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Covid-19

Getting Vaccinated

So as I mentioned on Twitter yesterday, I’ve now had my first coronavirus vaccine dose (Pfizer/BioNTech). Since I’ve been writing about the mRNA vaccines for months here and cheering on the vaccine efforts in general, I can tell you that I’m very, very happy to be able to follow through and actually take one. So far, the only signs are a sore upper arm – we’ll see later this month what the effects of the second shot are.

I wondered if I should even mention this, to be honest, because with the vaccine supplies continuing to ramp up, it’s (fortunately) no longer such a rare event to get vaccinated. States all over the country are opening their programs up, in many cases to anyone who wants to come in, which is excellent news. But I decided to make the public statement, in light of the continued emails and comments I get about the vaccinations in general. There are a lot of people out there still worrying about a lot of things: antibody-dependent enhancement, short-term immune reactions, possible long-term side effects, CNS penetration, and more. And those are just the worries that are founded in actual medical science – beyond those, you have the Bill-Gates-George Soros-microchip crowd, the 5G activists, the mark-of-the-beast fringe, and who knows what else. Fortunately, we don’t get too many of those folks around this site, but I know that they’re out there.

For people who are honestly wondering about real immunological issues, though, I wanted to say that as someone who’s been doing drug discovery work for over 30 years now, and who has been covering the vaccine developments in detail with great interest during the entire pandemic, that I had no hesitation about rolling up my sleeve. I weighed the risks and benefits as thoroughly as I could, with all the medical knowledge that I could bring to bear on the decision, and my decision was clear: get the vaccine. My wife has been vaccinated, my college-aged children are getting vaccinated (my son a few days ago in another state, my daughter tomorrow), and my wife’s mother is way out ahead of us with both her shots done some time ago. In short, I am very, very willing to take this step and have my closest family members do likewise – and I take their health and safety very seriously indeed (not to mention my own). If this can be of any use in helping to persuade someone who’s worried and on the fence about this decision, I’m happy to offer it.

The AstraZeneca/Oxford vaccine is not available in the US, so I didn’t have to make that call. My first choice was either of the mRNA vaccines, because I have been very encouraged by the real-world data (both safety and efficacy) coming out of the Israeli rollout of the Pfizer/BioNTech one, and I believe it and the Moderna vaccine are functionally equivalent. But I agree with this thread by Angela Rasmussen, who got the J&J vaccine: the differences (if there are differences) between that one and the mRNA ones is nothing compared to the difference between getting a shot and not getting one at all.

I will have no immune protection from this shot for at least another ten days. That’s the minimum time it takes to raise a protective adaptive immune response, and the clinical trial data have shown this effect very clearly. And I still have another shot coming up in three weeks, of course. I am continuing to wear masks when I’m out in public, except when I’m walking around outdoors without any other people close by (and I’m fortunate enough to live in an area where that’s not hard to do). But even after the second vaccination, I’m still not yet going to be hopping into crowded stores, going to the movies, or hanging out in any airports or train stations just yet. I’ll make those decisions on the basis of the case numbers where I live – the more they drop, the happier I will be about doing those things and more. It will be a great relief during this transition to know that I have more protection than just a mask and some physical space on my side, for sure – but we need to keep that behavior up until a much higher percentage of the population gets vaccinated and we can see clear signs of the pandemic receding. The more careless we all are, the better the chance of raising a variant form of the virus that could erode the advantages that we’re getting by vaccinating in the first place, and we have got to avoid that.

And that means that we have to get the rest of the world vaccinated as soon as we can, too. I’m very glad to see J&J setting up a deal with the African Union for 400 million doses, and I’m cheering on countries like Bhutan and others that are doing serious mass vaccination campaigns with their entire populations. South America needs a lot more help than it’s getting, though, and India and other countries are in vaccination races against the variant strains as well. The supplies of existing vaccines have been ramping up spectacularly, and more are coming – I think that the timetable for worldwide vaccination can and should advance in front of current estimates, and the faster that happens, the better. We – the human species – have our chance right now, and we need to take it.

225 comments on “Getting Vaccinated”

  1. Some idiot says:

    Amen. I had my second Pfizer/BioNTech shot a couple of weeks ago, and I am still using masks, keeping distance, and being tested 1-2 times a week, and will continue to do so until the authorities say it is no longer necessary.

    1. Zambo says:

      I get taking the other precautions (especially as masks, distancing, etc. are still mandated in a lot of states), but is getting tested multiple times a week really necessary? Seems to me like a waste of time/resources, unless your job requires it.

      1. Some idiot says:

        Good question… I will put it this way…

        1) The fact that I am vaccinated does not mean that I cannot be infected, nor does it mean that if I am in infected, I cannot infect others (although the chances of both of these are much lower of course). Therefore, I would like to minimise these risks (particularly to other people).

        2) I live in Denmark, and the testing system here works pretty well. There are PCR tests of roughly 5 % of the population daily, and a similar number of antigen “quick tests”. The capacity is very high, and the authorities urge people who leave their homes for work to be tested once weekly (and front-line workers, eg nurses, teachers etc) should be tested twice weekly. In addition, most of the positive PCR swaps are also sequenced, which allows for detailed mapping of variants. In short, there is no shortage of tests, and they are easy to book and get to.

        3) My workplace firmly recommends that all those who meet up for work get tested once a week (precisely to make sure that any outbreak here can be controlled quickly; fortunately, there has been none so far), and they have an on-site testing unit here once a week. I get tested here.

        4) On occasions (not frequent) I am engaged in some other activities, and the requirement there is that you have a negative PCR test that is less than 72 hours old. In which case I occasionally need to get a second test in a week to make sure I am covered.

        To sum up: I get tested because (a) my work recommends it, (b) the authorities recommend it, and (c) if I were to be infected, my test will help to map the variants in circulation. And (d) there is ample capacity, so I am not “taking a test away” from someone else.

        My guess is that when we get over a certain vaccination threshold, and particularly when all vulnerable people have been vaccinated, then the authorities will probably say that there is no need for vaccinated people to get tested (unless there is an outbreak “close” to them). And something similar at work, I would guess. At that time I will stop getting tested.

    2. Bill says:

      I’m fully vax’d and don’t believe masking serves a purpose regards my risk to others or my risk from others. But I continue to wear the mask in all appropriate conditions.

      The vast majority of the US is not fully vaccinated. It is critical to the ongoing health of the population that such people follow public health guidelines. I believe that many people who wear masks, do so because they’re expected to and would stand out should they forgo. I.E. peer pressure.

      If all of us who get vaccinated stop wearing masks, it will serve as an empowerment for those who need to, to stop. They will no longer stand out. And public health will suffer as a result. Give it a couple months — three tops. Masks will drop like flies.

      1. Belgian Grad student says:

        Well said!

  2. luysii says:

    Of course the scientifically literate readership of this blog will get vaccinated. Looking at this from the perspective of a physician concerned with the general health of the public, we have a huge problem getting the people who need vaccination the most (minorities, the working class) to accept it. The problem is very real and is out there. The link contains a possible solution.

    See — https://luysii.wordpress.com/2021/04/01/minorities-on-course-to-win-the-darwin-awards/

    1. dearieme says:

      He uses the expression “the minority community”. Is that a euphemism for something? Or is it just that “community” has lost all meaning?

      I ask as a foreigner who finds it hard to keep up with fashions in these matters.

      1. luysii says:

        Dearieme: Yes, there are semantic landmines in the term ‘minority community’. Current USA usage means essentially Blacks and Latins. Asians, those from the Indian subcontinent and Jews are usually excluded, even though statistically they are smaller minorities than Blacks and Latins. Your guess is as good as mine as to why this is so.

        1. metaphysician says:

          My cynical take: its because those who want to speak for “the minority community” want to pretend that there is a *single* ‘minority community’, both because that makes life simpler and because it increases their perceived importance and influence, due to speaking for more people. Admitting that just because you don’t have white skin doesn’t mean you have identical culture experiences, ideological goals, and ongoing challenges? Would mean admitting that no one person can “speak for” everyone.

    2. charlie says:

      Your idea (report at death whether person was vaccinated) is exactly what we need.

      We won’t get it.

      1. aviators99 says:

        What do you mean “whether or not” a person was vaccinated? If they died from COVID, they were not. So far. As soon as the first vaccinated person dies from COVID, it’ll be all over the news.

        1. L Holmes says:

          Three fully vaccinated people in Michigan have died, ostensibly from Covid. Or so says our local newspapers. (I’m in Michigan.) Two were three weeks out from their second shot. No further info has been given. https://thehill.com/homenews/state-watch/546953-michigan-officials-found-only-246-covid-cases-among-fully-vaccinated

          1. luysii says:

            L Holmes: According to Michigan state statistics there are 8,096,917 people over 16 in Michigan. 37.7% of them have been vaccinated or about 3 million. There have been 17,632 deaths from COVID19 in Michigan. It is likely that these 3 cases came to attention because they are so unusual. No one has claimed the vaccines will prevent ALL deaths. Unless a lot more cases like these 3 come to light, the numbers actually show the vaccine is working and working well.

            It would be so simple if state departments of health mandated that hospitals had to report the presence or absence of vaccination on all COVID19 deaths. Remember all the reporting we’re seeing presently is due to regulations put out by state health departments. The legislature did not have to meet. The governor did not have to do anything. Having practiced medicine under a variety of state health departments, I can assure you that they love to make rules.

          2. theasdgamer says:

            What is it–between 1 and 10% of adverse outcomes from the vax get reported?

          3. theasdgamer says:

            lucy,

            you aren’t sticking to the thread

        2. anwaya says:

          I expect they’ll be Canadian, where the interval between 1st and 2nd doses is currently 16 weeks. There is no evidence – a letter by MDs to the BCMJ says – that this delay is workable, no evidence that the second dose confers lasting immunity.

          I think the lesson of MRSA is that this could be worse than no vaccination.

          https://bcmj.org/letters-covid-19/updated-look-16-week-window-between-doses-vaccines-bc-covid-19

          1. Marko says:

            Yet those same MDs, in that same letter, conclude by saying :

            “…Although there is a lack of data to directly support a 16-week gap compared to shorter intervals, in the current setting of vaccine scarcity, it appears reasonable to accept the risk of an extended dosing interval in order to more rapidly provide protection to a greater proportion of the population. Vigilance will be key in determining whether this practice can continue safely while vaccine supply is limited; if the extended gap is found to put those waiting for dose 2 at excessive risk, then a shorter interval would need to be reconsidered. ”

            If vaccine doses were not scarce, this wouldn’t be an issue. Unfortunately, they are scarce, so you try to protect as many people as best you can. If the data suggests otherwise, you change the policy, but the UK experience to date, as well as basic immunology, suggests this won’t be the case.

          2. theasdgamer says:

            If people weren’t skipping their vaxx appointments, doses would be more scarce.

    3. theasdgamer says:

      What is it–65% of the medical community doesn’t want the vaxx?

      I guess they aren’t “scientifically literate.”

      1. Marko says:

        Still pulling numbers out of your butt, I see. Some things never change.

        This Kaiser survey shows much lower reluctance to get vaccinated, and , as you’d expect, the most educated are the most likely to get the vaccine. The choir you’re preaching to are the dummies :

        https://www.washingtonpost.com/politics/2021/03/19/yes-vaccine-skepticism-exists-among-health-care-workers-far-less-so-among-top-medical-professionals/

        “…The biggest gap in the poll, though, is in education. While 24 percent of those with less than a bachelor’s degree say they don’t plan to get the vaccine, that number is just 11 percent for those with college degrees and just 8 percent for those with postgraduate degrees…”

          1. Marko says:

            Oh, I see, you’re using Ohio nursing home staff to represent the “scientifically literate” medical community. Let’s see what they’re reading to attain that literacy :

            https://health.wusf.usf.edu/health-news-florida/2021-03-15/covid-cases-plummet-83-among-nursing-home-staffers-despite-vaccine-hesitancy

            “…In southwestern Ohio, Kenn Daily runs two Ayden Healthcare nursing homes. About half his staff and 85% of residents got vaccinated by mid-February, he said, and they haven’t had a case of COVID since. Still, he said, vaccine resistance persists among younger staffers who read misinformation online. “Facebook is the bane of my existence,” Daily said. Workers tell him they worry that “they’re going to microchip me,” or that the vaccine will change their DNA.”

            These are the people you choose to hold up as your informed sources in the medical community?

            Go back down your Q-Anon rabbit hole, where you have a more gullible audience.

          2. theasdgamer says:

            Marko, it’s people like you who are the easiest to fool–you follow the “experts” instead of the science.

    4. UserFriendlyyy says:

      Hard to understand why anyone you are calling to dumb to reproduce would be skeptical of your advice. It’s not like we live in some bizarro world where elites routinely get rewarded when their greed and incompetence kills millions of people….. Like Wall Street in 2008 or Purdue Pharma with Oxycontin, or Epstine and his pedofile Island.

      Conservatism consists of exactly one proposition, to wit:

      There must be in-groups whom the law protectes but does not bind, alongside out-groups whom the law binds but does not protect.

      Since neither of our hardcore right wing conservative legacy parties has even the slightest desire to change that you would have to be a moron to trust any expert.

  3. Robert says:

    Living in Switzerland and having relatives and many colleagues in the US who already got vaccinated, I can’t help myself but being jealous of you guys over there… My wife and myself are part of the group 6 out of 6 (<50, working from home, no contact with healthcare workers or other people, no pre-existing conditions) and as such we will probably get the first shot towards end of summer… So frustrating!
    Thanks Derek for the blog and keep up the good work!

    1. I would be glad to swap passports with you.

  4. Moran says:

    I am happy for you Derek that you have managed to get the vaccine that you have wanted. Unfortunately, however, more and more people are denied the right to make their own medical choices (unless they are willing to lose their job and starve to death, which is hardly a real option). I think this is much more important, and will have a much more significant impact on the future of humanity than the scientific question of how safe and/or effective is each kind of vaccine.

    I constantly hear people arguing that a person who refuses to take the vaccine endangers their friends, and should be thrown out of society. Regardless of whether this statement (which I do not agree with) is true, the same logic can be used, for example, to justify legally force people to donate kidneys. Is this the path that we want to follow?

    BTW, personally, despite strongly not wanting to have anything to do with the vaccine, I am going to get vaccinated next week because I am simply at the end of my rope. Regardless of whether you agree with me or not, I am sure that you can imagine how does it psychologically feel like.

    1. P says:

      Who exactly is compelling you to get vaccinated? Where do you live / what job do you work?

    2. Dr. Seymour Tushi says:

      You misspelled Moron

    3. SirWired says:

      Just like you have the freedom to refuse the vaccine, your employer has the freedom to make the decision that it is important to their business to use a vaccination mandate to protect other employees (some of whom may not be able to be vaccinated) and customers/the public from a serious contagious disease.

    4. Martin says:

      Kidney donation does not protect anyone from you. Protecting others from you is a different matter than making you actively improve the health of others through organ donation.

    5. John Wayne says:

      I’ve never heard of anybody being compelled to take the vaccine to continue working. Being fairly familiar with employment law, my guess is that this is wildly illegal. For example, I know an ICU nurse that turned down the vaccine; they are still working in an ICU.

      1. Riah says:

        Israel and New Zealand have made it a requirement for employment. People are losing their jobs in Israel and can’t use theatrs, gyms and even some grocery stores if they are not vaccinated. 16 years olds are prevented from taking their matriculation exams if they are not vaccinated. Matt Hancock, here in the UK, is trying to force through laws that compell care home staff to be vaccinated – or lose their job.

        Ireland has a new regulation from 10 April criminalising vaccinated people who dare have unvaccinated people from another household in their house. Unvaccinated people are not allowed to have anyone from another househild in their house. Wecome to medical faschism. And people wonder why there are conspiracy theories. Does anyone actually think this is OK? This is only going to get far far worse and people that have ramped up fear to hysterical levels without looking at the real data and facts have allowed it to happen.

        1. WST says:

          Could not find a trace of the new Irish mandatory vaccination law, do you have a link to Irish governmental site abut it ?

          it looks like a fake news.

    6. Big Fool says:

      This Supreme Court ruling has never been overturned, and has been used as a precedent countless times. Granted, this was not about an EUA vaccine, which attorneys state might place the Covid vaccines in a different category.
      Donating kidneys is not about protecting society in general, and no one will force you to do so. Not getting vaccinated (or refusing to wear a mask) is in the same light as yelling fire in a movie theater, according to the Supreme Court.
      “The liberty secured by the Constitution of the United States does not import an absolute right in each person to be at all times, and in all circumstances, wholly freed from restraint, nor is it an element in such liberty that one person, or a minority of persons residing in any community and enjoying the benefits of its local government, should have power to dominate the majority when supported in their action by the authority of the State.”
      “It is within the police power of a State to enact a compulsory vaccination law, and it is for the legislature, and not for the courts, to determine in the first instance whether vaccination is or is not the best mode for the prevention of smallpox and the protection of the public health.”
      https://supreme.justia.com/cases/federal/us/197/11/

    7. FoodScientist says:

      Getting vaccinated has never been mandatory. Even during pre-covid flu season for in-patient heal care workers. They always had the option to always wear protective equipment or get vaccinated. How did you really think it works with ICU nurses during flu season?

      This is by no means a new issue. More people are now considering it.

    8. Not-an-epidemiologist says:

      “Regardless of whether you agree with me or not, I am sure that you can imagine how does it psychologically feel like.”

      I’m sorry you’ve received a lot of pretty derisory and unhelpful replies; I can imagine how awful it would be to feel you’re being coerced into a medical procedure that you distrust or disagree with. I do understand that this is quite different from “normal” prescriptive activities like wearing seatbelts.

      Personally, I see getting vaccinated both as a means of protecting everyone around me, and as a means of helping the world return to some semblance of normality. The fact that I’m helping ensure I reduce my own chances of falling seriously ill is an added bonus, but I’m certainly glad for it. I hope as many people as possible feel the same way as I do. But my desire to see this happen shouldn’t compel anyone who does not wish it to be vaccinated.

      1. Iain Flynn says:

        Surely a better analogue to the situation of somebody not wanting to get vaccinated irrespective of the costs that will impose on everyone else in society, including their deaths and continued lockdowns and masks, is not being able to smoking in a restaurant. Or, to take a more extreme example, not driving on the right side of the road (the left in the US or most other countries), or not drinking and driving. People do not have an inalienable right to harm others in (I guess) all jurisdictions. It may be unpalatable to coerce or even force people to be vaccinated, but that’s a lesser evil than allowing the virus to continue to spread at great societal cost.

    9. me says:

      “Thrown out of society to protect everyone else”. Sort of like not allowing someone who doesn’t like brakes in their car from driving? Or like not allowing someone without training from flying an airplane?
      Or someone who doesn’t wash their hands from preparing food?

      This absurd rant, looks disturbingly like poorly done Russian misinformation.

  5. Sagar says:

    What would you suggest to those for whom AstraZeneca will be the only choice for several months at least?

    1. Moses says:

      @sagar
      I would say, get vaccinated.
      The incidence of side effects is at the 1 in a million rate, the risk of covid much greater

      1. JF says:

        Your claim about side effects being <1ppm is patently wrong. They had two cases in the small Euskirchen county (<194k inhabitants) alone. And these two cases (among which there was one fatility) came from a small group of women younger than 50 who were vaccinated early because they worked in hospitals. Precise numbers on that seem to be unavailable, but for the group of women younger 50 the risk seems to be substantial.

        1. Some idiot says:

          Hmmm… I can’t comment on the case you mention, but…

          EU experience suggests that incidence is roughly 1 in 100 000; UK maybe a bit higher (like 1 in 1 000 000. But these are rough numbers, and it cannot be otherwise at the moment, since there are relatively few (like relatively few million) people vaccinated at the moment. Therefore, trying to get accurate numbers on quite rare side effects (I am not discounting them; they are just rare) early on in the use of _any_ medicine/vaccine/procedure/whatever is pointless. For the first: these are not “controlled studies”, so there are likely to be confounding factors (such as male/female? age? pre-existing conditions? genetic factors?) which are going to make non-controlled comparisons almost useless.

          The other thing is, that statistics being statistics, you know that you will start to see clusters pop up, and some of these clusters will just be coincidence, and so don’t mean anything. Note that I’m _not_ saying that the case you mention doesn’t mean anything, but rather, that looking at much larger data sets is the only real way of trying to make sense of what is going on. And as far as I can see, the two biggest data sets are currently the UK and the EU. And their numbers suggest an incidence of somewhere between 1:1 000 000 and 1:100 000. But the number of cases is so low it is difficult/impossible to be more precise. So I usually use the 1:100 000 number in order to have a “worst case.”

          The data from the EU _suggests_ (as far as I last read) that the cases seem to biased towards lower age, and female. However, whether or not this is “real”, or just an artifact of the (happily) relatively small case numbers is a question for someone who knows more about this sort of thing than me…! 🙂

      2. theasdgamer says:

        uh, no, the risk of covid is about that of a cold–about like the risk of dying from a car wreck on your way to work

        1. No games says:

          theadsgamer says “the risk of covid is about that of a cold–about like the risk of dying from a car wreck on your way to work”

          Fortunately for us, genuine scientists have studied the risk of Covid relative to driving and have published their findings, so we don’t have to trust the words of mendacious liars who pull figures out of where the sun don’t shine.

          “The estimated age-specific IFR (infection fatality rate) is very low for children and younger adults (e.g., 0.002% at age 10 and 0.01% at age 25) but increases progressively to 0.4% at age 55, 1.4% at age 65, 4.6% at age 75, and 15% at age 85….

          These results indicate that COVID-19 is hazardous not only for the elderly but also for middle-aged adults, for whom the infection fatality rate is two orders of magnitude greater than the annualized risk of a fatal automobile accident”

          From “Assessing the Age Specificity of Infection Fatality Rates for COVID-19”, DOI 10.1007/s10654-020-00698-1

    2. Eric says:

      Take it, obviously. Why wouldn’t you?

    3. Derek Lowe says:

      The blood clotting problems seem to be real, albeit at very low incidence rates. This would be a decision based on what your local coronavirus levels are like, what your tolerance is (or still is!) for masking and distancing as an alternative, and the possibilities for other vaccines to eventually show up. . .

      1. Eric says:

        Official guidance here in the UK is that if you are <=30 they will do their best to get you something different. For other ages the benefits are still perceived to outweigh the risks at current, relatively low, prevalence levels. The risk of a blood clot was stated at about 1 in 250000. For most people, the risk from Covid is a lot worse than that. The risk of a blood clot from the oral contraceptive is also higher and an awful lot of people take that for non-life-saving reasons.

        There is some evidence that the JnJ vaccine also causes similar clots, but there’s less data at the moment.

        1. Cc says:

          Since it seems to be mainly young women suffering from these clots, has there been any investigation into links with the contraceptive pill?

  6. Prairie Seeker says:

    Thanks for acknowledging that you live in a society. This confers upon you many benefits. But, alas, it comes with certain responsibilities and limitations. In short, you surrender a degree of personal freedom for the greater good. It is clear that we all collectively benefit from mass vaccinations. While I don’t personally feel that getting the jab infringes upon my “freedom”, you clearly do. So on behalf of “society”, thanks for taking one for the team.

    1. Utilitarian says:

      “In short, you surrender a degree of personal freedom for the greater good.”

      Stalin and Mao are in strong agreement with you. How much surrendering of personal freedom for the greater good should we sacrifice? Just a simple utilitarian calculation? In that case, I have a great idea! There are hundreds of thousands of prisoners in our criminal justice system who have a documented history of violent and antisocial behavior. Even if they get out of prison, society will be lucky if they come close to breaking even as economic contributors. Most likely they will cost society much, much more than they ever produce. Why not just put the healthy ones in a random lottery and solve our shortage of donor organs? The utilitarian calculus is totally clear on this one, yet no one is suggesting we do such a thing. We give productive, law-abiding citizens a new lease on life, and remove the $60k/year it costs to imprison an inmate plus whatever drag they have on society when they get out.

      So maybe there are some inalienable principles that most people hold, that no utilitarian “for the good of society” argument can dent? Or we could be like China and treat people as variables in an equation.

      1. Dionysius Rex says:

        Being murdered hardly qualifies as losing a (small) degree of freedom you utter nutjob.

      2. a says:

        You are presumably also against “infringements of freedom” like sewer systems, seatbelt wearing in cars, prohibitions on smoking indoors etc.

        Libertarian bullshit will doom the human race and the biosphere.

        1. Try Harder says:

          There are many states that do not mandate helmets for motorcycles and allow smoking indoors, and the world has not ended. And you can live in a neighborhood that runs off septic if you don’t want to use the sewer system.

          1. Elliott says:

            Such places even provide a positive benefit to society. They increase the number of organs available for donation to those who need transplants.

      3. Derek Lowe says:

        What are your thoughts on seat belts? Paying for state auto inspection? Vaccination requirements for primary school registration?

        1. theasdgamer says:

          Seat belts restrict freedom very little and almost never result in harm. Our certainty about this is high.

          You can’t say the same for the vaxx because testing was rushed and steps were skipped. Our certainty about the vaxx’s is low.

          Reactions to the vaxx will be seriously underreported.

          1. Chris Phoenix says:

            Much of what theasdgamer says about vaccines is demonstrably false, including this comment. I wish we had stronger standards of accountability for spreading deliberate or deliberately clueless falsehoods.

          2. Chris Phillips says:

            It’s depressing to see the amount of anti-vaccine drivel being posted here now.

            Sometimes I think the human race will be too stupid to survive for much longer.

          3. Wake up sheeple says:

            Where’s the double blind trial for seatbelts? You’re being sucked in by big harness

          4. theasdgamer says:

            There are way too many credulous idiots posing as people knowledgeable about science.

            Any fool can see that a vaxx that was adequately tested wouldn’t need extra legal safeguards for pharma.

    2. Georgey Tenetey says:

      “…the needs of the many outweigh the needs of the few, Or the one.”

    3. Simon says:

      With regard to vaccination, where are the “my body my choice” crowd?

      1. Jo Jo says:

        This is just a stupid comment. Someone else’s pregnancy (or abortion of said pregnancy) doesn’t have the potential to endanger my health, where as their unwillingness to get immunizations does. Go troll somewhere else; this forum tends to have relatively high quality discourse, and you aren’t adding to it.

        1. Vader says:

          The baby could not be reached for comment.

        2. Simon says:

          I’m just trying to point out the hypocrisy here. None of the people who have concerns about the safety of covid19 vaccination is aimed at killing anyone. But every abortion is intended to kill someone.

        3. theasdgamer says:

          He had a point, but it couldn’t pass the minimal slope of your forehead.

          1. Simon says:

            LOL, can you put out an intelligent argument, rather than personal insult?

  7. HopefulCanuck says:

    Hopefully, as the US reaches whatever max vaccination will be (60% 70%, …?), it will allow vaccines other than AZ to be exported. Similarly for the UK. As many/most of the countries lack internal manufacture capabilities, vaccine nationalism has been a real problem. Probably should have beed expected after all of the dancing last year involving PPE, but it’s way easier to turn a hockey facemask into a medical one that conjure up a vaccine plant.

  8. boldstripe says:

    I’m a US citizen and resident who found themselves in the United Kingdom as vaccines started rolling out. By May 1st, 2021, I will be two weeks beyond my second AstraZeneca injection. If the AstraZeneca vaccine is still not FDA approved by then, what will be my vaccine status in the US: fully vaccinated or not?

  9. dbp says:

    I am around the same age and have no hesitation in getting the vaccine. My appointment is tomorrow. For someone like me, it’s as simple as comparing potential side effects (minimal to none and temporary) against a small chance of death or a slightly higher chance of health complications. If I was young, I might make a different calculation since the chance of death or health problems are just as remote as possible side effects. If I got it, it would be more out of an effort to be a good citizen than any personal benefit.

  10. Jack Komisar says:

    On Monday, the New York Times published an article about a low-cost COVID-19 vaccine that
    could be made by many countries that currently need to import COVID-19 vaccines. It was designed by Jason McLellan and his coworkers at the University of Texas. The vaccine is made by genetically-engineered Newcastle Disease Viruses grown in chicken eggs. The vaccine is entering clinical trials in Brazil, Mexico, Thailand, and Vietnam. Here is the link:
    https://www.nytimes.com/2021/04/05/health/hexapro-mclellan-vaccine.html

    1. Derek Lowe says:

      That one’s coming up in the next “Vaccine Roundup” post, for sure.

  11. FrankN says:

    Derek, you say: “I’m very glad to see J&J setting up a deal with the African Union for 400 million doses.”

    Actually, I am not – to the opposite:

    1. “Ad26 seroprevalence was 43.1–53.2%, 66.2%, 67.8%, and 54.6% in adults in South Africa, Kenya, Uganda, and Thailand, respectively. ”

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3138857

    In view of these figures, I am quite sceptical whether the Ad26-based J&J vaccine will be able to achieve more than 50-60% efficacy in Africa (or at least Southern and East Africa). Their Phase 3 results from South Africa were anything but encouraging in this respect.

    2. J&J’s Ebola vaccine, currently rolled out a/o in Rwanda and parts of the DRC, is also Ad26-based, as are a number of other J&J vaccines currently in clinical trial, e.g. against Malaria or HIV.
    Mass rollout of the J&J CoViD vaccine risks failure among those already vaccinated against Ebola. Even worse, it may be detrimental to any vaccination efforts against Ebola, Malaria or HIV.

    Don’t get me wrong. I think, the J&J vaccine is quite good, when applied in regions with low Ad26 seroprevalence and Ebola/ Malaria risk, respectively. Balkans, Ukraine, Caucasus and Central Asia, for example – all so far massively under supplied with vaccines. Or Latin America (which, however, AFAIK hasn’t been studied yet for Ad26 seroprevalence).

    But for vaccinating Africa, and also South East Asia, I deem it the worst of all possible choices.

    1. Derek Lowe says:

      That’s a good paper on this subject, but I note that it ends up recommended proceeding with Ad26-platform vaccines in these regions, though.

    2. Big Fool says:

      And yet the J&J vaccine had a 64% efficacy in South Africa in the addendum submitted to the FDA with the briefing. Can anyone make any sense of that, with that high a prevalence of that adenovirus?

  12. BV says:

    April 1: “Mysteries in human RNA”: only a few years ago we didn’t know anything about ncRNA and relatives! Even now it’s a huge black box!
    April 7:”I sure am glad I’m being shot full of those things we don’t understand very well at all!”

    I’m glad Derek has made so many statements on his blog thanking the former administration that made it all possible though.

    1. Jonathan B says:

      Which former administration? Derek has given interesting accounts of the history of the development of mRNA vaccines, but has tended to credit the scientists rather than the governments in power at the time. However a lot of the underlying research was indeed government supported via universities and research institutes.

      Are you talking about the administration when the structure of DNA was elucidated, and the genetic code, and the role of mRNA? Or when the idea of mRNA as a vaccine was first imagined? Or when the critical discovery was made about using modified nucleosides to make mRNA vaccines feasible? Or when Moderna was established as a company aimed at using mRNA vaccine technology in medicine? Or when Pfizer signed a deal with a German biotech company that had also been working on the technology?

      1. sgcox says:

        Yeah, it will be a revelation to Merkel that millions and millions of EUR in German governments grants to BioNTech over many years are all due to Trump.

      2. Surfactrant says:

        German biotech started by Turkish immigrants, if I am remembering correctly.

        https://www.nytimes.com/2020/11/10/business/biontech-covid-vaccine.html

    2. Derek Lowe says:

      You should realize that (1) mRNA is the form of RNA that we absolutely understand the best. It is not noncoding RNA; it’s at the exact opposite end of the spectrum. And (2) that the work on mRNA vaccines very much predates the previous administration.

      1. supermario says:

        Non-native and native mRNA may also act as non-coding RNA when partially degraded E.g. working as a miR mop (like lncRNAs) thus influencing gene expression (gene therapy does not have to be integrating). Just pointing this out

      2. theasdgamer says:

        Add in a retrovirus to the vaxx and what could go wrong?

  13. hey_BV says:

    I thought the mRNA vaccines reflect at least work since 2003 (SARS)? All the various governments have done is write checks (which is greatly appreciated). Isn’t Pfizer a German-researched vaccine and J&J a Dutch-researched vaccine (and AZ a UK-researched vaccine). Was Moderna the one from the US?

    Current and former governments merely created the urgency.

    1. sgcox says:

      Janssen is Belgium, not Dutch. More serious mistake actually than mixing up US and Canada. 🙂

      1. Hugo says:

        Vaccine development is done in Leiden, NL, not in Belgium.

        1. sgcox says:

          OK, sorry.

      2. hey_BV says:

        Same thing joke:

        Reminds me of a time I was working in London. When I first started one of
        the guys asked me, “Are you American”. I replied, “No Canadian”. He just
        said, “Same thing.” So, I asked him: “Are you English” and he said, “No
        I’m Irish.” I said, “Same thing”.

        I marvel at the fact that I’m still alive…

        1. Robert James Dancer says:

          🙂

          I am Australian, and once when I was walking in the Scottish highlands, I had a chat with some guys there in a pub. They asked me if I was from New Zealand, and I said “No, Australia”. They replied “Same difference…!” to which I quickly quipped “yeah, right mate, and you’re English…” Considering how red their faces suddenly became, I considered running, until one said “Sorry… I apologise…” and I did likewise, and we shared some good beer together…!

  14. Tony Warren says:

    I am a bit surprised that Derek is still advocating wearing masks or distancing after vaccination. I would think that he would know just about everything there is to know about relative and absolute risk reduction, and of course the immunity isn’t binary.

    The other part that surprises me is that Derek seems to be concerned about increases in case numbers, when a case of Covid 19 is for the most part defined as a positive PCR test.

    The only reliable data I have been able to source (as a private non-medical person) regarding cases has come from the clinical trial data and their method of defining a case. It is the same as every other definition of case up until Covid-19, symptoms and a confirming test result.

    It would be great if Derek were to do a blog on Relative and Absolute risk assessment and reduction, dumbed down so that I could understand it.

    1. Realist says:

      “The more careless we all are, the better the chance of raising a variant form of the virus that could erode the advantages that we’re getting by vaccinating in the first place, and we have got to avoid that.”

      That’s the quote you need.

  15. GT says:

    What are the major differences between the Pfizer and Moderna vaccines?
    Sequence? Type of spike protein – stabilized, naive? Etc?
    And differences in known measured immune response especially cellular parameters?

    1. Philip says:

      Minimal differences between the mRNA vaccines. Both use the same stabilized prefusion form of the spike protein. The lipid nanoparticle is different. The dose is different.

      BTW, the J&J vaccine also uses a stabilized prefusion form of the spike protein, with an extra change at the furin cleavage site. AZ, does not use a prefusion stabilized spike protein.

  16. Alan says:

    Derek, very happy for you that you have received your first shot. Curious though as to why you make the following comments:
    ‘I am continuing to wear masks when I’m out in public, except when I’m walking around outdoors without any other people close by (and I’m fortunate enough to live in an area where that’s not hard to do). But even after the second vaccination, I’m still not yet going to be hopping into crowded stores, going to the movies, or hanging out in any airports or train stations just yet.’

    I would have thought that once vaccinated, life would return to normal, no masks needed, meeting up with friends and family, shopping in crowded stores wouldn’t be a concern etc.
    Seems that you don’t trust that the vaccine will offer you protection? Or am I missing something that you may want to share in your next blog.

    I am based in the UK where about 400 people, under the age of 60 with no underlying health conditions, have died in the last year with Covid-19. This is from a population of about 50 million people under the age of 60.
    My view as an under 60 year old, vaccinate all those who are vulnerable, based on all we have learned this year, and leave others to make an informed choice. Good health to you!

    1. A quick look at the ONS statistics suggests over 800 people aged 15-44 died from Covid in 2020 in England & Wales. For 45-60 it was over 8000. You could probably add another 10% for Scotland and another 10% for 2021. Now, it depends what ‘underlying health conditions’ means, but the 400 number seems a bit on the low side.

    2. Chris Phillips says:

      “Seems that you don’t trust that the vaccine will offer you protection? Or am I missing something that you may want to share in your next blog.”

      If you don’t really know what you’re missing, it’s not worth wasting space here trying to explain it to you.

      Try Googling the word “efficacy”.

      1. Alan says:

        What are you talking about?

        1. Chris Phillips says:

          If you don’t understand something so basic, why are you trying to dissuade people from being vaccinated?

          In a situation like this, ignorance really can cost lives.

          1. Alan says:

            Why do you feel the need to be so rude? I asked a reasonable question of Derek in the hope that he would enlighten me as to his motivation for continuing with restrictions like masking and distancing once fully vaccinated. Some people!

          2. Chris Phillips says:

            Alan wrote:
            “I asked a reasonable question of Derek in the hope that he would enlighten me as to his motivation for continuing with restrictions like masking and distancing once fully vaccinated.”

            No, what you actually wrote was this: “am I missing something that you may want to share in your next blog.

            If you’re asking something very basic – in fact something so basic that it’s been central to every discussion of the vaccine trials, not only here but everywhere else as well – what you don’t do is couch your enquiry in a snide way like that, which implies that it’s Derek, rather than yourself, who is ignorant of the fundamentals.

          3. Nobody says:

            Don’t take it personally, Alan, he’s made a career out of it on these pages. Nobody ever did get to escape the Spanish Inquisition:

            https://www.youtube.com/watch?v=FAxkcPoLYcQ

    3. Derek Lowe says:

      We need a large percent of the population vaccinated before public life like that can resume. I will definitely be glad to closely associate with other people who I am sure are also vaccincated. I want this virus to *stop spreading* in the human population, so all our vaccinations are still useful and do not get wiped out by a future escape variant.

      1. myst_05 says:

        But the virus will never stop spreading in the human population? Isn’t it already a given that it will spread in humans for essentially forever, just like the flu and the various viruses that make up the “common cold”? So at what point could masks be abandoned?

    4. Ed says:

      “I would have thought that once vaccinated, life would return to normal, no masks needed, meeting up with friends and family, shopping in crowded stores wouldn’t be a concern etc.
      Seems that you don’t trust that the vaccine will offer you protection? Or am I missing something that you may want to share in your next blog.”

      Part of it, frankly, is the social signaling aspect. Where I live in NC we’re fortunate to have near-100% mask compliance indoors, but it was a little slow to catch on particularly in the neighboring suburban/rural areas. If the ~25% of the population who is now vaccinated stop wearing masks as well, a significant fraction of the remaining 75% of unvaccinated people would also stop wearing masks. Given that we have a small uptick in cases even with vaccinations and masking, getting sloppy with masks now could make things much worse.

      Also, vaccines are very good but not perfect. I’m vaccinated but I’d consider some things to be high risk – no basement choir practices for me! It’s also easier to keep wearing masks in uncertain moderate-to-low-risk situations, rather than quiz strangers about their vaccine status, or carry a CO2 monitor to determine how well-ventilated indoor spaces are. So my rule is much like Derek’s: mask on when indoors with people that I can’t be certain are vaccinated.

      1. Realist says:

        “The more careless we all are, the better the chance of raising a variant form of the virus that could erode the advantages that we’re getting by vaccinating in the first place, and we have got to avoid that.”

        I think you missed this sentence

      2. Another NC resident says:

        “Where I live in NC we’re fortunate to have near-100% mask compliance indoors”

        I’m also in NC, and I definitely don’t see near-100% compliance. The local hardware store is particularly bad, with most of the STAFF not wearing masks. (Which is why I only go when I really need to.) Every time I go to the grocery store, I see several unmasked people inside. Probably depends on where in NC you are.

      3. Irene says:

        Exactly. Also, in the current social climate, no mask indoors = high likelihood of COVID denier. I don’t want people to have to worry that I am such a person. Plus what Bill said way up above.

    5. Not Alan says:

      Alan, you may want to consider that firstly your figures sound wildly inaccurate, and second that the UK deaths reached 130k despite many months of lockdown, mask wearing, schools closed and social distancing. If the whole population had been infected you should expect the total to reach 5x that number, or north of half a million.

  17. Wilhelm Cody says:

    As to South America, it is by no means a single story. They may be late but many of the larger countries are vaccinating rapidly.
    Chile (59 doses/100) has now has a higher level of vaccination than the UK (55 doses/100) or the USA (50 doses/100) and is moving at a faster rate.

    Uruguay (25/100) has a higher level than Denmark (21/100), Austria (20/100), or the European Union in general and even Canada (19/100).

    Even Brazil (only 10/100) and Argentina (9/100), late comers, are now vaccinating at rates (doses/day/100 people) equivalent to those of the EU as a whole.
    This is very encouraging.

  18. Anon says:

    “Bill-Gates-George Soros-microchip crowd, the 5G activists, the mark-of-the-beast fringe, and who knows what else.”

    What is the difference between these people and people who believe in demons and angels or a human being was resurrected?

    1. metaphysician says:

      Well for starters, the latter group is on average less bigoted than you, while the former is probably closer to your level of bigotedness.

      1. Wallace Grommet says:

        Didn’t you mean to say “credulous”?

        1. metaphysician says:

          I’m fairly certain credulousness is not the above posters problem.

      2. Another NC resident says:

        Sometimes I wish I could thumbs-up a post. Well said, metaphysician.

    1. exGlaxoid says:

      That is an interesting structure, with the two unnatural proline analogs. It would look less than trivial to make, but if they got a kg made, it cannot be that bad. I hope that it and the Merck/Emory compound are both successful as the more tools we have the better in stopping this madness.

      Glad that Derek finally got his shot. In NC there seems to be enough slots for people to get a shot within a week from signing up, so I think the supply is doing well, and it is now open to all, but that will take a few weeks to work through everyone. But I think by May anyone who wants a shot can have it. There also seem to be a shrinking number of people who won;t get it, now that they see that the vaccinated people have not grown gills, extra limbs or horns… I had pretty much no reaction to the AZ vaccine (in a trial) on either shot, and many people I know have had little issue with the mRNA ones as well, so not everyone gets reactions, less than half I believe.

      1. sgcox says:

        Actually, it makes more sense to read it as Ac-Val-Pro-Gln, with Ac is trifluoro and terminal Gln side chain cyclized and C-end substituted by nitrile.
        Does it mimic the natural substrate(s)?

  19. Todd says:

    Because my job requires that I handle Covid-19 specimens, I’ve been able to get towards the front of the line with the shots and have been fully vaccinated since late February. I’ll say that you don’t appreciate the first shot until the second one comes out. Still, feeling fatigued and breaking out in mild hives beats actually having Covid-19. Good luck to all those getting their shots!

  20. Blaine White, M.D. says:

    Derek, I too and all my family have been very glad to get vaccinated, most of us with Pfizer. My one suggestion for you and all without other bleeding problems or anti-coagulation is one 81 mg aspirin daily for a month. This article in Science is from the Amsterdam group that has done some seminal work on the antibodies (Larsen M et al. Afucosylated IgG characterizes enveloped viral responses and correlates with COVID-19 severity. Science 2021; DOI: 10.1126/science.abc8378), and the potential modifications in Fc glycosylation can help these antibodies bind platelet Fc-gamma-receptors. These vaccines are safe and effective, and ours were a walk in the park – with quiet platelets for a while against the very rare clotting problems.

    1. Doug H MD says:

      can you elaborate on the link of glycosylation and low dose ASA?

      1. Blaine White, M.D. says:

        Yes, with a number of links. And I admit it’s a circumstantial case. Nevertheless: My attention was first drawn by the team at the University of Amsterdam providing seminal evidence that in C19 the adaptive immunity onset of IgG production can make a significant contribution to macrophage hyperactivity and platelet activation through Fc-IgG immune complex signaling that leads to subsequent pulmonary pathology in advanced C19 SARS (https://doi.org/10.1101/2020.07.13.190140). Their Science paper suggests severe pathology depends on the glycosylation state of the IgG-Fc (DOI: 10.1126/science.abc8378). These works begin with observation that severe pulmonary disease occurs ~10 days after initial symptom onset, coinciding with production of IgG. They cite Liu et al. (https://doi.org/10.1172/jci.insight.123158), who passively immunized rhesus monkeys with (SARS) anti-Spike IgG and showed that, although viral titers were reduced in subsequent SARS-CoV lung infection, the anti–Spike IgG caused severe lung injury by skewing the inflammatory response of macrophages; this injury was inhibited by antibodies against macrophage Fc receptors.
        M2 macrophages should secrete anti-inflammatory cytokines and so reduce inflammation and promote healing. The Amsterdam team assessed the effect on human M2 macrophages of immune-complexes of C19 Spike with anti-Spike IgG antibodies from critically ill Covid-19 patients. These immune complexes elicited dose-dependent production of inflammatory cytokines by macrophages. In a further in vitro model with human pulmonary artery endothelial cells, Spike-IgG immune complexes and macrophages induced long-lasting endothelial disruption (fluid leak). In addition, upon platelet perfusion of this system, there was both platelet adhesion to the endothelial cells and also a large release of von Willibrand Factor. They had developed an anti-Spike recombinant IgG from plasma cells of Covid-19 patients. Recombinant immune complexes elicited much less pro-inflamatory macrophage response, arguing for important post-translational modification of the IgG in severe Covid-19 patients. A key characteristic that determines IgG pathogenicity is glycosylation of the IgG Fc tail (Trends Immunol 2017; 38:358-372). The Amsterdam team found both increased galactosylation and somewhat decreased fucosylation of anti-spike IgG compared to total IgG in sick Covid-19 patients. Furthermore, when they modified their recombinant anti-Spike IgG by glycosylation, Spike-IgG immune complexes again drove the macrophage inflammatory responses. Fc-receptor specific antibodies that blocked Fc-gamma-2 receptors (FcG2R) inhibited the inflammatory response to the immune complexes. These receptors signal through the Syk kinase, which can be blocked using fostamatinib (FDA-approved for immune thrombocytopenia). Fostamatinib inhibited macrophage pro-inflammatory cytokine production induced by Spike-IgG immune complexes from severe Covid-19 patients. They went on to analyze macrophage gene expression and found fostamatinib down-regulated mRNA expression of genes for both inflammatory cytokines and also a set of platelet activation genes.
        Allow me without another pile of refs to just say that macrophages, PMNs, Mast cells, and platelets all have FcG2Rs and that PMN FcGRs stimulate NETosis. An aside, since famotidine has had therapeutic interest, is that mutant mice without FcGRs lack mast-cell degranulation (doi: 10.1016/s1074-7613(00)80494-x). There is compelling post-mortem immunohistochemical evidence of NET-platelet microclots in C19 (Blood 2020; 136:1169-1179), and such lung microclots are seen at 9-fold the frequency observed in flu viral pneumonia. This is a pattern of mildly thrombocytopenic thrombosis characteristic of inappropriate platelet activation associated with IgG-immune-complex binding to platelet FcGRs in SICK C19 patients (Blood 2021; 137:1061-1071).
        So, the pathophys sequence appears to involve (1) altered IgG Fc glycosylation, (2) enhanced immune-complex binding to FcGRs, (3) Syk signaling, and (4) macrophage activation syndrome (MAS), NETs, inappropriately activated platelets, and perhaps Mast cells. So what happens with lo-dose aspirin? VA series with 28,000 with >50% mortality reduction (https://doi.org/10.1101/2020.12.13.20248147) and another 22,560 series with similar mortality reduction (DOI: 10.21203/rs.3.rs-369927/v1). Then we have the AZ “weird” clotting with some thrombocytopenia. Not too bad for a circumstantial case – eh? Lo-dose aspirin short course is pretty safe.

        1. Doug H MD says:

          Thank you. Hopefully this will be pursued but for the moment everyone is advising against NSAIDS or Aspirin after taking the shot.

          1. Blaine White, M.D. says:

            Please forgive me (grin), but what is the evidence that what “everyone says” is not rubbish? It’s been 50 years since I graduated med school, and I bet you too have seen a lot or what “everyone says” be rubbish. I answered your question with a pile of circumstantial basic and clinical evidence. I’d be interested in as strong an even circumstantial case that lo-dose aspirin suppressed C19 vaccine-induced immunity??

  21. Lane Simonian says:

    I have appreciated Derek’s well-reasoned and informative coverage of the vaccines on this blog. I admire that more controversial topics such as potential clotting problems were not ignored. I am glad that some European scientists and regulators have not seen their role as cheerleaders for the vaccines but as real world evaluators of risk and benefits.

    I have not decided whether to get a vaccine or not. I believe that AstraZeneca got the heat for the rare side effects produced by its vaccine but to one degree or another these problems are probably associated with all the current vaccines being used in the United States. I don’t take heart from the doctor who said he was never more happy to get a shot in his life and then was dead from a brain hemmorhage a couple of weeks later or the people who felt pressured to get a vaccine and then died. It does seem to me that a better sense is being gained as to whom is at greatest risk for these extremely rare cases and what form of treatment may help (intravenous immunoglogulin) as opposed to those treatments which may make the condition worse (such as heparin).

    For the time being, I am content to double-mask, keep my distance, and hope the numbers of coronavirus cases, hospitalizations, and deaths begin to drop dramatically. The problem was that too many people did not take the necessary precautions before the vaccine became available and my concern is that they will not take enough precautions after the vaccinations. Very few things are 100 percent effective or a 100 percent safe. Some people can easily accept this, but there are a few of us who struggle with it.

    1. Chris Phillips says:

      “For the time being, I am content to double-mask, keep my distance, and hope the numbers of coronavirus cases, hospitalizations, and deaths begin to drop dramatically.”

      In other words, carry on what we’ve been doing for the last year, and hope it goes away?

      Of course, what you’re really hoping is that it goes away because enough people don’t behave as you’re going to do, but get vaccinated.

    2. Chris Phoenix says:

      You don’t say how old you are. I had a 50ish friend who raced sailboats and died of COVID recently. Then there’s the risk of stroke, psychosis, or long COVID. The B.1.1.7 vaccine puts 3% of children in the hospital.

      Given the number of people who will refuse the vaccine, if you don’t get the vaccine you will eventually get COVID. Would you rather take a one in a thousand chance of somewhat bad vaccine effects, or a one in a ten chance of worse COVID effects?

      If you’re playing the numbers with real numbers, you will get the vaccine.

      If you want others to be healthy, you will educate yourself on the real numbers – on both sides – and present them on both sides to help others make choices from information rather than fear.

      1. Chris Phoenix says:

        Sorry, very bad typo. The B.1.1.7 VARIANT (of COVID) puts people in the hospital, not Vaccine.

  22. Charles says:

    Thanks Derek for this post. Sadly, it is not as clear cut for many of us in Europe, where the only real option is the AZ vaccine. While I would take it in a heartbeat, a lot of edge cases exist which spur question marks. E.g. a family member has had high platelet levels consistently throughout her life, and haematologist still aren’t sure on the way forward themselves.

  23. Marko says:

    Crap, I just posted this to the wrong thread. It’s a Topol tweet showing a risk/benefit by age graphic for the AZ vaccine:

    https://twitter.com/EricTopol/status/1379832662685229058

    1. Marko says:

      A news story with similar graphics for “low” and “high” Covid-19 exposure risk scenarios :

      https://www.standard.co.uk/news/uk/astrazeneca-pfizer-people-moderna-vaccination-b928359.html

    2. Tony M says:

      Good graphic. Would be good if both harms from Covid-19 and risk groups were better delineated. Risks of harm from Covid-19 such as death, ICU admission, hospital admission, incapacitation at home (missed work or school) and long term Covid-19 health problems. Risk groups could be better delineated based not just on age but also sex and if person has a higher risk co-morbidity (such as Cardiovascular disease, Diabetes, Chronic respiratory disease, Hypertension, Cancer, etc) vs no co-morbidity. May also help assess the risks of children.

      1. Jonathan B says:

        Of course it would be “good to know” the breakdown of side-effects by subgroups. But these side-effects are so rare it isn’t possible to do so in a statistically meaningful way.

        The British MHRA briefing yesterday said that there were just 3 clotting cases in under-30s (I think I am remembering correctly). That was because the UK vaccination strategy has been to start with the older age groups who are most vulnerable to severe Covid. The relatively small number of under-30s vaccinated were predominantly female – because they dominate the caring professions eligible for vaccination – so they could not identify if there was a gender difference in risk. And further stratification (e.g. ethnicity) is obviously also impossible.

        The MHRA concluded the vaccine remained safe with no change to authorisation. It was the JCVI (present at the same press briefing) who had decided to recommend other vaccines for under-30s. They are the group resposible for strategy in rolling out vaccinations, for example they produced the priority order and decided on the change of dose interval with Pfizer in Britain. From the risk graphic shown, it would appear the rationale was that by the time the vaccination programme got down to under-30s the prevalence of Covid would be so low that the individual benefit would not be significantly greater than the risk from vaccination (there is obviously a population benefit as well which they didn’t attempt to quantify).

  24. Marko says:

    The idea of vaccinating children under 16 by this fall is going to be a minefield of dissenting opinions as a result of this clotting issue. The ongoing trials in children are not remotely sized to pick up such events, and Covid-19 risk for children is very low, so the risk/benefit calculation will just be a wild-ass guess when the rollout begins.

    1. Chris Phillips says:

      Actually the AstraZeneca trials in children in the UK have been suspended:
      https://www.bbc.co.uk/news/health-56656356

  25. ChadS says:

    Based on how happy people are to receive vaccines that have not gone through the typical level of FDA-regulated testing, I can only assume that we are now in favor of overhauling the FDA approval process to streamline all new drugs into the market with collection of safety data later. Some 8,000 people a day in the US die and most of them are not dying from COVID-19, so should we not make exceptions for other drugs as well?

    1. tally ho says:

      If you’re referring to the epidemic of gun violence that is a staple of American life, that’s pretty much taken care of by the GOP’s interpretation of the Second Amendment and a market flush with assault weapons. Regulation has a purpose; so does voting.

      1. "Assault Weapons"? says:

        Less than 3% of all murders in the US are committed with rifles of all types, so the guns you incorrectly call assault weapons are responsible for a vanishingly small amount of murders. The vast majority of murders are committed with handguns, but you need to get your camel nose under the tent first before you go after those.

      2. TiredOfCopyPasta says:

        That’s a load of prefab talking points.
        Compared to similar New World countries, the USA has a low murder rate. We’re a lot closer and more similar to Mexico than we are to Norway. Subtract a few high-intensity lawless cities where everyone knows who the gang members are and no one gives evidence against them and the USA has murder rates as low as any large nation.

        The issue is a cultural one; this is a new country comprising very different cultures which have very different levels of accepting violence in daily life. Government and criminals will always have guns, sometimes in co-operation with each other. See: Boston office of the FBI.

  26. curious guy says:

    Does Moderna produce more antibodies than Pfizer does?

  27. Zambo says:

    I just got my first shot of Pfizer/BioNTech yesterday as well, and just wanted to take the opportunity to give thanks for the great work you’ve done covering the virus/the vaccines/everything else in the last 12 months. I was never really in doubt as to *if* I’d get a hypothetical vaccine, and was more interested in *when* it could actually happen, but nonetheless your analysis of all the early and late stage trials throughout the pandemic has truly been invaluable.

  28. Andrase says:

    The first jab (shot), I wondering on that previously a lot, how its change a behaviour. I got (Hungary/Europe) a few days ago the Russian SPUTNIK V first jab, and i start to be extreme cautious, about ‘not getting’ the Covid before the 2nd dose (3 week) not done + 2 week. And i see the same in most people, they ‘fear’ about getting the Covid before the immune protection build-up time, something like ‘not break-down in the finish line’…

    p.s: Sputnik side effects was as its expected: 46+ year old male, after the jab (morning time), approx 10-12 hour: 37.5C (99.5F), after that by 2 hour: 38.3C (101F) + cold shivers. Next morning 37.3C (99.1F), and its go down nicely, some general fatigue for the most of the day. Nothing serious.
    p.s.: may in the news the Sputnik mentioned as storage temperature is ‘fridge temperature’, however, in the reality they produce only the -18Celsius version.
    p.s: 2nd doses period in here: Pfizer: 5week (and not 3), Moderna: 4w, Astra: 12w (pretty much the maximum), Sputnik: 3w, Sinopharm: 4w

  29. anon says:

    What will the effect of what looks to be a large number of different species capable of propagating SARS-Cov2? With many animal vectors it seems that eliminating it only in humans would not be sufficient to achieve worldwide control, and that those animal sources might well produce problematic variants going forward.

    Certainly having high transmission in a partially immunized population seems to be an ideal selection protocol for mutations that escape the vaccine.

    1. nigel says:

      Yes this does not fit the narrative of being saved by vaccination. But well done for highlighting a simple inconvenient truth

    2. Chris Phillips says:

      “Certainly having high transmission in a partially immunized population seems to be an ideal selection protocol for mutations that escape the vaccine.”

      If you’re suggesting that as an anti-vaccine argument, you’re talking nonsense.

      High transmission in a partially immunised population is precisely what we would have got by carrying on as before, without vaccines. Wave after wave of it. But with people being immunised by the disease rather than a vaccine, so 1% of them would have been dying. And of course there would be still be selection for escape – but from disease-acquired immunity rather than vaccine derived immunity.

      The point is that vaccination – as well as saving all those lives – will reduce transmission, and therefore reduce the number of mutations. I still think it’s quite possible that universal vaccination would turn COVID-19 into a rare disease. Not if the anti-vaccine nutters get their way, though.

      1. anon says:

        Not at all. I’m fully vaccinated and I urge everyone I know to get vaccinated. As someone who has worked for a very long time on drug resistance I’m primarily concerned that we aren’t doing a better job of containing the virus during this phase and may inadvertently be creating a selection protocol for viruses able to escape the vaccine.

        I just haven’t hear much about the animal reservoirs and am curious as to the current thinking on their importance or lack thereof.

  30. Big Fool says:

    Derek – I think it is important for you to say that you were vaccinated, considering our position, and to relay your experience.

    Discussing your side effects is important as well. People have amplified the side effect of these vaccines to the point where people are acting as if they are getting major surgery. The media is picking up on every case that lasts more than 2 days, it seems, and the media never mentions the side-effect free vaccinations, which are actually common (sore shoulders for a day don’t count).

    I had the same side effects from my first Pfizer shot that you had, and exercised with my arms actively on vaccination day and the next day, despite a small swelling.

    I was wondering how my second shot was going to go, so I looked up how this shot compares with other vaccinations. I found an article that compared the 2 mRNA vaccines with the flu shot and the shingles vaccine, and learned that the flu shot was a bit milder and that the shingles vaccine was worse. The Shingrix vaccine is noted for having horrible side effects.
    https://www.samhealth.org/about-samaritan/news-search/2021/02/09/covid-19-vaccine-side-effects-compared-to-other-vaccines

    I got the 2-shot Shingrix regimen when my doctor told me to get it a couple of years ago. He didn’t warn me about potential side effects, and being uninformed, I had no reaction at all to either shingles vaccination shot.

    I looked at the Pfizer clinical trial, and a third of those in the 16 to 55 range had headaches and a third had fatigue from their first – placebo (!) – shot. https://www.nejm.org/doi/full/10.1056/NEJMoa2034577

    I’m proposing that we stop scaring our friends to death about these vaccine side effects, that more people mention that they had no reaction and that the media tones down their attention to them, and maybe we’ll cut them in half.

    1. Druid says:

      Very good point. I have had the Pfizer-BioNTech vaccine with no side effects at all.
      It used to be the norm for physicians not to inform patients of side effects because that way there were fewer of them. But that was a gift to m’learned friends who heard “ker-ching” in that silence. So, package inserts get longer and longer to try to cover all conceivable side-effects. One of the arguments wiith the EU last summer was trying to get indemnity for vaccine side-effects, given the desire to shorten the development & approval time.
      That said, the risk of cerebral venous sinus thrombosis with thrombocytopenia from the AZ-Oxford vaccine deserves some discussion because early recognition of the warning symptoms could save lives. However, it is better to check a medical website than trust me so I won’t list them.

    2. Irene says:

      People have to report every side effect when they’re in trials, even ones they don’t think are connected. So, yeah, people got headaches after the placebo, because headaches are common. (I was in a flu shot trial once and distinctly remember having to report such a headache, which I was nearly certain was just a regular mild tension headache such as I get fairly frequently.) What I’ve been seeing (not just with COVID vaccines, but with Shingrix, which many of my friends are just at the age to be getting) is people being open about side effects they got in order to say they are NORMAL, not cause for alarm that some terrible thing is happening. I didn’t have any definite symptoms from the first Pfizer shot except a mildly sore arm myself, but because I had been warned, I would *not* have panicked had I, say, run a bit of fever or found myself falling asleep for two hours on the couch.

      1. Chris Phillips says:

        In the UK, comparison of vaccination symptoms seems almost to have supplanted the weather as an acceptable topic of polite conversation.

        1. Big Fool says:

          I’d say the same goes for the United States. In addition to polite conversation about side effects, emails and phone calls are criss-crossing the country to find out how they are managing after the Covid vaccine.

          No one asked me how I did after my Shingrix vaccines. I also never told anyone I was getting them.

      2. Druid says:

        A radiologist friend told me 2 days ago that there is now a queue for CT scans due to vaccinated people with headaches thinking they have cerebral thrombosis and GPs unsure how to diagnose.

        1. Chris Phillips says:

          And therefore really impossible to make a meaningful statistical comparison with the “normal” incidence, because normally people don’t go to their GPs with a headache or get referred for a CT scan.

          The only way to be sure would be a randomised blind trial, and this side effect is so rare that the trial would need to be hundreds of times larger than the Phase 3 trials in order to pick it up and produce statistically meaningful results.

  31. M says:

    I think I’m missing stuff here, although my biology knowledge consists of some high school plus later reading (this blog and other stuff) over the years.

    Does the vaccine protect against the disease or not? Once you are vaccinated, what further risk from the disease is there?

    My questions are:
    1. Can you still catch it, i.e. display symptoms? I would count a positive PCR test where you never display any symptoms afterwards as “no”. If yes, what are the relative odds?
    2. If you can catch it, what are the risks? Would the vaccination cut down on the severity of any symptoms?
    3. Following up on 1 above, can you still be infected and pass it on to others while being asymptomatic (the Typhoid Mary syndrome)? Do we have any evidence that this scenario happens?

    As far as mask protocols go, if the answers to the 3 questions above are negative I see no reason to continue to wear a mask if you are immune and cannot be contagious. In fact a lot of “getting back to normal” will consist of discontinuing this practice.

  32. Karl Pfleger says:

    Derek, any data you know of on shoulder/deltoid intramuscular injection vs other IM sites, anterolateral thigh being the next most common for IM as I understand it? Quick Googling suggests to me that though buttocks has commonly in the past been used as alternative to upper arm (really deltoid), it’s not as effective because the adipose isn’t as good as muscle.

    I’m on board with getting a COVID-19 vaccine, but I’d rather avoid even the small chance of Shoulder Injury Related to Vaccine Administration (SIRVA) since I’m currently operating with only 1 fully functional shoulder due to adhesive capsulitis in the other and so adding a problem to the good shoulder would be terrible at the moment, a much more severe risk than under normal circumstances. Unless there is some good reason to avoid the thigh. The thigh is far away from all joints so seems safer. But it’s amazing how little info I can find to read about different administration sites. I assume that almost everyone gets upper arm so there is little data directly on point.

    1. Marko says:

      Per the CDC:

      “The deltoid muscle of the arm is the preferred site for intramuscular injection. If the deltoid muscle cannot be used or accessed, the vastus lateralis muscle of the anterolateral thigh can be used.”

      https://www.cdc.gov/vaccines/covid-19/hcp/faq.html#vaccine-administration

  33. Canadian loser says:

    I am in Canada where the AstraZeneca vaccine is approved and available. [I note that the recent status in Canada is that this vaccine is not given to anyone under age 55.] It’s easy for people to say that they would take any vaccine given to them in a heartbeat. But if you had the choice between Pfizer/BioNTech, Moderna, J&J, and AZ, I am sure the majority of people would choose AZ last. Even myself, if I had to theoretically choose between AZ and Sputnik, I would pick Sputnik based on the data I have seen. The science is one thing. Emotion and psychology weighs more on action.

    Many people here in Canada are flaming angry that Canada can’t get its shit together and “forcing” people to take the AZ vaccine. They said if they were offered it, they would walk out (even though these people are under age 55, so its essentially a moot point that they will even get that vaccine). That’s how emotional it has gotten.

  34. Laurence Fitzgerald says:

    3 weeks since my 1st Moderna shot. A little tender in the deltoid for a few days. Four days after injection shot a 76 at Kona Country Club. Best round in over a year. All those newly synthesized circulating spike proteins did it!

  35. Vader says:

    1. I had the second shot (Moderna) a couple of days ago. The first shot gave me a very sore arm but no significant systemic effects. The second gave me a very sore arm, a sleepless night afterwards, and very bad chills for a couple of hours the next day. I treated these with an electric blanket set on Deep Fat Fry and my favorite furball napping on my chest. Still glad to have got it.

    2. Guys, not everything is political, _nor should it be._

  36. nobody says:

    The vaccination situation in the rest of the Americas outside of the United States is entirely the result of decades of US policy to undermine the self-sufficiency of countries in its direct sphere of influence.

    Here in Canada, the Americans *told* us to dismantle our domestic vaccine and biotech infrastructure in the 1980s under the pretext that American economies of scale meant that you could do manufacturing better than we could. Come 2020, we were rewarded for our compliance with a vaccine embargo that has resulted in Canadian vaccine delivery lagging behind every other developed country. The United States has more vaccine doses on hand than people willing to be vaccinated but will not export these doses because, for American foreign policy, the sadism is the point.

    From Mexico southward, the United States has, since its inception, maintained a policy to prevent the economic diversification of the continents, to the point of violently overthrowing Latin American governments that attempted to move up the economic value chain from primary resource extraction. Central and South America have no capacity to vaccinate their own people because this is precisely what Washington wanted.

    When you look at the vaccination numbers in the Americas, don’t blame Canadians or Latin Americans: blame the US governments *you* elected. Every unnecessary COVID-19 death in the Americas is directly due to US policy that Americans, of both parties, support without question. You, as American voters, have blood on your hands.

    When the Brazilian P1 variant rips through the un-vaccinated US population, remember that this is the disaster Americans created and it is absolutely the is the disaster that Americans deserve.

  37. sgcox says:

    Instead of introducing “vaccine passports” as I would dare to say a way to downgrade people who refused or can not get vaccinated,
    – yes, I got a jab and very happy about it but uneasy about the whole passport concept.
    how about using positive reinforcements like in Beijing ?
    https://www.theguardian.com/world/2021/apr/08/beijing-colour-codes-buildings-workers-covid-vaccination-rates

  38. Andre Brandli says:

    Regarding side-effects of covid-19 vaccines:
    – Incidence of blood clotting events after AstraZeneca vaccination: 1:200’000
    – Incidence of anaphylactic shocks after Pfizer/BioTech vaccination: 1:200’000

    Now tell me which vaccine is the safer one?

    For the US:
    – 31 million case of covid-19 infections detected to date (~10% of the population)

    – Percentage of covid-19 requiring hospitalisation: 0.5%

    => Chances of contracting covid-19 with hospitalisation: 1:2000

    It seems to me a clear case that the risks of vaccination (whether it’s a mRNA or vector based vaccine) outweighs the risks of getting severe covid-19.

    1. metaphysician says:

      . . . those numbers you post, combined with the argument you suggest that they support, makes me think you have not the slightest idea what you are talking about.

      Hint: 1/2000 odds of life threatening illness is *considerably worse* than 1/200,000 odds.

      1. Marko says:

        Yes. Either the final sentence is just poorly constructed, or he’s confused about his own stats.

        1. Andre Brandli says:

          Thanks for the corrections! Sorry. The numbers are correct but the last sentence was a badly formulated:

          “It seems to me a clear case that the risks of getting severe covid-19 outweighs by far the risks associated with covid-19 vaccinations (whether it’s a mRNA or vector based vaccine).”

    2. FrankN says:

      Wonder about your numbers. Last time I checked for the AZ blood clot risk, it stood in Germany at 31 confirmed cases from approx. 2 million vaccinations ~ 15.5/ million or 1:65,000.
      9 fatal cases ~ 4,5 per million. Certainly lower then the risk to die from C19 if you are over 60, but higher than the C19 death risk for anyone under 40, and approximately equal to the C19 death risk for females aged 40-49.

      1. Chris Phillips says:

        If we’re talking about infection fatality rate, then even on the basis of the high-end suggestion of 4-5 fatalities per million vaccinations, the according to this recent estimate, the IFR for COVID-19 is much higher for all age groups:
        https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0246831#sec017

        Roughly speaking, it is twice as big even for the youngest children, 20 times as big for those in their 20s, 200 times as big for those in their 40s and 2000 times as big for those in their 60s.

        And that estimate appears to be based on “classic” COVID-19. Of course, the IFR has been estimated to be substantially greater for some of the variants. Using those estimates and the UK figure for vaccine fatalities, even for those in their 20s the risk from the vaccine might be only 0.005 of that from the virus. And anti-vaccine nutters are always telling is that virus fatalities in that age group are far too rare to worry about …

    3. FrankN says:

      P.S.: Confirmed German SVT cases now up to 42, according to the PEI. Unsure about the underlying number of vaccinations, could be anywhere between 2 and 3 millions.

  39. Anon says:

    My family lived in American for ten years. We had to return back to my home country last year when my work visa expired. I won’t mention which country we are in now.

    My Russian wife is messaging with her friends in America. They are all reporting and gloating about how they got the vaccine.

    Meanwhile, my wife whines everyday about how we cannot get the vaccine in this terrible country we are in. She has used the U.S. as the standard of expectation. Not a day goes by when I don’t hear her wish that we should have stayed in USA (even though my work visa had expired, so it was a virtual impossibility).

    She threatens to go back to Russia so she can get her vaccine, damn our marriage, damn the children, damn the life we have built together.

    Sorry to spill my guts out here, but at least I can do it anonymously. This pandemic is taking a terrible toll.

  40. Dave K says:

    I am curious, what is the main difference between people that have an adverse outcome from being infected with SARS-Co-2 and those that don’t have complications ?

    1. sgcox says:

      If you find the answer, you have a good good shot at Nobel

  41. supermario says:

    Dear Derek,
    You got vaccinated against an ancestral spike protein, your vaccine induced antibodies may not behave as expected when they encounter a significantly mutated virus. They could conceivably make you sicker. Can you explain why you believe that the vaccine you received will protect you against currently circulating or future variants? I’d be keen to learn how you are so certain that the vaccine won’t actually end up harming you or your family?
    The science is explained here:
    https://www.nejm.org/doi/full/10.1056/NEJMc2103740
    Recent history (in living memory) disasters involving Dengvaxia and RSV vaccines were limited to fatalities in small clinical trial populations. However the massive scale of this hasty vaccine roll out experiment has really thrown caution to the wind. Caveat emptor applies to “free” things too.

    1. Derek Lowe says:

      A reasonable question. I base this on (1) the in vitro results from vaccinated-patient plasma against variants, which suggests that the antibodies elicited by the mRNA vaccines handle B.1.1.7 very well, and the others at slightly lower levels (but still well over what is believed to be a protective threshold). And I also take note of the real-world experience with them so far – I have been seeing no reported surge in suspected cases of antibody-dependent enhancement in the vaccinated population. Indeed, it’s been the opposite: severe cases of disease have dropped *steeply* after vaccination so far in every study I’m aware of.

      These data suggest that we are not yet seeing variants that escape the immunogenicity conferred by vaccination, and given the number of different strains in circulation, it also suggests that hitting on such a strain may well be a rather low-probability event. Not zero – just unlikely. As mentioned in the post, I would want to cut down on the spread of the existing variants as quickly as possible so we don’t get a chance to be wrong about this. But so far, I’m very happy with the real-world performance that we’re seeing.

      1. supermario says:

        Thanks Derek,
        I’ve decided that there are too many unknowns – your language “so far, suggests, believed, not yet” are all confirmation of uncertainties.
        I also distinctly remember the Pandemrix debacle where mass vaccination of children caused drastically life altering, lifelong side effects (narcolepsy and cataplexy incidence of 1:55,000 estimated). I am deeply concerned that children will be administered this experimental vaccine where the risk from COVID is <<<<'flu. Manufacturers are indemnified from any harm caused and rushing to cash in on jabbing kids – the dynamic is all wrong from a patient safety perspective. I'd bet my entire future earnings that vaccine manufacturers would UNDER NO CIRCUMSTANCES allow their products to be used to vaccinate children if they had liability for any resulting harm. I've decided against vaccines for me or my children, I wish everyone all the best and I respect their own informed opinions and choices. Making any medical treatment mandatory is controversial and in the case of Covid vaccines can only be done once all uncertainties have comprehensively been ruled out. Informed consent and freedom of speech and opinions are always an absolute unalienable right.

    2. Cass says:

      I’m guessing you haven’t seen Derek’s previous posts all about ADE – here’s the latest one: https://blogs.sciencemag.org/pipeline/archives/2021/02/12/antibody-dependent-enhancement-and-the-coronavirus-vaccines.

  42. Marko says:

    Good thread by Burn-Murdoch, with data on cases, B.117, vaccination impacts, etc :

    https://twitter.com/jburnmurdoch/status/1380512731456016385

    1. Marko says:

      There was an error in a B.117 graph in the above thread, which he corrects here :

      https://twitter.com/jburnmurdoch/status/1380548736657600515

      Personally, I’m inclined to think the first graph may be closer to the truth, based on the Helix SGTF data, but absent rigorous genomic surveillance in the US, we can’t know for certain.

  43. Marko says:

    New study suggests that vaccine-induced binding antibodies and/or T-cell response, rather than receptor blocking/neutralizing antibodies, may be the better correlate(s) of protection:

    https://www.cell.com/med/fulltext/S2666-6340(21)00152-5

    1. Thomas Fairfax says:

      Whereas lockdown beliefist gurus serving on government advisory panels are always right to egg on governments to shut down jobs, livelihoods and educations of erks lacking the luxury of covid-secure public sector salaries and grant awards?

      C’mon Doc Marko, cut the anti-denialist guru crap. So 2020. You’re better than that.

      As for opendemocracy.net, sound mathematical principle of functionalising two goods to make a doubleplus good squared. Closed totalitarians will be quaking in their jackboots.

  44. Kaleberg says:

    We got our vaccines done over a month ago, but we’re still cautious. Then again, our car has seat belts AND airbags, and we still make sure we’re driving on the correct side of the road. Reduced risk is not the same thing as no risk.

    Right now, COVID prevelance is too high for us to relax completely. If you are wearing a bullet proof vest, you might be more comfortable going somewhere with the bullets flying, but you’d be even more comfortable after the cease fire.

  45. ralph says:

    It goes without saying that South America needs a lot of help at this time, particularly Brazil, it would seem. I hope that some authorities mobilize to offer meaningful assistance, and that the government there takes the issue more seriously. Projections appear to show that their current wave will crest around the end of May, but the healthcare system is already breaking down, and this will have dire consequences not only for them but for the rest of the world, as the high pool of circulating virus there continues to generate all sorts of variants.

  46. Marko says:

    Evidence for increased breakthrough rates of SARS-CoV-2 variants of concern in BNT162b2 mRNA vaccinated individuals

    https://www.medrxiv.org/content/10.1101/2021.04.06.21254882v1

    “….Here, we performed a case-control study that examined whether BNT162b2 vaccinees with documented SARS-CoV-2 infection were more likely to become infected with B.1.1.7 or B.1.351 compared with unvaccinated individuals. Vaccinees infected at least a week after the second dose were disproportionally infected with B.1.351 (odds ratio of 8:1). Those infected between two weeks after the first dose and one week after the second dose, were disproportionally infected by B.1.1.7 (odds ratio of 26:10), suggesting reduced vaccine effectiveness against both VOCs under different dosage/timing conditions.”

    The P.1 variant will likely show a similar pattern to B.1.351, and it’s showing up increasingly in the US, though it’s not at high prevalence in any state yet (as far as we know). I’m not surprised that B.117 evidences some immune escape potential, as it has been demonstrated repeatedly in neutralization studies, if at a reduced level compared to the other VOCs.

    1. Marko says:

      Crotty’s sketches from a month ago depicting immunity to variants over time look like they’re going to be close to the mark, based on the real-world results from Israel, above:

      https://twitter.com/profshanecrotty/status/1367559003534811136

    2. Chris Phillips says:

      Thanks for this.

      But having just had a quick look at that preprint, I really wonder how meaningful those figures are. Figure 1A shows the prevalence of B.1.1.7 indistinguishable by eye from 100% and the prevalence of B.1.351 indistinguishable from 0%. At the same time, the number of samples plummeted to under 10 a day in late February and now appears to be 2 or 3 a day.

      So the number of samples that aren’t B.1.1.7 must be tiny, and the statistical power of comparisons between different variants must be very feeble. When I looked for confidence limits I found this:
      “For all primary analyses a one-sided paired (exact) McNemar’s test was used in order to compare breakthroughof a variant in partially or fully vaccinated individuals. Notably, this test does not allow reporting a confidence interval for the inferred odds-ratio.” [my emphasis]

      One thing I thought was interesting is that the prevalence of B.1.351 is shown as having dropped to close to 0% from a peak of something like 5% in early February. At the same time the prevalence of B.1.1.7 rose from perhaps 85% to nearly 100%. That suggests to me that under the prevailing conditions, which are obviously a mixture of vaccination and social restrictions, (1) B.1.351 hasn’t been able to remain at the same percentage of a declining number of cases, let alone maintain itself at the same absolute number of cases, and still less grow in numbers, and (2) even including the effect of any superiority in immune escape, B.1.351 has been significantly less transmissible than B.1.1.7.

      That all seems like good news to me.

  47. Marko says:

    A good story about breakthrough infections post-vaccination, if you ignore Topol’s baseless comments:

    https://www.newyorker.com/news/our-columnists/the-mystery-of-breakthrough-covid-19-infections

    1. Marko says:

      There are no fans of ONE DOSE that I know of. There are fans of a delayed second dose strategy, as has been deployed to great success in the UK, and most of those fans, including myself, agree that it makes sense to make exceptions for LTCF residents and over-80s in general, who typically have reduced responses to the vaccines.

      In any scenario, delayed dosing or not, an outbreak like the one described in your reference that was allowed to flourish, almost entirely within the 3 wks since the administration of the first dose, says more about the shoddy infection control procedures of the facility than it does about vaccines and dosing protocols. 23 of the 26 infections in that facility occurred before the second dose would have been administered on day 21, so dosing interval had little if anything to do with the outbreak.

      1. Chris Phillips says:

        It’s worth noting that in the UK the policy really is delayed second dose, rather than one dose. Numbers of second doses are currently running at 4 or more times the numbers of first doses, so the focus has now returned to those most at risk, who had their first doses in January.

  48. Marko says:

    France extends gap between mRNA vaccine shots to ramp-up rollout

    https://www.reuters.com/article/us-health-coronavirus-france-idUKKBN2BX0L6

  49. Chris Phillips says:

    On the whole, I’d say that – with one exception – the plots of the prevalence of different variants in European countries here tells a similar story about B.1.351, though there its prevalence has grown gradually rather than disappearing as in that Israeli study:
    https://www.nytimes.com/interactive/2021/04/09/world/europe/europe-coronavirus-variants.html

    The exception is Luxembourg, which is strange for both B.1.1.7 and B.1.351. Perhaps the number of samples is inadequate.

    1. Marko says:

      It’s similar in the US. Not much B.1.351 or P.1, although the California variants seem to be holding a fairly steady share and the NY variant’s share is growing :

      https://covid.cdc.gov/covid-data-tracker/?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fcases-updates%2Fvariant-proportions.html#variant-proportions

      I’d agree that overall the Israel study is encouraging. It may be that the population that is particularly susceptible to B.1.351 is only a very small fraction of both the vaccinated and those previously infected, and that among the naive population the higher-transmissibility B.117 dominates , so it never gets much of a foothold.

      We need more genomic studies like this on both reinfections and breakthrough infections in vaccinees before the variant picture will become clear regarding the practical implications of immune escape mutations. As long as severe disease and deaths are rare among those with immunity, variants won’t be much of an issue once everyone is vaccinated.

      1. confused says:

        Yeah. I wonder how significant the variant situation actually is – ie how much of this “looks weird” because we didn’t have the tools to track it in past pandemics?

    2. Christian Weisgerber says:

      The Luxembourg numbers probably reflect a transborder regional outbreak. There was a concerning rate of B.1.351 in the Lorraine region of France, at up to 35% of infections in the Moselle department. This also leaked across the border into Germany, mostly the Saarland region. If you look at a map, you’ll see that Luxembourg is right in that area as well. France and Germany are so big that those regional figures disappear in the national ones.

      France has discontinued the use of the AZ vaccine in Moselle, as well as some overseas departments where B.1.351 is dominant, over concerns about AZ’s limited effectiveness against this variant.

  50. bewd says:

    Evidence for increased breakthrough rates of SARS-CoV-2 variants of concern in BNT162b2 mRNA vaccinated individuals

    https://www.medrxiv.org/content/10.1101/2021.04.06.21254882v1

    1. Chris Phillips says:

      That is discussed a bit above. I’m not a fan of data points without error bars, particularly if the number of samples is limited.

      The cynic in me can’t help wondering whether the reason they used a statistical analysis method that didn’t provide confidence intervals, was because if they had calculated confidence intervals they would have been so wide as to put publishability in question.

  51. Brussels bureaucrat says:

    Here is a rhetorical question:
    Why was it wrong of authorities to release information about AZ side-effects to the public (an issue that few people understand), but at the same time correct to keep releasing information about new mutants (an issue that few people understand)? Don’t we risk thatpeople will assume that vaccination is not important since it will not prevent infection with new mutants anyway?

    1. confused says:

      I don’t think giving the data is bad!

      But I do think the *framing* of what is presented has “under-played” the efficacy of the vaccines, and that’s not good.

  52. bewd says:

    Chinese vaccines ‘don’t have very high protection rates,’ said the director of the China Centers for Disease Control, Gao Fu

    https://www.livemint.com/news/world/chinese-covid-vaccines-effectiveness-low-says-china-s-top-official-11618140463649.html

    1. Christian Weisgerber says:

      A whole year ago it was reported that Shanghai Fosun Pharmaceutical had partnered with BioNTech to market the latter’s vaccine in China.
      https://www.reuters.com/article/us-biontech-fosunpharma-vaccine-collabor-idUKKBN2130O5

      Whatever became of that? Interference from the top in China?

  53. Marko says:

    CDC ramps up scrutiny of rare post-vaccination ‘breakthrough infections’

    https://www.washingtonpost.com/health/2021/04/09/do-people-get-covid-after-being-vaccinated/

    “The precise number of these breakthrough cases is unknown, but figures released by states suggest it is at least several thousand.”

    We should have sequences on virtually all of them. Instead, I’ll bet we’ve done no more than a handful. The US should be publishing real-time studies like the one from Israel above, which would allow us to keep tabs on the vaccine escape potential of variants, but our main concern seems to be in keeping the place tidy by dumping the swabs in the bio-waste bins as soon as the PCR test reads out.

    1. Marko says:

      “Scientists are investigating the role of variants, but “currently, there is no evidence that Covid-19 after vaccination is occurring because of changes in the virus,” CDC spokeswoman Kristen Nordlund said in a statement.”

      Great. The CDC has now adopted the famous WHO double-speak, where “no evidence” really means ” we don’t have any effing clue”.

  54. Eric K says:

    Just a simple thank you here, Derek. As a scientist who has also been following every detail (and indeed new the main companies well before the pandemic), it’s been a bit of a mental struggle to get past those rare/unknown long term *hypothetical* risks. I would prefer old-fashioned Novavax because – well, its the devil we know (saponin/lipid matrix, protein subunit). Which doesn’t make it necessarily better. I got my Pfizer shot 1 today, thanks in part to your post.

    1. Doug H MD says:

      why no news on the Novovax front ? seems like an awfully long delay

  55. supermario says:

    https://www.forbes.com/sites/brucelee/2021/04/11/3-breakthrough-covid-19-coronavirus-deaths-among-700000-fully-vaccinated-in-oregon/?sh=96984c1333fb
    The case sample size is small here but concerns more cases than some EUA’s were granted emergency use for! The data set ought to cover the entire US with up to the minute data given the experimental nature of these vaccines and the legit concerns about their safety – how do the FDA not have this data? If they are not adequately resourced then how could they allow manufacturers to get away with such lax PV on an experimental medicine? They are pulling in billions of sales with no liability for use of their products!!!
    CFR amongst these breakthrough cases looks worryingly high at 1.8%, this closely mirrors the US CFR for the entire pandemic to date which includes figures from early days when testing was very low (remember wave one when you needed to be very sick to get tested).
    We are not exactly living under real-world conditions either with masks and lock downs restrictions impacting on transmission and ‘immunity’ is only a few months in – we know to expect ADE with waning Ab titres. The lack of post marketing pharmacovigilance is pathetic especially under EUA conditions which allowed this experiment to proceed – where is the monitoring and proper PV? This is a very worrying signal suggestive of variant escape, ‘real world’ inefficacy and perhaps even the nightmare scenario of ADE. Yet the breakthrough cases have been reported independently of the regulators (thank god somebody’s looking) and have not been properly sequenced? The regulators are shamefully asleep at the wheel, which is not good enough given their allowance of the vaccines use.

    1. WST says:

      There are several report of vaccine “breakthrough”, some imprudent conspirators published even a real studies (Israeli 600,000 vaccinated, 600,000 placebo , NEJM), with 12 sever cases and 4 deaths.
      Another US study:” … bigger investigation conducted by the health department in Washington state found that of 1.2 million fully vaccinated people, there was evidence of 102 breakthrough cases,
      …. In the case of the Washington state investigation into the two potential breakthrough COVID deaths, both patients were older than 80 years old and had underlying health issues…”

      1. supermario says:

        Hi WST,
        “In Oregon, at least 168 fully vaccinated people have had “breakthrough” Covid-19 coronavirus infections so far. Of those, 19 ended up being hospitalized, and three died, according to the Oregon Health Authority (OHA).”
        Oregon is a small part of the US so please feel free to extrapolate the data.
        When was the study you reference conducted? Link?
        Underlying health issues and extreme/old age – apply the same rationale to count Covid deaths and the pandemic lethality drops dramatically (more than halves).
        As I said we ain’t living in the real world and vaccine fever has caught on like the ol’ snake oil!

      2. garfunkle says:

        Also clear that vaccine induced deaths were being written off in this manner, even VIPIT induced ones were denied until very recently, even after the MOA had been elucidated. “No evidence” , this will end in tears and the words of the prophets are written on the wall, in letters ten feet tall. Apparently echoing in the wells of silence.

  56. Marko says:

    At least I’m not the only one frustrated by the CDC’s lame variant surveillance efforts:

    “It looks like B.1526 is out-competing B.117. CDCgov should be urgently focused on determining why B.1526 appears more fit than B.117. Does it spread more easily? Is it piercing prior immunity? Many weeks have gone by as these same important questions continue to be asked.”

    https://twitter.com/ScottGottliebMD/status/1381729145386897411

    1. Garfunkel says:

      Some guys on the comments are claiming a huge victory for PV and safety monitoring! Not sure if they know what PV entails – post market surveillance and safer monitoring is shambolic here for mega blockbuster products. The manufacturers can and should properly pay for this function in return for being written blank cheques with full indemnification from causing harm!

  57. Tom Maneiro says:

    Came for the nitros, stayed for the facts.
    (Still miss the nitros…)

    Thanks Derek for your awesome coverage on COVID-19 since this global disaster, I always recommend this blog to anyone that needs a good starting point to get properly documented on stuff like the effects of the disease and, of course, vaccinations

    Too bad that in my personal case, as a citizen of Soviet Venezuela, I have a fat chance in hell to getting the jab due to political reasons (it’s a communist country where not only people is disregarding all basic protection measures due to sheer stupidity, but also Maduro and its folks heavily botching EVERYTHING since the pandemic started: while the country is now getting vaccines shipped and distributed, the rollout has been a total and complete disaster for oh so many reasons I’m not getting in detail in this blog, but it all boils down to politics of a failed regime), but a man can dream… At this point I’ll take the blood clots over dying of some unknown (and nasty!) SARS-CoV-2 mutation, really.

    I’m not dropping my facemasks and hand sanitizers anytime soon, and will keep avoiding crowded places and public transportation for years to come, that’s for sure!

  58. Marko says:

    CDC updates variant proportions thru Mar. 27 :

    https://covid.cdc.gov/covid-data-tracker/?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fcases-updates%2Fvariant-proportions.html#variant-proportions

    Illinois seems to be the state to watch to gauge the evolving impact of the P.1 variant. Shows at 7.9% prevalence as of 3/27. Illinois is one of the states with a significant upturn in cases over the last few weeks. Mass. is next highest in P.1 prevalence at 3.1%. Four states range from 2.0 – 3.6% prevalence as the highest ones for B.1.351 (N.C., Va., Md., and Georgia).

    All to be taken with a grain of salt. There are many states where we have no clue what’s going on due to a lack of surveillance.

  59. Marko says:

    Racaniello, who has a habit of being wrong, takes a premature victory lap on the topic of increased virulence of B.117, and gets promptly shot down in the comments:

    https://twitter.com/profvrr/status/1381991374162067456

    1. Marko says:

      Table by Nick Davies showing why this new study doesn’t show what Racaniello wants it to show:

      https://twitter.com/_nickdavies/status/1381899352537464838

  60. Marko says:

    We know that infants can gain passive immunity against CoV2 by breastfeeding, and I’ve often wondered why adults couldn’t similarly benefit. It appears that they be able to :

    Bovine Coronavirus Immune Milk Against COVID-19

    https://www.frontiersin.org/articles/10.3389/fimmu.2021.637152/full

    1. Doug H MD says:

      i am willing to sign up for that trial. <:

      1. Doug H MD says:

        well not the bovine version

        1. sgcox says:

          I do not know… After a year of lockdowns. :/

  61. Blaine White, M.D. says:

    So, in the absence of an answer to my above request for evidence that lo-dose aspirin reduces vaccine efficacy, I went literature hunting. A Johns Hopkins anesthesiologist opined IN A FOX NEWS story that aspirin or ibuprofen might do so (https://www.fox32chicago.com/news/taking-common-pain-relievers-before-covid-19-vaccination-could-lessen-efficacy-experts-say), and the only study cited in this news article was this 2009 study from the Czech Republic (https://doi.org/10.1016/S0140-6736(09)61208-3). Note that the drug involved in the Czech study of INFANTS was paracetamol, which is actually TYLENOL!! An actual 2015 study of adult lo-dose aspirin (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4737981/pdf/nihms726884.pdf) and the H1N1 vaccine found no effect on the immunological response by lo-dose aspirin, and the Czech study was the only counter suggestion cited. I find no other credible published CLINICAL evidence for the allegation that lo-dose aspirin will diminish the efficacy of C19 vaccines. So, this “everyone says” is in fact RUBBISH. Conversely, in the literature I cited above, it is very clear that platelet microclots are associated with C19 and that platelet activation by both the Spike protein and the Fc functions of the Spike-IgG immune complexes have been directly implicated in platelet activation. Furthermore, above I cited 2 large series together involving >40,000 patients with substantial mortality reduction by aspirin. This suggests we might be unsurprised by rare thrombocytopenic clotting associated with vaccine-induced Spike production, and a limited course of lo-dose aspirin is a reasonable precaution associated with decades of safety.

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