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Moving the Covid Vaccine Goalposts

Summary:
Our Covid brain trust member GM has been on a tear recently with his readings of fresh studies and news reports about vaccine efficacy, particularly against the Delta variant. The bulk of this post will be quotes from his missives, but first some cheery updates. Delta is indeed looking not nice. From NPR’sThe Delta Variant Isn’t Just Hyper-Contagious. It Also Grows More Rapidly Inside You (hat tip David L): After months of data collection, scientists agree: The delta variant is the most contagious version of the coronavirus worldwide. It spreads about 225% faster than the original version of the virus, and it’s currently dominating the outbreak in the United States. A new study, published online Wednesday, sheds light on why. It finds that the variant grows more rapidly inside people’s

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Our Covid brain trust member GM has been on a tear recently with his readings of fresh studies and news reports about vaccine efficacy, particularly against the Delta variant. The bulk of this post will be quotes from his missives, but first some cheery updates.

Delta is indeed looking not nice. From NPR’s
The Delta Variant Isn’t Just Hyper-Contagious. It Also Grows More Rapidly Inside You (hat tip David L):

After months of data collection, scientists agree: The delta variant is the most contagious version of the coronavirus worldwide. It spreads about 225% faster than the original version of the virus, and it’s currently dominating the outbreak in the United States.

A new study, published online Wednesday, sheds light on why. It finds that the variant grows more rapidly inside people’s respiratory tracts and to much higher levels, researchers at the Guangdong Provincial Center for Disease Control and Prevention reported.

On average, people infected with the delta variant had about 1,000 times more copies of the virus in their respiratory tracts than those infected with the original strain of the coronavirus, the study reported.

In addition, after someone catches the delta variant, the person likely becomes infectious sooner. On average, it took about four days for the delta variant to reach detectable levels inside a person, compared with six days for the original coronavirus variant.

Bizarrely, and (as usual) irresponsibly, the CDC and the FDA are recommending against booster shots soon, when Pfizer data from heavily vaccinated Israel (and recall those shots were administered in a much tighter time frame than in the US), shows the waning of immunity there translates into the need for more jabs soon. I’ve been saying for some time that the officialdom should be preparing those who have been vaccinated of the need for another round of shots in the fall/early winter, yet they are trash taking the idea.1From CNN:

Drugmaker Pfizer said Thursday it is seeing waning immunity from its coronavirus vaccine and says it is picking up its efforts to develop a booster dose that will protect people from variants.

It said it would seek emergency use authorization from the US Food and Drug Administration for a booster dose in August after releasing more data about how well a third dose of vaccine works.

But in an unusual move, two top federal agencies said Americans don’t need boosters yet and said it was not up to companies alone to decide when they might be needed.

Hours after Pfizer issued its statement, the FDA and Centers for Disease and Control issued a joint statement saying Americans do not need booster shots yet.

“Americans who have been fully vaccinated do not need a booster shot at this time,” they said.

Pfizer and its partner BioNTech said evidence was building that people’s immunity starts to wane after they have been vaccinated. The Pfizer vaccine requires two doses to provide full immunity.

“As seen in real world data released from the Israel Ministry of Health, vaccine efficacy in preventing both infection and symptomatic disease has declined six months post-vaccination, although efficacy in preventing serious illnesses remains high,” Pfizer said in a statement emailed to CNN.

And even though there is reason to be skeptical of Pfizer, news stories confirm that their is a rising number of breakthrough cases in Israel, including ones that contra the CDC look to have been contagious.

GM’s remarks:

Efficiency is down to 64% in Israel right now…

And that’s efficiency against both infection and symptomatic disease, though it is still holding higher against hospitalization.

The notable thing here is that Israel vaccinated first, i.e. a lot of people there are already at the 6-month mark. Moderna have been claiming that neutralization activity against the more immune-evasive variants has fallen below the protection level at the 6-8 month point in the clinical trial subjects, so seeing a lot of breakthroughs in Israel and at this time makes sense if they were indeed correct.

This is being spun right now as “Vaccines work against hospitalization and death, nothing to worry about” and as “nobody promised absolute protection from infection”, which is an obvious goalpost shift because a lot of the people who have “symptoms” but are not hospitalized are far from OK, and, of course, the CDC current guidelines are very much and quite explicitly based on a presumption of sterilizing immunity. But even that narrative will fall apart eventually, because the next step in the decay progression will be for the vaccinated to also start filling up the ICUs, and it’s not far off in the future.

Which is why in Israel they are seriously pondering right now whether to start giving out third doses.

But that’s Pfizer, the best of the best, not the supposedly crappy Chinese vaccines.

Even I, and I am not known for being an optimist, did not expect boosters for the mRNA vaccines so soon…

And, of course, there are more variants on the way, while we still don’t have an updated vaccine and will be injecting people with the vaccine for the 2019 virus well into 2022. So the fourth doses may well be needed even sooner than the third.

Also, right now there are all sorts of schemes around the world involving vaccination passports for the fully vaccinated. But what the hell does “fully vaccinated” mean with 60% efficiency that is gone in less than a year? That house of cards is going to collapse too.

Meanwhile the UK (and several other countries in Europe too) has fully reopened everything with a very openly stated shift to a “herd immunity” policy (which isn’t really a shift, that was the policy all along). But what “herd immunity” can we talk about if even the vaccine has faded in less than a year?

They may get away with it now without collapsing their hospitals and “only” a few tens of thousands of deaths because they are mostly recently vaccinated and right now it’s infecting primarily the young, but that will not be the case during the next surge in Winter, when it’s going to be a different, yet more immune evasive variant driving it.

GM was also not optimistic about treatments as an alternative for tackling Covid:

There is most likely never going to be a treatment. I would not be blaming the medical establishment for not working hard on that (and they are), this is a predictable dead end, and pursuing it will only lead to more false promises.

The mechanisms of pathogenesis are such that it is unlikely there will ever be a “treatment” — something like hepatitis progresses slowly and can be treated because there is plenty of time after its identification for a treatment to be effective.

But here you get infected, you don’t know you are infected for a few days, and even then the symptoms are not very specific, aside from the loss of smell, but even that is something far from all people experience. Meanwhile the virus multiplies exponentially and spreads from the URT to the lower lung and the rest of the body. If the body manages to control it at that point, you are more often than not fine (at least for the short term, you can still have various autoimmune and neurological issues). If it gets to the lower lung and does damage there, you get the sudden runaway immune hyperactivation, and from that moment on it is your own immune system doing most of the damage, not the virus. But that’s on day 9-10, not months into it.

So it’s a rather fast two-stage progression.

Antivirals, with which we have never had much success, could be effective only in the first stage, when the virus is multiplying initially. After that they can do very little. Which is why it is so sad to watch all the pleas for plasma donations by relatives of sick people who are on ventilators — the only thing that plasma is going to do is select for immune escape variants, but curing the patient it will not do. Remdesivir and monoclonals are useless for that very same reason too. If you catch the virus sufficiently early, then a drug could be effective in principle, but making sure you catch each and every case early enough is not compatible with “going back to normal”, that requires constant testing and surveillance because of how sneaky the virus is in the early days of an infection.

In the second stage it is the immune system doing the damage and you need immunosuppressants. But how much better can immunosuppressants get than what we already have and can they become more efficient without doing more damage than good? And are they even going to be effective to the point of being cures? We got the mortality down by 50% with the current steroids, but that’s not at all a “cure”, and there was hesitation to use them initially because the experience with SARS-1 was that overaggressive use of steroids did a lot of damage aside from the effects of the virus. And if you got to the point of needing them, you are most likely going to have lasting damage.

Suppression of infections is the only way out.

One report we got over the transom and was chewed over by our Covid mavens was of a pre-school being closed for two weeks due to symptomatic cases among the toddlers. Our correspondent’s offspring was one case, infected by another child who got visibly sick earlier and is the apparent index case for this bunch. This school has PMC parents, many of them academics in the bio sciences and/or medically adjacent.

Again from GM:

Take a look at this Twitter thread from Biden’s former Senior Pandemic Advisor.

Who in 2020 was putting out articles like these:

We Can Eliminate Covid-19 if We Want To

And giving New Zealand as an example to follow:

Now?

He is doing a book tour (which raises the obvious question of where exactly his priorities lie). And we get the following:

“As we do regular testing & contact tracing we will find many more asymptomatic harmless cases. Doesn’t mean there are more necessarily. This is in the “if a tree falls…” school. Getting sick is what we should measure. ”

“Sports teams & other occupations or events with regular testing will show more asymptomatic and mild cases that we wouldn’t have seen.”

This is straight out of the Trump/Bolsonaro/Magufuli/Lukashenko/Berdimuhamedov/etc. “If we do not test and report, there will be no pandemic” playbook. Exactly the same thing.

Then:

“The UK is seeing a spike begin in cases that could reach 10s of thousands. That is likely to happen here as well at some point. The big question is whether hospitalizations & deaths follow.”

One curious thing about the UK so far is how few unvaccinated old people there are in the cases, even proportionally. There aren’t a lot of them, but it does seems like it has not yet made its way into those age groups.

But there is the major difference between the US and the UK — the UK has a very high vaccine uptake, 95% if the older age groups, it just has not gotten around to vaccinating the young yet. The US on the other hand is at a similar percentage of full vaccinated, but it is more evenly spread and there are a lot of old people who are not vaccinated. So the same let-it-rip approach that is taken by both countries will result in a huge number of deaths in the US even if it does not do so in the UK. In the short term, of course, in the long term things will be back to March 2020 without constant revaccinations…

And if that wasn’t cheery enough, another reader pointed to a hospitalization of someone in his circle who had been vaccinated. GM was not as bothered by that since it turned out that individual had had a very bad case of Covid before being vaccinated and was also immunocompromised. But GM’s additional observations were sobering:

This is a reinfection in this case, and, despite what a lot of prominent experts have been telling us, there are very good reasons to expect symptomatic reinfections to be worse, re-reinfections to be even worse, and so on. The reason old people are so hard hit is immunosenescence, but not even immunosenescence itself, but the chronic inflammation that comes with the age-related degeneration of the immune system, and which is the key risk factor for a bad response to SARS-CoV-2 infection. This is also why young people with obesity, diabetes, etc. are also at risk — those are accompanied by chronic inflammation too.

But the virus itself attacks the immune system in such a way that it leaves it in this weird inflamed state that can last a long time (there have been multiple papers showing strange T cell subpopulations developing and persisting after COVID). Which means that when the next infection comes, they will have an elevated risk of severe progression.

And this is aside from the direct organ damage that has been caused by the previous infections, which is also a risk factor. If you have lost 30% lung capacity, and you lose another 50% on the second infection, then what does that leave you with…

That spiraling towards complete ruin will happen more quickly in old people because they start from a worse position and the damage incurred is greater at each step, but eventually, with sufficiently many reinfections, young people will be wrecked too. This is also why the “vaccines or nothing” approach is so criminal — even with a reasonably effective vaccine that you need to take annually, you will still get COVID multiple times — 3 times by the age of 60 for a 95% effective one, 6 times for a 90% effective one, and so on.

Go long masks and social distancing. They’ll be back soon.

______

1 If we are lucky, we may have more traditional vaccines approved by then, for the benefit of those who are leery of the newer tech offerings. mRNA vaccines were out of the box first because they can be developed very quickly. Recall that GM also flagged a nasal vaccine that looks to be extremely promising, but it is unlikely to be approved and distributed before late 2022.

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