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Covid-19 #29: Gazing Into the Abyss, Again


Fragile Bird

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4 hours ago, Zorral said:

Informative article in the NY Times describing how and what went wrong at the Baltimore plant -- paywall:

That's a very damning article.   

62m J&J and 70m AZ!!!   Wow.  While i'm sure the US intends on using the 62m.  The 70m AZ would make a huge difference to other countries.  I hope they can save them.

3 hours ago, Fragile Bird said:

My other question is, if all the J&J doses are on hold, where have J&J doses come from? Did they all come from Europe?

https://nymag.com/intelligencer/2021/04/the-story-of-one-dose.html

That's a long article but it goes into the J&J story.  I read it a few days ago but its probably behind a paywall.  Anyhow, this is the relevant line.

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But until it could sort out the mess, Johnson & Johnson was forced to rely on vaccine substance produced at Janssen’s plant in Leiden

The other thing to note:

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in March, President Biden announced that the pharmaceutical giant Merck, which had abandoned its own vaccine initiative, would convert and upgrade its facilities to help manufacture more J&J doses

Not sure when the Merck factory comes online.

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9 hours ago, Mudguard said:

You say this from the point of view of a country with arguably the best supply of vaccine in the world.  Yeah, the US has the luxury of relatively ample supply so we can generally stick to the standard dosing interval.

But most other countries don't have nearly enough supply, and the delivery times are hard to accurately predict, unlike with the US.  These countries face a very difficult decision, which states in the US also faced early on when the vaccine pipeline was just getting going. Do you vaccinate as many people as possible with a single dose, or do you only vaccinate half the number and reserve half of the supply for the second dose? 

But isn't that the key here, the uncertainty of the supply without a perfect understanding of just how long the first shot is good for? And your last sentence is the real rub. I thought we had to prioritize the most vulnerable first. If there were only enough shots to get each vulnerable person partially vaccinated, do that, but if there's enough for each of them to get both shots, you do that before spreading out the first shots among those less in need. Imo that's when you should be really thinking about making sure everyone gets their first shot regardless if they'll have to wait longer than would be ideal (but not too long as to undermine the goal of being as vaccinated as possible.

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There's data that suggests that a single shot of these vaccines provides very good protection, about 70 to 80 percent, for at least months.  And the studies are certainly ongoing, so the estimated length of protection from the single shot doses is lengthened for each month they don't observe a drop off in efficacy.  If they see a drop in efficacy, I'm sure they'll schedule the second dose for everyone ASAP and adjust their dosing planning accordingly.

My worry is that 70% to 80% might not be good enough to combat variants of COVID, and there are obviously going to be more of them as time goes on. I've heard mixed reporting about how effect an incomplete vaccination can be in fighting off these mutations.

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You say that 100 days is absurd, but it's not.  Immunity normally won't just disappear in a short period of time, and could very well last for years, even after a single shot.  Also consider the J&J vaccine which is a single shot vaccine and is similar to the AZ vaccine (both are adenovirus based dna vaccines).  If the mRNA vaccines generate a strong response after a single shot, it wouldn't be surprising for the protection to last a long time as well.  The data collection around this is ongoing, so we should get a warning if this is not the case.

And isn't the J&J single shot basically as effective as just getting the first Pfizer/Moderna shot? 

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It's a risk to not hold any vaccine in reserve, but I think it's a reasonable level of risk given what we know about the vaccines and Covid-19.  I actually think it's the right call to vaccinate as many people as possible, which will help knock down the rate of infection quicker.

It's a gamble, which is why I said above I'd be more open to that approach after the most vulnerable have been fully vaccinated, as well as all medical staffers as they must be a high priority as well.

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1 hour ago, Karlbear said:

My first dose of Pfizer kicked my ass last week. Headaches, major fatigue, body pain and really weird-ass dreams. No fever to speak of. 

Mine got me high, but that was it. How long did the strange dreams last for?

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1 hour ago, Karlbear said:

My first dose of Pfizer kicked my ass last week. Headaches, major fatigue, body pain and really weird-ass dreams. No fever to speak of. 

I got the AZ vaccine 2 weeks ago. I had weird dreams too but then I always do anyway. Mostly because I am restless enough to remember them. 

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....Nearly half of new coronavirus infections nationwide are in just five states — a situation that is putting pressure on the federal government to consider changing how it distributes vaccines by sending more doses to hot spots.

New York, Michigan, Florida, Pennsylvania and New Jersey together reported 44% of the nation’s new COVID-19 infections, or nearly 197,500 new cases, in the latest available seven-day period, according to state health agency data compiled by Johns Hopkins University. Total U.S. infections during the same week numbered more than 452,000....

 

https://www.nydailynews.com/coronavirus/ct-aud-nw-covid-infection-hotspots-20210406-f4mkkyla7nfcpdxs5bmrbj7jqe-story.html

My region all the way, ladies and gentlemen.  Well, not Florida -- but so many here are always coming and going to Florida.  I suppose not Michigan either, but due to the people we know who live there, we feel it is.

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New research published Tuesday in The New England Journal of Medicine shows the two-dose Moderna COVID-19 vaccine to still produce antibodies after six months.

Research is continuing to see just how long antibodies are detected in people who have received the vaccine.

 

https://www.nejm.org/doi/full/10.1056/NEJMc2103916

Moderna is the one I got, and get the second time Friday. Partner does 2nd Pfizer tomorrow.

 

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30 minutes ago, Tywin et al. said:

Mine got me high, but that was it. How long did the strange dreams last for?

About 3 days. Really sucked, with lots of zombie chasing and whatnot, along with me thinking I was going to be eaten. 

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Unfortunately the Emergent BioSolutions story (the vaccine factory in Baltimore) is another example of why infrastructure investment is so infuriatingly wasteful because it becomes an invitation to graft.  Pre-investing in a facility that can surge production of vaccines is a great idea, but hundreds of millions of dollars were sunk into this by the govt with no real accountability.  And we’re all feeling good about having spent this money on a valuable safety net, until an actual pandemic arrives and it proves fucking worthless.  

It’s like political cronies building flood levies out of cardboard for inflated prices. Sooner or later the rains come.

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Not something that had occurred to me, but should have, probably?

An Unexpected Boon to America’s Vaccine Towns
Out-of-towners looking for shots are unintentionally lifting local economies after a tough year
. [paywall after 3? or 4? clicks]

https://www.theatlantic.com/technology/archive/2021/04/vaccine-tourism-economic-boost-towns/618504/

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...I felt guilty driving north to Plattsburgh, even though I have a qualifying health condition. When I entered the vaccination center, I was seriously questioning my judgment. The nurse administering my shot asked where I was from, and I responded, sheepishly, “Westchester County.” What she said next surprised me. “I actually don’t mind that so many people are coming here for vaccines,” she told me. “It’s been good for the economy.” It turns out that for at least a few rural areas with mass-injection sites, the main result of vaccine tourism has not been out-of-towners stealing doses. It’s been a much-needed economic boost.

Plattsburgh, nestled along Lake Champlain, is so far from New York City that Quebec is just 25 minutes away. That means when I went there twice, once for the first dose and again for the second, I had little choice but to stay overnight—and spend a lot more money than expected. During just one of the trips, I picked up food from Olive Ridley’s Taphouse & Grill, visited a pharmacy, and shopped for groceries at Cumberland Bay Market to make dinner at my Airbnb. I even did some COVID-cautious sightseeing. Rather than driving back to Westchester the next day, I took a ferry from Plattsburgh to Vermont to see the mountains that line each side of the lake....

....Other small cities and towns home to mass-vaccination sites told me they’ve seen significant spikes in commercial activity. Habersham County, a rural part of Georgia that’s around 90 miles from Atlanta, has seen an economic bump in many of its restaurants, stores, and hotels since a site opened in Clarkesville in late February. “Having the vaccination site here has definitely refueled the economy after a really tough year,” says Mary Beth Horton, the president of the county’s chamber of commerce....

....Still, vaccine tourism does not generally help underserved communities access shots—and it is those communities who need them most. Last week, a Kaiser Family Foundation analysis of 40 states found that 25 percent of all white people have received at least one vaccine dose, compared with just 15 percent of Black people and 13 percent of Latinos. There are many factors underlying this disparity, but one problem is access to transit: People of color are roughly twice as likely as white people to live in households without cars, making it more difficult for them to travel beyond where they live for doses....

 

Plus, in the same issue, 

"Canada’s Vaccine Mess
Canada has universal health care and millions of doses on order. So why are so few of its citizens vaccinated?"

https://www.theatlantic.com/international/archive/2021/04/canada-vaccine-rollout-problems/618516/

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....“I think we have nothing to be proud of on this, that’s for sure,” André Picard, a health expert in Canada and a longtime columnist for The Globe and Mail, told me.

To some degree, this is the natural result of living in a small country during an unprecedented global health crisis that has scrambled supply chains all over the world. Without much domestic manufacturing capacity to speak of, Canada had to sign advance-purchase deals with international vaccine companies. The country hedged its bet by mostly going with companies funded by Operation Warp Speed, and so far its strategy has been to overbuy doses in the hopes of securing enough to vaccinate all of its citizens. A mounting critique, however, is that perhaps Canada should have been more specific than “first quarter of 2021” in terms of arranging vaccine-delivery timing. Picard said that Canada, by not giving manufacturers a specific week, or even day, allowed them to push delivery until the outer limit of the quarter.

“The time between the vaccines being approved and the vaccines getting into people’s arms is one where you can’t do it fast enough,” says Tim Evans, the head of McGill University’s School of Population and Global Health as well as Canada’s COVID-19 Immunity Task Force. “A large majority of people see vaccines as our ticket out of this pandemic. So I think that’s part of the issue—every day seems like an eternity.”

But Canada’s problems run deeper: Through a combination of bureaucracy and legislation, the country has slowly lost its drug manufacturers that were doing original R&D, its capacity to respond to potential pandemics early, and its federal clout in organizing national strategies for pandemic response and emergency vaccine rollout.

“I think it’s a frustration for Canadians, especially to see this massive rollout in the U.S. next door, and to see some countries around the world have much more vaccination per capita,” Picard said. “But I think a lot of it is historic, unfortunately.”....

 

But this seems almost to be written with the aim of leaving the US off the hook?  When contrasted with some of what Bird has written. :dunno:

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18 minutes ago, Zorral said:

Not something that had occurred to me, but should have, probably?

An Unexpected Boon to America’s Vaccine Towns
Out-of-towners looking for shots are unintentionally lifting local economies after a tough year
. [paywall after 3? or 4? clicks]

https://www.theatlantic.com/technology/archive/2021/04/vaccine-tourism-economic-boost-towns/618504/

Plus, in the same issue, 

"Canada’s Vaccine Mess
Canada has universal health care and millions of doses on order. So why are so few of its citizens vaccinated?"

https://www.theatlantic.com/international/archive/2021/04/canada-vaccine-rollout-problems/618516/

But this seems almost to be written with the aim of leaving the US off the hook?  When contrasted with some of what Bird has written. :dunno:

The reporter works for a very large-C Conservative paper (150 years worth) and they attack the government relentlessly. Some is justified, some is bs.

Note, we are in the same position as Europe, and Europe has massive multi-national drug companies.

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12 hours ago, rotting sea cow said:

By the way, that article is very misleading.   While it does quote him correctly, he apparently goes on to say (but not reported in that article)...

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Mr Cavaleri, the vaccines chief, told Il Messaggero that he expected the product information accompanying AstraZeneca vaccines would be updated to make it clear there was a link to such blood clots as a side effect in rare cases.  However, he did not expect the agency to recommend limiting the vaccine to certain age groups. 

https://www.irishtimes.com/news/world/europe/ema-official-says-clear-link-between-astrazeneca-vaccine-and-blood-clots-1.4530231

2 hours ago, Tywin et al. said:

And isn't the J&J single shot basically as effective as just getting the first Pfizer/Moderna shot? 

They all claim to have 100% efficacy against severe COVID.  Although, I don't think there is much data behind those claims.  Not that anything could really be 100% efficient.  But in fairness, they probably all get close enough.

I think the other important question is how long their efficacy lasts.  There must be something in the J&J vaccine to ensure durability (or why have a 1 dose vaccine), similar to the other (2 dose) vaccines.  But I don't understand the science enough to get into that.

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1 hour ago, Fragile Bird said:

The reporter works for a very large-C Conservative paper (150 years worth) and they attack the government relentlessly. Some is justified, some is bs.

Note, we are in the same position as Europe, and Europe has massive multi-national drug companies.

Thanks, Bird. Particularly because of what you have posted, I tended to have a level of questioning. Also, you started as a journalist yourself, iirc?

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6 minutes ago, Zorral said:

Thanks, Bird. Particularly because of what you have posted, I tended to have a level of questioning. Also, you started as a journalist yourself, iirc?

Yes. But the other thing I should point out, he said that Canada should have set more specific deadlines, which is a great thought in hindsight but I don’t think anyone set out week by week deliveries, or even firm monthly deliveries. And contracts were signed long before the US EO was created. To say we tied ourselves to the US Warp Speed program is strange as well - who else were we supposed to sign with? The Russians? The Chinese, after they reneged on their deal with us? The only company I don’t think we have a contract with is Curevac.

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7 hours ago, Padraig said:

By the way, that article is very misleading.   While it does quote him correctly, he apparently goes on to say (but not reported in that article)...

I saw that later. I find it weird that Mr. Cavaleri went (almost) out of the record to give his personal opinion on the matter. EMA statement about the issue is expected only today but more likely tomorrow. Probably there are many positions to reconcile there.

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16 hours ago, RhaenysBee said:

God how I wish more communication channels shared your outlook on this. Sounds so much healthier than... well everything else. 

I also have my days when I find the whole situation terribly depressing. There are sometimes worrisome news at the fringes and the political situation certainly doesn't help.

 

16 hours ago, RhaenysBee said:

If it’s a question, the answer is I have no information about the topic to tell but it sounds about right to me. They got the base facts right: the Roma community is a younger demographic, trust in authority is low (so it makes sense that it’d be so in vaccines as well - and, plausibly, in science due to lower education which is a long standing issue among the Romas as a marginalized minority), and the vaccine rollout is based on voluntary registration and prioritizing healthcare workers and the elderly. The assertion that covid would hit them harder is logical, but I don’t know if it’s based on any actual data or just hearsay and deduction. 

Thanks. Yes, the data about this is hard to come. It's like governments refuse to acknowledge the situation and attempt more targeted policies. I mean, I know people in relatively privileged positions who claim that everything is a lie because they don't know anybody who got covid. Of course, they can isolate without a problem and meet within their own safe bubbles. But in other places covid is running rampant because people do not have the chance to take care of themselves.

Regarding your positive PCRs. Remember viral shedding can last a good while. At the same time, Hungary is having a bit surge. Labs are likely working at the limit and crosscontamination of samples does happen.

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So lets talk about Brazil as Manaus in the Amazonas region seems to be the new global hotspot. The dominant virus variant there is the P1 mutation which is even more transmissible than the UK variant and apparently also causes a higher percentage of severe cases. This is worrisome on many levels. It shows that we are in a continuous longterm fight as the virus is put under evolutionary pressure to mutate to still be able to do its thing (reproduce and spread). It’s survival of the fittest, overcoming of anti-bodies (vaccines or previous infections). Remember that Manaus was one of the regions where a large percentage of the population already got infected in the first wave last summer. And now they face the same shit, and even higher mortality rates. 
 

I wonder where are all those supersmart people now who advocated for herd immunity through „controlled“ infections? It seems they failed to consider the factor time. You might get herd immunity but only for 6 months. And afterwards you might have to deal with an even nastier virus variant. Anyway the conclusion is clear: vaccination won’t be a one-time event but at least for the next couple of years expect to be vaccinated once or twice (more realistic) every year until this corona virus loses its edge and evolves into something like its brethren (common cold corona viruses). That’s the hope everyone has, and a justifiable one. But there is no law of nature that dictates a virus to become less harmful over time. Empirically it happens more often than not but not always. 

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Apparently the EMA and the MHRA are giving statements about AZ today at the same time (16:00 central European time). so a joint action? Afterwards the health ministers of the EU will meet. For me that sounds like the EMA may come around to the Norway / Germany /France / Netherlands position of recommending to not use AZ for younger people (women?) if there is a choice of vaccine.

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1 hour ago, Arakan said:

Anyway the conclusion is clear: vaccination won’t be a one-time event but at least for the next couple of years expect to be vaccinated once or twice (more realistic) every year until this corona virus loses its edge and evolves into something like its brethren (common cold corona viruses). 

It was always going to be a multi-year vaccination process. You don't have to be a doctor or scientist to see the obvious.

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I was just looking at a story about excess deaths in Canada (longer post in the Canadian Politics thread) and it looks like we had about 3,000 more Covid-19 deaths in 2020 than originally reported. We had 13,800 excess deaths, 5% higher than deaths in 2019. Analysis by researchers suggests we had 3,000 more deaths in 2020 that likely should have been attributed to Covid-19. 15,606 is the official number.

Out of curiosity I looked up the US number, which just came out last week, and apparently there were 523,000 excess deaths in the US, an increase of almost 23% from the average. That number is from March 1, 2020 to January 2, 2021. 72% are attributed to Covid-19, and while there are a number of explanations for some of the other 28%, like failure to seek medical attention because of fear of going to the hospital, suicides, drug overdoses etc, many are likely to be from Covid-19 and not identified as such.

I have tried to find an official number for Covid-19 deaths in the US without success. The closest I’ve come is “almost 400,000” from an article about a CDC report that sets no figure, saying it will take months for states to get final numbers in. The January 1 number on Worldometer was 364,314, and I think the John’s Hopkins number was about 15,000 lower. I find the JH website almost impossible to use. The Worldometer number and the excess deaths number have an astonishingly huge gap. However, if 72% of the excess deaths number are attributed to Covid-19, that’s about 376,560. Since the death toll is about 200,000 higher now, you can see how bad the 3rd wave has been in the US. The same can be said for Canada, where deaths now stand at 23,141, an increase of over 50% since year end.

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So, not a joint action of EMA and MHRA:

EMA says: it is a confirmed adverse side effect but does not give an age/sex recommendation.

MHRA says: its not confirmed but people under 30 should take a different vaccine.

 

?

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