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  Heterologous Boosters
Posted by: M_T - 10-13-2021, 05:02 PM - Forum: Vaccine - Replies (6)

A new NIH-sponsored study has been posted.  The study has a lot more than what is in the media today, but I haven't had a chance to digest it. (For instance, adverse events)  

The study is ongoing.  Neutralization results for the Delta variant were only available for Moderna. (Otherwise, neutralization results were for an early COVID version (WA-1).)

This must have been rushed out.  There are tables with data from 15-days post-booster but "in process" for 29-days post-booster.   Perhaps the FDA had this rushed so they could make a decision on the Moderna booster.


Quote:People who got the Moderna vaccine for their original shots and Moderna again for their booster appear to have gotten the best immune response, followed by those who got Pfizer boosted by Moderna and then Moderna boosted by Pfizer — although the increase in immune response with the mRNA vaccines was probably too small to really make a difference in protection in most groups.

The most significant finding suggested that people who initially got the J&J vaccine seem to have gotten the best response if they got Pfizer or Moderna as their booster.

NOTE: This study used a 100mg (full) dose of Moderna as a booster.   Moderna has applied to the FDA for a 50mg (half) dose of Moderna as a booster.

I notice in the study that those that got the Moderna boost had a shorter interval after their first vaccinations until the boost (basically 14-17 weeks versus 20-24 weeks for Pfizer and 18-21 for J&J).  This is noticeable in the neutralizing titers prior to booster (original Moderna vaccine patients:  Moderna booster (16.4 weeks): 88.7; J&J booster (19.3 weeks): 61.7;  Pfizer booster (22.9 weeks): 57.6).  This makes me a little leary of their multiplicative factor as a measure of how effective the boost was.

I also don't believe this study can give a good idea of how enduring the effectiveness is.

However, the boost is quite significant for the mRNA boosters.  The J&J boost for J&J takes a low number and makes it a bit better -- sorta like an fading Pfizer and not as good as a fading Moderna.

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  (Lack of) Variants
Posted by: M_T - 10-13-2021, 04:26 PM - Forum: COVID-19 - Replies (1)

The CDC shows the proportion of variants in the US.  We have 99.9% B.1.617.2 (delta).
Hawaii, at 95.3%, has the most other variant 3.4% of AY.1 (also delta).
Florida, at 97.5%, is next most. 2.2% "Other" (not a variant of concern, of interest, or being monitored).
11 states have between 1 and 2% "Other".
(Puerto Rico is 92.5%, with 7% Other.)

While another nasty variant may arise, it seems that B.1.617.2 is relatively stable, or is squeezing out other variants as they may occur.  Considering that most of the vaccines weren't optimized against B.1.617.2, and yet they do a pretty good job of reducing hospitalizations for it, I am hopeful that some vaccine-escaping deadly variant is unlikely to emerge.

I'd guess the reason Florida & Hawaii & Puerto Rico have more Other infections is the frequency of foreign visitors, arriving from other countries with less effective vaccination.

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  Alameda County inpatients
Posted by: akiddoc - 10-13-2021, 12:37 AM - Forum: COVID-19 - Replies (1)

The public health hospitals for Alameda County are now down to 5 inpatients with Covid. 81 percent of eligible (12 and up) individuals are fully vaccinated in the county. Oakland Unified School District voted to make the vaccine mandatory for 12 and up. That likely takes effect on January 1. I still see the odd child with Covid. Mostly among preschoolers right now. One of the mothers in my practice died of Covid in August.

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  Census bureau survey
Posted by: M_T - 10-01-2021, 12:26 AM - Forum: COVID-19 - Replies (1)

I received a text today (allegedly & actually) from the  US Census Bureau, with a link to a survey at covid.census.gov.  After validating that everything looked legit, I took the approximately 20 minute survey.

See about the survey at

They wanted to know everything about you, except your name.
Age, gender, address, income, race, email (because I said to use email vs text), education, household size, sexual orientation,  gender identity, etc. (not religion or politics)
I almost aborted the survey.

Most of the COVID related questions were short term (last week or two).  I guess there was one where they ask if a health professional has told you you had COVID.  They didn't ask how many times you were infected, whether it was mild or critical, how many times you've been tested.  (They did ask 0, 1, or all vaccinations, but not what kind.)  Instead they asked more about financial & emotional negatives (did you have trouble making payments;  were you feeling stressed, etc.)

Judging from what the news covers,  I'm sure I'm an outlier.  But even outliers should do the surveys.

What I feel about surveys like this is that they are pre-selected by someone who wants to make an issue of what the survey measures.  If a survey is done about whether people are a vegetarian or not, that becomes an issue du jour, even if, say, the weather is the biggest influence on the country at the time.

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  Bio marker for bad outcome?
Posted by: M_T - 09-05-2021, 11:16 AM - Forum: Research - No Replies

"Autoantibodies neutralizing type I IFNs are present in~4% of uninfected individuals over 70 years old and account for ~20% of COVID-19 deaths"

Quote:Circulating autoantibodies (auto-Abs) neutralizing high concentrations (10 ng/mL, in plasma diluted 1 to 10) of IFN-α and/or -ω are found in about 10% of patients with critical COVID-19 pneumonia, but not in subjects with asymptomatic infections. We detect auto-Abs neutralizing 100-fold lower, more physiological, concentrations of IFN-α and/or -ω (100 pg/mL, in 1/10 dilutions of plasma) in 13.6% of 3,595 patients with critical COVID-19, including 21% of 374 patients > 80 years, and 6.5% of 522 patients with severe COVID-19. These antibodies are also detected in 18% of the 1,124 deceased patients (aged 20 days-99 years; mean: 70 years). 
We also hypothesized that the prevalence of auto-Abs against type I IFNs in the general, uninfected, population may increase with age and that these antibodies may be more common in men than in women.

These aren't being developed in response to COVID, but are in the population prior to COVID.

I'd tend to think of this more as another comorbidity - a condition that exacerbates the outcome of COVID.

IFN = Interferon.

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  COVID deaths in US before Feb 1 2020
Posted by: M_T - 09-03-2021, 11:07 AM - Forum: COVID-19 - No Replies

I missed this Mercury News article 10 days ago, indicating 6 deaths spread across the US attributed in part to COVID before Feb 1, 2020.  Reporters have now determined the identity of the person in Kansas whose death is the earliest listed, January 9, 2020.  When her death certificate was amended to add COVID (in May 2021), her family wasn't told.

The elderly woman had comorbidities, but no travel.

Presumably there haven't been any epidemiological studies done yet either to see who may have infected her or whether anyone was infected by her.

I would keep in mind that samples may be contaminated before/during testing, which could lead to false positives.

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  "Close contact"
Posted by: M_T - 09-02-2021, 04:12 PM - Forum: COVID-19 - No Replies

With all the obviousness of the different nature of Delta versus the original COVID, the CDC has failed to extend "close contact" to either shorter time or larger separations.

This feels like the whole "We don't need no stinking' masks" situation again.  

Per the CDC's own cautious underestimation, " The Delta variant is highly contagious, more than 2x as contagious as previous variants.".    So, why doesn't the "close contact" definition reflect that?

Can anyone understand why they haven't adjusted "close  contact"?

(In schools, "close contact" is defined to be within 3' not 6';
US rate of cases: 323/100K in 7 days
CA rate of cases: 141/100K in 7 days
LA Unified School District:  2600/665K  =  391/100K students in 7 days.     Despite required masks.   Ouch!)

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  How it spreads
Posted by: M_T - 08-29-2021, 12:10 AM - Forum: Humor - No Replies

From Steve Shafer's COVID postings:
[Image: image004.png?part=0.0.4&view=1&vt=ANaJVr...NqMc_vNgcI]

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  Marin Co. Elementary School incident
Posted by: M_T - 08-28-2021, 11:51 PM - Forum: COVID-19 - No Replies

Here's the publication at the CDC on the Marin County (CA) elementary school incident.

"Outbreak Associated with SARS-CoV-2 B.1.617.2 (Delta) Variant in an Elementary School — Marin County, California, May–June 2021"

What I missed in the headlines:
  1.  This was near the end of the last school year (May 2021).  The variant wasn't yet named "Delta".  It was 1% of US cases at the start of May, and 7% at the start of June.
  2.  The CDC reports (in their poster) "12 of 24 kids infected"  while the paper shows that only 22 were tested, so it SHOULD say 12 of 22 kids infected, with 2 unaccounted for.
  3.  All 5 in the front row were positive.  3 of the 4 tested in the 2nd row were positive.  Then 1 of 5, 1 of 4, 2 of 4.
  4.  Another classroom nearby 3 grades higher had simultaneous cases.  6 of the 14 tested were positive.
       Several of the infections had identical genomes to those of the teacher.
  5.  Siblings of students in the index class (in other grades) later showed up with cases.
  6.  There were 5 other identical genomes in the community, including one from May 18, but an epidemiological link couldn't be established.
  7.  There was plenty of ventilation and an air filter in the classroom.
  8.  Desks were separated by 6' in two dimensions.

The teacher had attended "social events" May 13-16 (Thu. - Sun).  The teacher taught the class prior to and during the week of May 17 (Monday) to May 21 (Friday).  Symptoms happened on Wednesday May 19.  Test was taken on Friday, with results on Monday.   Student symptoms (both classrooms) started on Saturday May 22.

Apparently, the reading without a mask happened multiple times (date(s) not given).

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  Los Angeles County school infection rate last year
Posted by: M_T - 08-28-2021, 10:50 PM - Forum: COVID-19 - No Replies

Kindergarten Through Grade 12 Schools and in the Community — Los Angeles County, California, September 2020–March 2021"

The CDC has posted the above document that reports on cases in L.A. schools last school year (September 2020 - Mar 2021), which they acknowledge is pre-Beta.

Although the authors, members of LA County Dept. of Public Health and LA County Office of Education claim no conflicts of interest, to me this is the same as if employees of, say, Delta Airlines reported it was safe to fly.  Their organization's financial situation depends upon student attendance.

Four numbers are provided for each of the 7 months:  

  • Adult case rate in the county
  • School staff member rate in the county
  • Children/adolescent rate in the county
  • At-school rate for children/adolescents
The numbers look pretty good for the schools -- the rate of cases reported to the schools is less than the case rate in the community.
"In schools with safety protocols in place for prevention and containment, case rates in children and adolescents were 3.4 times lower during the winter peak compared with rates in the community."

The issue I wonder about is that there is no independent validation of the true case rate for students or the community.  If only one out of three cases are reported in the community, and one out of ten cases are reported to the schools,  that would cause different stats.   In the footnotes is "Schools relied on staff members, students, parents and guardians, and testing programs where available to inform them of cases "  (for the 2nd and 4th set of stats above) 

If you think about it, it is hard to come up with a rationale why those kids that happen to be mingling at school would have a lower case rate than those that are at home with their own families during their at-home schooling. It is a lot easier to imagine why a parent might not report to the school that their child had COVID ("You mean I have to keep him home for 10 days??!!") Personally, I would credit that as the reason for the difference in reports of in-school vs not-in-school numbers for (at least) the kids.

I also have a quibble about the year-end holiday.  I would argue that the school numbers in December and January are likely lower than they should be.

At some point, I expect California to report case rates for unvaccinated school staff under the current rules that require periodic testing for  the unvaccinated.  When they come out, I would expect them to be higher than community rates since they should be detecting almost all the cases of that group.  Of course, how the state will couch it is that the unvaccinated case rate is way higher than the vaccinated case rate (where the latter group are not being periodically checked).

If you believe these stats, then we should never have sheltered at home. We should have gone to schools in groups of 20-30, each from a different household. We would have had half the infection rate!

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