you did catch it regardless.

      This doesn’t even consider that there is some data which indicates that extending the gap between doses up to 12 weeks can increase efficacy.

  40. Chris says:

    In other news yesterday In Europe there were 162,000 new cases of COVID and 3,600 deaths. Cases are increasing in many countries. Deaths due to cancer, heart disease are also rising due to hospitals having to divert resources to care for COVID patients. Folks need to realise there is not a zero risk option.

  41. Laura says:

    so far have not found anyone clearly stating that the problems seen are running higher in the vaccinated patients, anyway (if someone does come across such numbers or such a statement, I’ll amend this post immediately with a link).
    —> unfortunately, it seems Germany did find this for sinus vein thrombosis
    https://www.pei.de/EN/newsroom/hp-news/2021/210315-pei-informs-temporary-suspension-vaccination-astra-zeneca.html;jsessionid=A99BAB04CC374E7ED411DD51765B4D1F.intranet231

    1. Chris Phillips says:

      That’s what they said, but see the comment above – that their estimates of the prevalence of the condition are out by exactly the excess factor they estimated.

  42. John Davies says:

    I am shocked and surprised by how many fundamental data errors there are in an article published here. It makes me wonder how many other articles are a fabrication of lies. To start with, the suggestion that the AstraZeneca vaccine is the only one available in most European countries is a complete and utter lie: “Currently, the BioNTech-Pfizer (Comirnaty) vaccine represents 65-75% of doses administered in different EU countries, AstraZeneca 17-30%, and Moderna 6-8%”.

    There are many other provable untruths in this article, which I will not bother to go into here.

    1. Chris Phillips says:

      John Davies

      Derek didn’t say “in most European countries”, but “in many cases in the EU”.

      I think what he was referring to the fact that some European countries (such as Bulgaria) are said to have decided to reply heavily on AstraZeneca rather than the more expensive options. Apparently their allocation of the mRNA vaccines was then taken up by other member states:
      https://www.politico.eu/article/austria-eu-coronavirus-vaccines-distribution-european-commission-sebastian-kurz-summit/

      1. A Nonny Mouse says:

        Not to mention Hungary and Serbia (not EU) who are using Russian and Chinese vaccines due to frustration with supply.

  43. O Cazier says:

    Contrary to most commentators, I think there could be a problem.
    When AZ says the number of thromboembolic events is not significant, their argument is that the normal frequency of these events is roughly 1 or 2/Thousand ans par year.
    But the PEI ( german institute) is speaking of the occurence of a very special type of event ( Sinus vein thrombosis associated with thrombocytopenia) , on people under 50, with a frequency according to PEI, or 1 per million and per year.
    In truth, the frequency of these events is not well known ( litterature gives between 2 to 20 per million per year) but even with 20 cases/year/million, the number of events, according to PEI, is not “normal”
    It does not mean the benefit/costs of the vaccines are not good, but like some commentators, the way AZ handled the data have been shameful, and do not induce trust

    1. Chris Phillips says:

      The information circulating about this PEI estimate is very confusing. You say they assumed 1 case per million per year. The quotation from Paul Hunter above (taken from this page – https://www.sciencemediacentre.org/expert-reaction-to-news-that-germany-has-halted-vaccinations-with-the-oxford-astrazeneca-covid-19-vaccine/?cli_action=1615843614.467 ) seems to imply they assumed 2-5 cases per million per year, and that that was an underestimate by a factor of 4 to 8.

      The PEI statement linked above says they calculated the expected number of cases for 1.6 million people in a 14-day window and got an answer of about 1. By my reckoning that equates to a rate of about 16 per million per year (the higher of the two estimates cited by Hunter). Which suggests Hunter didn’t know or misunderstood the basis of the calculation.

      That seems to take us back to where we started.

  44. ochenta says:

    Are we talking about the same COVID associated trombo… ?
    What is the rate of COVID related trombo ? Do the vaccination reduced it?
    If that is the case, the vaccine suspension will rise again that risk by exposition to COVID.
    Some body know the numbers? (COVID-trombo rates)

  45. Chris Phillips says:

    Astonishing that Ursula von der Leyen has chosen today to launch a not-very-veiled threat to restrict vaccine exports from the EU to the UK, the pretext being – of all things – her transparently false allegation that the UK is preventing vaccine exports to the EU. The vaccine in question, of course, being the one that much of the EU is currently refusing to use and destroying public trust in!

    Can the antics of these people conceivably get any more ridiculous? And are there any grown-ups still in positions of power in the EU?

    1. John Wayne says:

      This is a reminder that the historical conflicts of Europe have led to the current state of the world. We should be happy they are using words and threatened economic sanctions (with health consequences) instead of the carpet bombing of cities.

      Can we get our ‘most improved’ award?

    2. Chris Phillips says:

      Reportedly, Pfizer and BioNTech have warned the EU that their factories in the EU are heavily dependent on supplies of lipid ingredients from the UK, and that without these their manufacturing process would grind to a halt within weeks.

      The thing that worries me is that this kind of scenario might not be wholly unwelcome to an unscrupulous politician seeking to distract people from her own shortcomings.

  46. Danish vikingj says:

    I count at least four instances in the discussion thread above where someone argue that the reason for the European investigations into the AZ vaccine is that “EU is angry with the UK leaving the EU”!?.
    From my chair, here in Denmark, this seems rather silly. On the contrary, maybe some people in the UK are a little too obsessed with the whole Brexit mess?

    1. A Nonny Mouse says:

      Who said it’s a mess (other than you)?
      Clearly, in terms of vaccines, it was decide that the EU’s approach would be a mess according to the Cummins disclosure today. And so it has proven.

  47. An Old Chemist says:

    AstraZeneca Troubles Continue as Study Shows Ineffectiveness Against South African Variant (BioSpace,03-17-21):

    https://www.biospace.com/article/despite-extremely-rare-blood-clotting-many-countries-halting-astrazeneca-oxford-covid-19-vaccine-distribution/

  48. Amanda says:

    I very much doubt the number stated less than 40 include my friends mum who had stroke like symptoms and slurred speech after less than 2 weeks of taking one shot of the Oxford vaccine and now has chronic back pain that is debilitating.

  49. FrankN says:

    A German news outlet has done a “back of the envelope” calculation:

    In Jan/Feb 21, at the peak of the German “second wave”, 7 people w/o comorbidities in the 15-35 y/o age bracket died from CoViD 19. This translates to a fatality of 0.35 p. million in that age group,

    If those people had been vaccinated with AZ, their expected fatality would, based on available data, have been 1.875 p. million (3 fatalaties among ca. 1.6 m vaccinated), 5-6 times higher.

    Based on such calculations, first German experts are now calling for a reversal of the vaccination strategy: Exclusively vaccinate young people with mRNA vaccines, while using AZ for the elderly, where the CoViD-risk is far higher and outweighs the vaccination risk.

    Italian EMA member B. Gänsbacher, in the meantime, has voiced his concern about the AZ data, stating that he personally would for the time being not consider taking the AZ vaccine if offered.

    https://www.rainews.it/tgr/tagesschau/articoli/2021/03/tag-AstraZeneca-Stopp-coronaimpfung-Norwegen-italien-407fdc7f-907b-416f-b2ee-f5b26c5219bd.html

    1. sgcox says:

      Vaccine gives protection against covid illness during the peak of the wave (what is it, week or two of year long and not ending pandemic?), but for much, much longer time. Hope life long but that is unlikely unfortunately.
      That is the number we do not know yet but which should be compared with alleged – yes, only alleged as I understand – number of side effects..

      1. FrankN says:

        Not quite, sgcox. If you are under 35, and have the choice between getting AZ now, or waiting for a few months to receive a mRNA vaccine, the rational thing to do is to wait. At least, if there is a high probability that the mRNA vaccine will become available to you within the next six to nine months – which should be the case in the UE, the EU or Canada.
        For Africa (except South Africa), OTOH, the assessment looks different. Better AZ now, than a mRNA vaccine some time in 2022 or even as late as 2023.

        1. sgcox says:

          Do we have solid statistic comparison of serious side effects between different vaccines, not a collection of case reports ? I remember reading about sudden deaths after Pfizer vaccine some time ago but do not have links.
          JVT spoke very assuring today that there is no sign whatsoever of excess serious events or deaths over expected after analysing ~12,000,000 AZ inoculations administered in UK.
          Ideally we need a blinded trial between two vaccines administered to the same cohort. Would never happened of course for obvious reasons.

        2. Marko says:

          “If you are under 35, and have the choice between getting AZ now, or waiting for a few months to receive a mRNA vaccine, the rational thing to do is to wait.”

          Agreed. That’s what I would do if I was young and healthy, based on the admittedly limited information available. At this stage, however, Europe shouldn’t be vaccinating young healthy people anyway, with any vaccine.

          It seems to me that the German , and other countries’, experts could have done that same back of the envelope calculation before they paused the entire AZ vaccination campaign.

          1. Stroodle says:

            If young people getting the vaccine allows society to open up again, then it’s certainly not worth waiting. Individuals might not want to take the ‘risk’ unnecessary, but the possibility of vaccine passports will likely be a driving factor.

        3. sgcox says:

          FrankN,
          Actually, looking on your numbers from some German news outlet in you post:
          COVID fatality of 0.35 p. million in 16-35 age group without comorbidities.
          vaccine fatality estimation of 1.875 p. million (3 fatalities among ca. 1.6 m vaccinated) in “those people”. Does it meant that 1.6 M of healthy 16-35 age people have been vaccinated in Germany now and the actual cases in your example came from this cohort?
          As Marko correctly say, it should not have happened in Germany or any EU country in the first place as of today.
          And once again, covid mortality ws for one ? two? weeks time. Delaying even by two months will raise the number five fold if no other measures were taken.

        4. Chris Phillips says:

          I only hope your rationale decision to avoid a one-in-a-million risk will go along with strict self-isolation for however many months it takes – otherwise you are going to be endangering other people who are at far greater risk of dying of COVID-19.

          But if you’re really so risk-averse as to worry about a one-in-a-million chance – that is, a risk that, if repeated every single day, would be expected to take 2,740 years to materialise – perhaps you never leave your home!

  50. Allie says:

    Here’s an open question I’d like to pose to this very knowledgable group. Our family will need to make a decision at some point about vaccination for my 86 year old, very healthy (still working full time!) mother.

    When vaccination first became available to her in early Feb, we decided to wait. Our reasoning: she was able to work from home and continue to isolate generally, so her risk for acquiring covid was close to zero. As cautious people, we wanted to wait until more data became available on all the vaccine candidates, including safety in her age bracket, efficacy in her age bracket, and efficacy against the variants that were starting to arise. In addition, we thought if she was vaccinated right away, her employer would likely put more pressure on her to come into the office, so vaccination could perversely increase her covid risk.

    I have been closely following the track record of the three vaccines that currently have an EUA in the US, plus three that seem to be likely to follow soon: Novavax, Covaxin (from India), and AZ. As someone who prefers to see an long safety track record for any pharmaceutical intervention, I tend to be inclined to favor the traditional platforms used by Novavax and Covaxin. But this is admittedly not based on a lot of data, because there is not a lot of data available.

    Regarding efficicy, my impression is that age and the variants scramble the picture enough that it is hard to say which of the six are more efficacious than others.

    I would love to know your thoughts on which of the 6 vaccines above you would advise an older person to get, assuming they are able to wait and shelter long enough to have a choice (I assume its probably not AZ but include it for completeness). I have many friends who are asking me this question on behalf of their parents as well.

    Thanks in advance!

    1. Chris Phillips says:

      Thankfully, I think most people will be taking the first one that is offered, and not worrying about trying to choose the best until a choice becomes available. It seems very unlikely that there won’t be an opportunity to choose (for those who can afford it, at least) when it comes to annual (or whatever) follow-up doses.

      If anyone is determined to wait, I think the criterion should be how well the different vaccines (modified if necessary) cope against whatever variants are most successful in the future.

  51. This one just in and it may be among the best addressing this issue:

    https://www.sciencemag.org/news/2021/03/it-s-very-special-picture-why-vaccine-safety-experts-put-brakes-astrazeneca-s-covid-19

    This is likely not a problem limited to the Aztrazeneca vaccine as it has been seen also with the Moderna and Pfizer vaccines. Vaccines don’t always trigger beneficial immune responses in all people. The argument that you are more likely to become seriously ill or die from the coronavirus is not the most appealing argument to make to someone who might die from the vaccine or become seriously ill from the vaccine (or to the families that this has already happened to). The best thing that could be done now is to figure out which sliver of the population is likely to suffer such consequences and either to not take the vaccine or have a treatment plan in place to try to counteract any negative and very serious consequences from the vaccine.

    1. Chris Phillips says:

      No doubt Marko will be interested to see the speculation in that article (one of several) that – if a real consequence of the vaccine – this might be an effect occurring in people who had already been infected by the coronavirus (health workers being at higher risk of exposure). I’d have thought that should be easy to check for, and if confirmed to screen for in the future.

      1. Marko says:

        That is interesting and it makes some sense based on the fact that it’s known that seropositives generally have a stronger immune response to the vaccine. If it proves true, they may react by setting up a pre-screen for anti-N antibody, using a rapid, finger-stick LFT device, so seropositives could at least be warned that they may be at a slightly higher risk of this side effect.

        If that happens, it would also allow them to make the vaccine rollout more efficient overall, by delaying vaccination of seropositives for some months (and with only a single dose), which would be vaccine-sparing during a time of shortage and might also reduce the risk of these adverse side effects in the seropositives once they are vaccinated.

  52. just wondering says:

    Let’s say, after a thorough investigation of the data, it was determined that the incidence of CVST post-vaccination with AZ was found to be statistically significantly increased, with a convincing p-value of, say, 0.001.

    But if you drew up a list of 1000 rare, dangerous medical conditions, one of them would likely end up with an increased incidence at p=0.001 (and, for that matter, one of these 1000 conditions would be found to be equally convincingly reduced by the vaccine, too). Even if the vaccine was entirely inert.

    Weren’t we always destined to find a really convincing, dangerous side effect from the vaccines, considering how hard they are being looked for, even if none actually exist?

  53. M. Saltarelli says:

    Wait a minute, Derek. Regarding the apparent excess of thromboembolic events, deep vein thrombosis, and pulmonary embolism, I am not certain that we necessarily discount these events as unrelated to treatment, nor can we accept A-Z’s assertion that the rates are lower than what would be expected in the general population. Where did AZ get these data? Epidemiological data of annual incidence would not be relevant, given this unique population and the limited amount of time from injection to serious adverse event. What was the time to event from injection, AZ? How many thromboembolic events have been observed following jabs with the Pfizer and Moderna vaccines, which have been administered to many more individuals and arguably provide the best control population in this natural experiment. There would have a similar public disclosure of any serious events with these vaccines, and since there have been no similar disclosures, we must conclude that the AZ vaccine profile is inferior, even if the events are rare.

      1. M. Saltarelli says:

        Hi Andy, thanks for sharing. Appears there is similarity across the vaccines with regards to thrombocytopenia, but interestingly, there is no report of SAEs related to DVT and PE. With case series it is not always clear whether thrombotic events were seen, but it appears they were not an issue. In any case, given the rarity of these events, it still appears that there remains an adequate risk benefit across the population.

  54. Gary Petrie says:

    It’s simply political which makes it all the more depressing. The EU was slow to commit (invest, plan) to a vaccine problem and so was behind the curve from day 1. In addition, it looked at the UK with envious eyes and a bitterness due to Brexit. The initial response of the EU was to throw a tantrum and threaten to block any vaccines manufactured in the EU leaving the EU block until their orders were fulfilled first – queue jumping – despite other countries having fully paid legal contracts in place. Italy recently blocked a shipment of Oxford vaccine going to Australia. Add into the mix, the confusion the EU created with re to vaccinating over 65s with the Oxford vaccine. They have simply made a mess of the whole process. Their response now? Despite placing a temporary ban on the Oxford vaccine they are still threatening to block shipments. A complete farce and a classic case of politicians covering their own backsides. When it results it many people dying needlessly it is beyond contempt.

  55. Marko says:

    “The committee has come to a clear scientific conclusion: This is a safe and effective vaccine. Its benefits in protecting people from COVID19 with the associated risks of death and hospitalization outweigh the possible risks”, says Emer Cooke at EMA_News press conference.”

    Further comments in this thread :

    https://twitter.com/kakape/status/1372579807213596676

    1. FrankN says:

      The tweet provides, in the comments, a link to

      https://ashpublications.org/blood/article/109/7/2832/125650/Adenovirus-induced-thrombocytopenia-the-role-of

      “Thrombocytopenia has been consistently reported following the administration of adenoviral gene transfer vectors. The mechanism underlying this phenomenon is currently unknown. In this study, we have assessed the influence of von Willebrand Factor (VWF) and P-selectin on the clearance of platelets following adenovirus administration. In mice, thrombocytopenia occurs between 5 and 24 hours after adenovirus delivery. The virus activates platelets and induces platelet-leukocyte aggregate formation. There is an associated increase in platelet and leukocyte-derived microparticles.”

      So, apparently, the risk has been known since 2006 at latest. I really wonder why nobody at MHRA and EMA has ever looked into the issue prior to admitting the vaccine.

      1. Chris Phillips says:

        I am only a layman, but Google tells me that the risk of thrombocytopenia is very well known in relation to vaccines in general, not just coronavirus vaccines and not just adenovirus-based ones. But I can see comments on it in relation to coronavirus vaccines, made before the current panic, and what they say is that the risk is so small that it’s far outweighed by the benefits of vaccination.

        1. Gmac says:

          Relatively few second shots have been administered of this vaccine and repeat challenge will flush out the presence or absence of this effect (which may or may not have killed many people under age 50, it could still be a fluke temporal association). If it’s immune related there is a risk that re-exposure will elicit a stronger adverse response.
          In the UK 25M have had the first dose and <2M the second dose (figures include all vaccines).
          Serious reservations exist on how a COVID death is recorded – dying WITH covid and FROM covid are two very different things.

          1. Novacek says:

            And given the _massive_ increase of excess deaths in the US, we know it’s people dying FROM Covid.

          2. Chris Phillips says:

            Plenty of people in the UK and elsewhere will have received the AstraZeneca vaccine after having been infected by the virus itself. (They will include, today, the Prime Minister and the Chief Medical Officer.)

    1. WST says:

      ..and Norway will not resume vaccination at this time.
      With their very successfully control of infection policies ( 1 death a day) , they have more options than most of the EU countries.

    2. jule s says:

      confirmed by a team from Greifswald University :

      https://www.zeit.de/wissen/gesundheit/2021-03/astrazeneca-impfstoff-corona-impfungen-hirnthrombosen-forschung-einzelfaelle

      They propose surveillance (D-dimer?) and treatment (?)

      1. Some idiot says:

        I have a question (this is not my field, so my ignorance abounds!):

        As far as I understand it, they (I have read about the Norwegian results; I presume the German results are similar) have found an antibody that is reactive vs blood platelets, causing clotting. They have also (as far as I can understand) demonstrated that this particular antibody can only have arisen due to the vaccine.

        My questions: (a) how do they know it is reactive (I guess they have done an assay between the antibodies and blood platelets), and (b) how can they say that it can only have arisen due to the vaccine? I have no clue on this one…!

  56. FrankN says:

    The German case count for thrombocytopenia following AZ vaccination has increased from seven (Monday) to thirteen per this afternoon (12f, 1m, age 20-63 years).

    https://www.n-tv.de/panorama/Inzwischen-13-Hirnvenen-Thrombosen-gemeldet-article22434243.html

  57. Soon2BeCityRefugee says:

    Does anyone here know of the functional difference (if any) between the New York City variant and the original formula? Pop press has described the New York mutant as more aggressive, more numerous, and more likely to kill an unsuspecting average person
    but that’s from small town papers reporting on the influx of New Yorkers fleeing the lockdowns.

    1. Marko says:

      The big worry seems to be with the B.1.526 variant that carries the E484K mutation, in common with the SA and Brazil variants, that confers an immune escape advantage:

      https://outbreak.info/situation-reports
      pango=B.1.526&muts=S%3AE484K&country=USA&country=USA_US-NY&selected=USA_US-NY

      1. Rob Sutherland says:

        The Economist did a nice graphic showing many of the variants of concern appearing in different geographic locations:
        https://www.economist.com/graphic-detail/2021/02/27/the-same-covid-19-mutations-are-appearing-in-different-places

        1. Marko says:

          That is a useful graphic, but it’s already out of date re: the California variant, as is the Topol quote in this piece from yesterday :

          https://elemental.medium.com/variant-or-scariant-when-to-worry-about-covid-virus-strains-f2224f90c3de

          “…Then there are “variants of interest,” those that scientists are just monitoring. The New York and California versions are “variants of interest” for now. Although the New York version may become a variant of concern, says Topol, the California variant isn’t ringing many alarm bells so far. In fact, early panic about that variant is a good reason to dial down the “variant mania,” he says, because there’s no evidence that it’s as worrisome as first reported.”

          Two days before this was published, the CDC categorized the California variants as “Variants of Concern” (VOCs). Oops !

          1. Rob Sutherland says:

            Yeah, I guess the folks that did the graphic were not too keen on regular updates, otherwise we’d seen one – lol.
            Of interest, and just a news report to date AFAIK, Reuters published an ‘Exclusive’ back on Mar 5 suggesting AZ had data that their vaccine was effective agains the Brazilian P1 variant, at the time, top of almost everyone’s Scariest Variants list, but I’ve seen nothing subsequently.
            Since the P1 contains the more transmissible N501Y mutation and the ‘eek’ (E484K) mutation, I did not put money on the AZ vaccine being very effective against P1.

          2. Marko says:

            Yes, to date I just haven’t seen the data that suggests that any variant poses a high risk of severe disease or death to someone who has been vaccinated or previously infected. It’s likely that considerable numbers of reinfections are occurring in Brazil, and while it’s certainly possible that they’re contributing to the death toll significantly, I haven’t seen any data that shows that to be the case.

            While on the topic of Topol embarrassments, here’s another recent one :

            “…The new CDC findings prompted Dr. Eric Topol, director of the Scripps Research Translational Institute in La Jolla, to declare that the California variant “is on its way to obsolescence.” The fact that the U.K. variant’s transmission rate is higher than that of the California strain means the latter “will be quickly crowded out by B.1.1.7,” he said. In a contest for population dominance, “spreading rules the roost.”

            Topol said two other variants — one identified in South Africa (called B.1.351) and another in Brazil (P.1) are likely to meet the same fate “because they do not carry such enhanced spread capacity as B.1.1.7……”

            https://www.latimes.com/science/story/2021-03-17/coronavirus-strains-california-versus-uk

            It’s far too early for Topol to make such claims. The California variant, P.1, and B.1.351 all have some degree of immune-escape potential that B.117 lacks, so in a high-seroprevalence population, they may in fact out-compete B.117 even if they don’t spread quite as fast. And we don’t even know as much about their transmissibility characteristics as we do about B.117, though it’s thought that the Brazil variants spread very quickly indeed. I suspect the main reasons we haven’t seen much of an impact of the Brazil and SA variants yet are: 1) they were seeded less often and later in the US than B.117 and the home-grown California variant and 2) we’re not doing enough genomic surveillance to detect the outbreaks of these variants where and when they do occur.

        2. Marko says:

          Today Topol inserts his second foot, and then somehow, a third. He gets appropriately dissected in the replies:

          https://twitter.com/EricTopol/status/1373712302894026752

  58. Nick Schetakis says:

    “Proving” vaccine injury as a cause of death almost never happens.
    The only event where one would see a vaccine causing death would be an immediate case of
    anaphylaxis and the vaccinated person dies almost instantaneously!
    How and what gets officially reported (vs actual) as vaccine injury or death, will always be very challenging to discern.
    And the longer it takes to investigate and report such events, the more unlikely to be attributed to the vaccine.
    Even worse, the delayed development of any serious adverse effects , would be the ultimate challenge to connect to the vaccine.
    It’s a “lose-lose” situation for the victims, most of who would be left to battle their “non-pursuable” vaccine injury on the own in the end.

    1. Gmac says:

      There is still a risk of ADE, especially as antibody levels wane and new variants further affect the neutralising ability of the vaccine antibodies. Some recent observations and lessons from closely related preclinical programs are summarised here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7943455/pdf/fimmu-12-640093.pdf
      If this happens it could easily be blamed on variants

  59. Some idiot says:

    FWIW, Denmark has announced that it will continue the 2 week pause whilst the investigations continue (i.e. until 25th March). The “precautionary principle” is claimed as the reason. My best guess is that (a) they are kinda curious to see how the current investigations turn out, and (b) are probably trying to make sure they don’t feed vaccine skepticism by cutting the “2 week pause” short.

    There was a press conference where this was announced, led (apparently) by the Chief Health Officer in the Department of Health here in Denmark, Søren Brostrøm. He has shown here during the pandemic to be a very straight-shooter, and has serious street-cred. He was apparent asked whether or not he would be happy to receive the AZ vaccine, and he promptly replied “if the Department of Health recommended it, yes.”

    1. Bill says:

      So they’ll continue suspension of a life-saving vaccine to reduce hesitancy? That’s really how that works?

      1. Some idiot says:

        The situation in Denmark is not quite what your comment would imply… The short version is that the rate on infection is pretty flat (has been remarkably flat despite the fact that the UK variant is now responsible for >95% of infections), hospitalisations are falling, as are death rates to COVID-19. Plus, very importantly, the AZ vaccine represents a smallish minority of the vaccines given in Denmark (less than about 15%, I think).

        So yes, one week’s extra delay will, long term, lead to some extra infections and some extra severe infections (and possibly another death or two). But basically nothing that is likely to have a noticeable effect. If you were talking about an extra month, then it would be different. But one extra week: not much at all.

        Contrast this with the fact that vaccine scepticism is not that far under the surface here. If the general public were to lose faith in vaccines, with the result that far fewer would be vaccinated, then that would likely to have a much bigger effect in the long run.

        Personally, I wouldn’t want to make that call. But, knowing the public health experts who have been doing a damn good job here in Denmark, I trust them to have made the most appropriate decision with the information they have at hand.

        1. Bill says:

          No, you may have missed my point — which I admit is speculative.
          Which was, while a certain amount of direct damage to the program resulted from a week or two delay, it may more seriously be grist for the vaccine hesitant and that “movement” may be empowered due to these problems so serious that massive suspension across the EU was needed. Only the future will tell the effect of hesitancy on civilization. I’ve seen some suggestions that it may likely serve as a reservoir for the virus which not only keeps it “alive” but provides opportunity for unending variants perhaps leading to escape from current vaccines.

          1. Some idiot says:

            Hmmm… Personally, I would be more worried about the effect on “vaccine hesitancy” if the authorities did not be seen to be taking it seriously. We appear to have different points of view, but I take your point.

  60. Doug H MD says:

    were there not going to be some live virus challenge studies done? I seem to recall hearing that? any word?

    1. Doug H MD says:

      https://www.nature.com/articles/d41586-020-02821-4

      live virus trials: any results yet? Should be fast ! (once past ethics)

      1. Chris Phillips says:

        Reportedly beginning about now, having started recruitment last month. Will initially look at transmission of the original form of the virus in unvaccinated subjects, then potentially move on to evaluate vaccines (and presumably variants).
        https://www.imperial.ac.uk/news/215173/call-volunteers-worlds-first-coronavirus-human/

  61. Marko says:

    “Britain’s “one-jab” strategy is working, offering lessons for the world.”

    https://nycdailypost.com/2021/03/19/us/britains-one-jab-strategy/

    The by-the-book “two-jab” ship has already sailed in the US, but it’s not too late for Europe and the rest of the world to follow the UK’s lead on delaying the second dose. They’d also be wise to delay the rapid lifting of restrictions as the UK has done, admirably. The only exceptions to the delayed dosage strategy might be the very elderly – over 80 or thereabouts – as recent studies show they don’t respond very well to the first dose.

    1. FrankN says:

      Marko: Unlike the US and the UK, the EU, in its wisdom, hasn’t given an EUA, but a conditional, but full market authorisation. The advantage is that under an EUA most liability for vaccination damage has to be borne by the Government, while under regular authorisation it falls on the manufacturer. To the extent, of course, the vaccine is applied in the manner authorised, which includes the vaccination interval.

      As such, there is no simple way for the EU, and/or member states, to change to a “one-jab strategy”. It would require revoking the market authorisation on EU level, to be replaced by individual EUAs in all member states, Which raises not only liability problems, but also hinders cross-border cooperation on vaccination, e.g. by doctors that in Germany shall start vaccination in their private practice from April on, plus – possibly far more relevant – vaccination of company employees.

      Remember, Europe is no island, and along some borders, up to 25% of workers commute into their German workplace from abroad (e.g. France, Belgium, the Netherlands, Austria, Czechia).

      1. Marko says:

        Thanks. Yes, I can see how their hands may be tied. That’s a shame, as they need a rapid rollout.

      2. Chris Phillips says:

        Has Germany not already extended the interval between AstraZeneca doses?

    2. Doug H MD says:

      South Africas zero dose strategy is working even better!
      Snark aside, a bit early to claim one dose works dont you think. The study data from Scotland says otherwise as does that from Denmark

      1. Marko says:

        Nobody is arguing for one dose. It’s about delaying the second dose, and the results from the UK are showing they made the right choice. Canada wisely followed their lead. Other countries will, as well, I’m sure, as long as vaccines remain scarce.

        If the delayed-dosing strategy was failing in the UK, with numerous infections and hospitalizations occurring between the first and second dose, they’d know about it by now.

        1. Doug H MD says:

          if a zero dose strategy was failing in SA we would know about it too then i guess.

          1. Chris Phillips says:

            Obviously you can gauge the effect of one dose by comparing infections and deaths after one dose with the figures for those who haven’t been vaccinated – even if overall rates are falling.

        2. Marko says:

          Here’s the latest PHE report on vaccine effectiveness monitoring :

          https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/971017/SP_PH__VE_report_20210317_CC_JLB.pdf

          “… As before, we find that among those who develop symptomatic infection, risk of hospitalisation is reduced by 35 to 45% after one dose of either vaccine. Combined with the reduced risk of becoming a case, this is consistent with a vaccine effectiveness against hospitalisation which is similar to previously reported value of 80%.”

          In other words, the delayed dosing strategy is still a strong “go”.

    3. Micha Elyi says:

      Marko, your New York Daily Post headline is misleading.
      Britain’s vaccination strategy is not “one jab” (one dose). Britain is following a two dose strategy, what one might call ‘first dose fast, second dose delayed’.

      1. Marko says:

        Yes, people who only read headlines may indeed be misled. I’m not gonna lose any sleep about that.

  62. Rob Sutherland says:

    Re your posting at 4.33pm, the La Times article did not spell out the mutations in the two California variants they mentioned. Only one of those (B.1.429) features in the outdated Economist graphic but there is no info re that one on there either.

    Up here in Ontariario, vaccination is a mess! Only a week or so ago Health Canada finally OK’d the AZ vaccine for everyone over 18, but another Fed agency (NACI – National Advisory Council for Immunization) came out with recommendation to limit AZ to those under 65. This was based on lack of data showing ‘efficacy in over 65s’, despite the huge Scottish and English studies coming out some time before they made this announcement. I’d never heard of the NACI prior to this, so maybe they do indeed live under a rock!
    If that was not sufficiently confusing, the NACI also OK’d a booster delay of up to 4 months, for which there is no data AFAIK. A week later, they may have relented in the face of loads of evidence for AZ vaccine’s effectiveness in over 65s, but it is hard to keep up…..
    On top, you have the Provincial Governments doing their own thing as well. Only Quebec has followed the UK approach almost from the beginning, but now most (I think) are now following the 4 month delayed booster approach.
    Due to these and other uncertainties generated by the blood clotting issues, most lay folks are desperately trying to avoid the AZ vaccine. I would take it in a heartbeat at 70y/o.
    And now we have Biden finally sharing some of the AZ vaccine with us and Mexico that was manufactured and hoarded in the US, likely only now because some of it is now close to its use-by date.

    1. Marko says:

      Here’s a CDC page that outlines the spike mutations and attributes of the VOCs :

      https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/variant-surveillance/variant-info.html#Concern

      I think the CDC’s main concern with the California variants is that they carry a less common, so-called Class 3 immune escape mutation (L452R). Class 1, 2, and 3 designate different immunodominant regions of the spike RBD. The fear may be that a recombination event with a variant like P.1 or B.1.351, which both have Class 1 & 2 escape mutations, could result in a very potent immune escape strain. Alternatively , the California variants could evolve the more common Class 2 (E484K) and Class 1 (K417N/T) escape mutations independently.

      1. Marko says:

        It looks like the primary concern revolves around variant resistance to monoclonal Ab therapy:

        FDA HALTS BAMLANIVIMAB DISTRIBUTION IN THREE STATES

        https://www.biospace.com/article/fda-suspends-use-of-monoclonal-antibody-cocktail-in-three-states-due-to-rise-of-california-covid-19-variant

  63. Rob Sutherland says:

    Thanks for the link; better than than the graphic – lol
    All this posting is doing wonders for rehabilitating my math skills!

  64. Marko says:

    Fauci said today that B.117 now accounts for about 20-30% of infections in the US :

    https://www.yahoo.com/lifestyle/more-deadly-covid-invading-america-181003369.html

  65. sgcox says:

    Anyone knows what is the status of J&J two-doses clinical trial ?
    I guess it should be done by now. As J&J is very close to Oxford and almost identical to Sputnik so comparison between single and double doses should be transferable.
    Actually, the fact that J&J gamble and succeed with single dose trial means for for me delaying or even cancelling second dose of Oxford or Sputnik will have only minimal effect on efficacy. It just simply has not been in proper clinical trials. There was obviously no time to fine tune time interval during pandemic.

    1. debinski says:

      I read a while back (a month ago?) that they expected to have data by May on their 2 dose trial.

  66. Egil says:

    ~60% maybe against symptomatic disease, there still hasn’t been anyone hospitalized in the trial in the UK, SA and Brazil, while 15 people were hospitalized in the control group. Does anyone have a link to a source which reports confidence limits on the effectiveness of the J&J vaccine? They break their estimates up by different countries, but I have only seen point estimates, not confidence limits, and given they break their data up, I suspect they are quite wide.

  67. Dan says:

    Maybe we spend the time to learn that “one size never fits all” ? Unfortunately time and money are our real enemy when we study and try to issue a beneficial fix? So if after year of data we can better protect the vulnerable first and carefully study the less vulnerable more carefully? Deaths either way is what we fear the most?

  68. Z-iel says:

    My partners grandmother has just passed away, three days after her first injection of the AZ vaccine. Halted circulation to her hands and feet began after 2 days, thrombosis is listed on the death certificate. Her death is therefore completely out of the picture in the global assessment of the safety of this vaccine.

    Doctors refused to list the vaccine as cause of death without a full post mortem, which would have meant not being able to have the body returned for a funeral, so was chosen against. She was in her early 80’s, but her health was previously very stable, she has no known history of blood disease, or anything else. All suggests that the vaccine has killed her.

    Would someone be so kind as to explain to me how the long term effects of this vaccine could possibly be assumed safe based on limited trials, considering that in the short term it has clear potential to be deadly?

    Secondly, have any trials been made concerning the risk to the unborn if this vaccine is taken by pregnant or soon-to-be-pregnant women?

    Thirdly, is it possible that the global press, certain governments, the companies producing the vaccines and/or the major health organisations would have any incentive to limit publicity of cases of deaths happening in direct correlation to vaccinations, or is this just an outlandish idea? This kind old lady passed away in Morocco, a small village near Fez. Another elderly distant family member has suffered the same fate, dying two days after a jab given to them at the hospital despite them only going in for a standard check up of their otherwise stable health. Both these cases have fallen though the gaps of data collection in relation to the vaccine because of ‘lack of evidence’. How many more people are dying worldwide shortly after recieving the vaccine, with regional systems of data collection not being fit to purpose in assessing rates of mortality and side-effects post-vaccination?

    How possible is it that incidents of serious side effects and deaths are not being properly reported between regions, and are not being sufficiently documented in some areas? Would there be any political or economic reasons for this, or is it simply the incompetance of the pharmeceutical and major health organisations, and local institutions, in organising efficient data collection?

    Lastly, does anyone know what the profit margins are for at least the AZ vaccine, and who exactly is rolling in it?

    Side notes. She died on my partners birthday. Yes, i am throwing some layman humanisation into the mix. She was pressured into taking the vaccine by neighbours telling her that she would be in trouble with police and would have her liberties stripped if she didn’t take it. I am here to remain reasoned, but am urgently looking for reasoned answers amongst what appears to me to be a limited debate and a great deal of one-sided prerogative in the global media. I really cannot believe her death was pure coincidence. And i’m very concerned that in a desperate hope that this vaccine works well, and with the profit-motives, the fallout is being disregarded. Thank you.

    1. A Nonny Mouse says:

      This link will give you all the information reported for the UK on both the Pfizer and AZ vaccines side effects/deaths post vaccination according to the yellow card scheme (just before Annex 2).

      https://www.gov.uk/government/publications/coronavirus-covid-19-vaccine-adverse-reactions/coronavirus-vaccine-summary-of-yellow-card-reporting

      There have been more deaths in the UK post AZ rather than Pfizer, but that is generally because the AZ vaccine has been given to much older and infirmed people who are unable to get to the main vaccine hubs where they might give the Pfizer vaccine due to storage considerations.

      1. Chris Phillips says:

        I don’t think the difference between those numbers of deaths would be statistically significant (given the larger number of AZ vaccination) even if there were no difference between the populations (which I agree there will be).

    2. Cass says:

      Z-iel, I’m so sorry for your loss.

      Maybe these two anecdotes can offer some comfort or contrast to your belief that “all suggests that the vaccine killed her”: in the TWIV 720 podcast at 52:35 (,https://youtu.be/54WDQYvvcCs), Paul Offit tells about a baby who had a fatal seizure five minutes before they were about to receive a (non-Covid) vaccine, and in TWIV 728 (1:49:20 in the corresponding YouTube link), a reader tells about her friend’s elderly mother who died of organ failure a week after deciding to wait on getting the Covid vaccine. If the baby or the mother had actually been vaccinated, of course their family/friends would have suspected the vaccine to be the cause, but it would not have been true.

      That latter reader also wisely says “It’s hard to convince yourself with data when the anecdote is someone you know”, so I understand your pain. But to responsibly evaluate vaccine safety, we have to look at large datasets over anecdotes. It is inevitable that some people will have fatal heart attacks, strokes, etc, including in seemingly healthy people, and that some of those events will by chance happen soon after vaccination. These rates have to be compared to the background level in a matched unvaccinated group to detect a true safety concern.

  69. Moses says:

    @Z-iel
    I’m sorry to learn of your loss. I don’t think anyone will be able to ascertain whether this was from a side-effect of the vaccination or not, or indeed a manifestation of having Covid itself.

    Regarding: “Lastly, does anyone know what the profit margins are for at least the AZ vaccine, and who exactly is rolling in it? ” AZ have stated that they will not take any profits from the manufacture & supply of their vaccine for the duration of the pandemic.

    1. WST says:

      Correct, this is their agreement with Oxford University, vaccine sold at cost, which can be bit different in different parts of the world depending on AZ component suppliers. EU pays $2.15, SA $5.

      And this is a real problem. AZ business plan is broken, for various reasons, future profits look bleak. So AZ is not really interested in the project any more….
      EU should recognize that and pay AZ $1-$2 for every dose delivered on schedule, and thus help their bottom line and make AZ interested in proactively fixing problems, its a win-win.
      EU’s legal threats and other other coercive measures is a lose-lose.

      1. Marko says:

        “So AZ is not really interested in the project any more….”

        Link to source ?

        I think I already know the answer to that….

        1. WST says:

          I read an article about AZ European suppliers, during a visit by EU inspectors, they complained that they did not see any AZ employees or inspectors for a long time. Can’t find a source right now but will continue search.
          There was also an evaluation of AZ business model and enumeration of serious risks for the future profits.

  70. FrankN says:

    Don’t know where would be the best place to post this: A new study from Denmark:

    ” In 2020, as part of Denmark’s extensive, free-of-charge PCR-testing strategy, approximately 4 million individuals (69% of the population) underwent 10·6 million tests. Using these national PCR-test data from 2020, we estimated protection towards repeat infection with SARS-CoV-2. (..)

    Among eligible PCR-positive individuals from the first surge of the epidemic, 72 (0·65% [95% CI 0·51–0·82]) tested positive again during the second surge compared with 16 819 (3·27% [3·22–3·32]) of 514 271 who tested negative during the first surge (adjusted RR 0·195 [95% CI 0·155–0·246]). Protection against repeat infection was 80·5% (95% CI 75·4–84·5). The alternative cohort analysis gave similar estimates (adjusted RR 0·212 [0·179–0·251], estimated protection 78·8% [74·9–82·1]). In the alternative cohort analysis, among those aged 65 years and older, observed protection against repeat infection was 47·1% (95% CI 24·7–62·8). We found no difference in estimated protection against repeat infection by sex (male 78·4% [72·1–83·2] vs female 79·1% [73·9–83·3]) or evidence of waning protection over time (3–6 months of follow-up 79·3% [74·4–83·3] vs ≥7 months of follow-up 77·7% [70·9–82·9]).”

    These results give a good indication of the protection to be expected from inactivated viral vaccines (e.g. Sinopharm, Sinovac). Low protection against re-infection for 65+ is in line with reports about under 50% efficacy of Sinovac in this age group.

    https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00575-4/fulltext

    1. Chris Phillips says:

      Thanks – that’s interesting.

      Although they say their results are consistent with those of previous studies, on the face of it that’s not really true. The confidence intervals of the different studies don’t all overlap, and one from Qatar that they cite showing 95% protection really seems significantly different from their conclusion of 80% – at least when you view it as cutting the number of reinfections by a factor of four. That seems to be because in Qatar they also applied a sequencing criterion to estimate how many cases were definitely reinfections:
      https://www.medrxiv.org/content/10.1101/2021.01.15.21249731v2

    2. Marko says:

      The missing part of this study, like so many other reinfection studies :

      “One of the limitations of our study is that we could not correlate symptoms with protection against repeat infection because detailed clinical parameters are not typically recorded unless the patient was admitted to hospital due to severe COVID-19 symptoms”

      The part I’m most interested in is almost always left out. In the over-65 group , they had 31 reinfections compared to 4980 infections among the unexposed group. A significant fraction of over-65 PCR positives are hospitalized, so there would’ve been some data there to access. It would have been useful if they’d told us those numbers. The numbers may have shown significance even though the exposed PCR positive group was relatively small.

  71. sgcox says:

    So what Monsieur Macron and Frau Merkel will say now ?
    https://www.bbc.co.uk/news/health-56479462

    1. PastTense says:

      79% is much better than I expected. It is higher than the earlier flawed study; while I expected the number to probably go down–because of the substantial increase in number of variants since that early trial.

      1. Chris Phillips says:

        Here is a link to the press release:
        https://www.astrazeneca.com/media-centre/press-releases/2021/astrazeneca-us-vaccine-trial-met-primary-endpoint.html

        I think it is encouraging, given that the interval between doses was 4 weeks, which the post hoc analysis of the other trials suggested might be sub-optimal.

        The total number of symptomatic cases was 141. Given the 2:1 design of the trial, I reckon the confidence interval would be about 70-85%.

        Also encouraging to see similar efficacy in over-65s, though as those were only about 20% of participants the confidence interval there would be quite a bit wider.

        As a recipient of AZ, I am reassured by those figures.

        1. Susan Smith says:

          “100% efficacy against severe or critical disease and hospitalisation” That’s all we need to know. As for the blood clots, there have been similar safety concerns about the Pfizer and Moderna vaccines as well, they just haven’t enjoyed the same propaganda as the scaremongering against the AZ on the Continent. I think the EU did a very good job at rubbishing the AZ vaccine and now most of their citizens will not want to take it – yet they are threatening the UK with export bans – it just doesn’t make sense to me – then again, not many things in the EU make sense these days.

  72. Chris Phillips says:

    And on the same day, a YouGov poll underlines the scale of the loss of confidence in the AstraZeneca vaccine in Continental Europe. The percentage who think the vaccine is safe has plunged into the 20s and 30s in France, Germany, Italy and Spain. What a disaster for the public in those countries, on top of the bungled procurement programme:
    https://yougov.co.uk/topics/international/articles-reports/2021/03/22/europeans-now-see-astrazeneca-vaccine-unsafe-follo

  73. exGlaxoid says:

    As another trial participant, I am happy that the study gave good data, and the vaccine is at least mostly effective, more importantly, completely effective for preventing serious illness and death. I had no side effects, and was not even sure I had the vaccine until unblinded recently.

    I hope the US will approve it eventually, even though the US should have ample supplies of other vaccines shortly, but the more options, the better. But I am also happy if we give our doses to other countries that need it more. Either way, the trial worked well enough to show that it is safe and effective.

    As for blood clots, there is always the chance of side effects, but given that the first recipients of most of the vaccines were sick and elderly people in nursing homes, I am not surprised that some died, as that tends to happen in sick, elderly people. It is a sad event, but humans are mortal and we need to accept that death happens eventually to all of us. In the big picture, the vaccination will save many lives, both from covid, and from the ability to get back to dealing with healthcare (and other things) in a better manner than the last year, which has a huge challenge.

  74. Marko says:

    List of states to watch in the developing upturn in cases :

    https://twitter.com/AndrewMakeTweet/status/1373953272868958209

    Concentrated in the Northeast, Mid-Atlantic, and Upper Midwest. The situation should become much more clear in the next 1-2 wks. I suspect a few states may tighten their restrictions in response, but most will wait until it’s too late, as usual. Thankfully, we’ve upped our game on vaccination rates in the US, getting close to 1% of the population per day recently.

    1. Marko says:

      New upturn also showing up already in some of the hospitalization data, most notably Michigan:

      https://twitter.com/reichlab/status/1374087846441713664

    2. Marko says:

      New U.S. COVID-19 cases show weekly uptick for first time since January

      https://www.reuters.com/article/us-health-coronavirus-usa-trends-graphic/new-u-s-covid-19-cases-show-weekly-uptick-for-first-time-since-january-idUSKBN2BE29K

      “Thirty out of 50 states reported more new infections in the week ended March 21 compared with the previous seven days, up from 19 states in the prior week, according to the Reuters analysis…..Hospitalizations have fallen for 10 weeks nationally, but they are rising in 18 states, up from four states the previous week….”

  75. Marko says:

    Mumbai, like Manaus an area with presumed high seroprevalance, is also experiencing a major new surge in cases:

    https://twitter.com/muradbanaji/status/1373944575564341254

  76. Marko says:

    Immune-escape variants we miss when we only look at antibody :

    Interferon Resistance of Emerging SARS-CoV-2 Variants

    https://www.biorxiv.org/content/10.1101/2021.03.20.436257v1

    “…Our data revealed increased interferon resistance in emerging SARS-CoV-2 variants, indicating that evasion of innate immunity is a significant driving force for SARS-CoV-2 evolution. These findings have implications for the increased lethality of emerging variants and highlight the interferon subtypes that may be most successful in the treatment of early infections.”

  77. Marko says:

    Risk of reinfection after seroconversion to SARS-CoV-2: A population-based propensity-score matched cohort study

    https://www.medrxiv.org/content/10.1101/2021.03.19.21253889v1

    “In conclusion, documented SARS-CoV-2 reinfections were exceedingly rare, with an
    incidence of 0.3 infections for every 1000 persons-week, and none were severe.”

    94% protection against reinfection, lasting >8 months. Included elderly and comorbid subjects.

  78. Marko says:

    Persistence and detection of anti-SARS-CoV-2 antibodies: immunoassay heterogeneity and implications for serosurveillance

    https://www.medrxiv.org/content/10.1101/2021.03.16.21253710v1

    Bottom line: Many serosurveys are junk because they use junk assays.

  79. Danish vikingj says:

    Early in trails, there was one instance of an adverse reaction to the AZ vaccine. Is it known if this reaction was thrombosis?

    https://www.statnews.com/2020/09/08/astrazeneca-covid-19-vaccine-study-put-on-hold-due-to-suspected-adverse-reaction-in-participant-in-the-u-k/

    1. Mariner says:

      It was transverse myelitis, I seem to recall. Don’t that should be anything to do with thrombosis, though I am not a medical professional! They also had another suspected case which turned out to be the onset of MS.

  80. Marko says:

    COVID-19 hospitalizations in Michigan surge 800% in March among people 40-49 years old

    https://www.freep.com/story/news/local/michigan/2021/03/24/michigan-covid-young-people/6983313002/

    “The group said Wednesday that from March 1 through Tuesday, hospitalizations increased by 633% for those aged 30 to 39……The association’s report said hospitalization rates decline as the vaccination rates per age group increases, underscoring the need for vaccinations. For example, hospitalizations are increasing by only 37% for those age 80 and older, and in Michigan 44% of the population age 80 and older are fully vaccinated…”

    It seems like they should have a better coverage rate in the 80+ group than 44%. Hopefully, most of the rest have received their first dose.

  81. JS says:

    FYI, the Danish health authorities have just extended the AstraZeneca vaccine pause by another 3 weeks for a total of 5 weeks.

  82. Marko says:

    Good sequencing graphic from Luxembourg showing that B.1.351 still expands and maintains ~20% proportion , even as B.117 becomes dominant and crowds out the other lineages. This wasn’t supposed to happen, according to Topol :

    https://pbs.twimg.com/media/ExWRc9JXIAIwnW7?format=jpg&name=small

  83. My mum suffered a massive stroke, due to a clot in the brain, 6 days after receiving the AZ vaccine. I do not believe she has been included in the figures. It should be those having a clot 28 days after the vaccine as with the virus recording cases.
    She was not asked any questions at the hospital about the vaccine and I do not believe it was recorded, despite me volunteering the information.
    How do I find out how the clot victim figures are collated. ?

    1. Moses says:

      You could look on the C-19 Zoe website for information, I think its run by Imperial.

    2. Moses says:

      You should also ask again on the updated Pipeline thread as more informed readers will be likely to see it:
      https://blogs.sciencemag.org/pipeline/archives/2021/03/30/blood-clots-and-the-az-vaccine-revisited

    3. JJ says:

      If you are UK then you can use the Yellow Card scheme to report this incident. However, the hospital or her GP may have reported the circumstances of this death. Data is anonymised in published reports as this is confidential.

      https://yellowcard.mhra.gov.uk/the-yellow-card-scheme/

      Sorry about your mother. Best wishes.

  84. Juan says:

    Please consider this hypothesis that is easy to test, it is based on the presence of the signal peptide (SP) of Tissue plasminogen activator (tPA) in the Astraseneca vaccine. This in my opinion is a serious principle mistake. Do not vaccinated with autoantigens unless you desire an autoresponse, even if it is just a signal peptide.

    1. An individual X has developed anti platelet factor 4 (PF4) autoantibodies.

    2. X is vaccinated with anti Covid19 Astraseneca vaccine.

    3. X responds to tPA SP and attacks vascular endothelial cells expressing tPA. Platelets assist in the response.

    4. In the inflamatory context of attacked endothelial cells, PF4 binds heparan from endothelial cells and is recognized by antiPF4 antibodies previously present.

    5. Spontaneous HIP develops.

    For this to be true:

    1. antiPF4 antibodies should be present. They have been detected a posteriori. In late unset they might be induced.

    2. Endothelial test should be attacked. This needs to be investigated.

    3. There most be a response to tPA SP. To be tested.

    4. Endothelial Heparan-PF4 must be recognized by antiPF4 antibodies. To be tested.

    As with regard to J&J. Here comes the paranoia. Suppousely, the antigen does not carry the TPA SP, but it was present among their candidates tested in rhesus. It is possible, the wrong antigen was used. Although improbable, they already made a mistake and 15 million doses were retired from production because, as reported, it was exchanged with Astraseneca vaccine??? Sorry, but I think every thing should be considered and production and vaccine samples should be sequenced at all stages, from all facilities.

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