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RE: 2019–2022 CORONAVIRUS PANDEMIC POSTINGS

I don’t have time today to carefully read this study. I am posting it now because it addresses a question that has been raised here: what effect does changing the time between prime and boost have on vaccine effectiveness. Two-dose SARS-CoV-2 vaccine effectiveness with mixed schedules and extended dosing intervals: test-negative design studies from British Columbia and Quebec, Canada MedRxiv preprint 26Oct2021 Background The Canadian COVID-19 immunization strategy deferred second doses and allowed mixed schedules. We compared two-dose vaccine effectiveness (VE) by vaccine type (mRNA and/or ChAdOx1), interval between doses, and time since second dose in two of Canada's larger provinces. Methods Two-dose VE against infections and hospitalizations due to SARS-CoV-2, including variants of concern, was assessed between May 30 and October 2, 2021 using test-negative designs separately conducted among community-dwelling adults =18-years-old in British Columbia (BC) and Quebec, Canada. Findings In both provinces, two doses of homologous or heterologous SARS-CoV-2 vaccines were associated with ~95% reduction in the risk of hospitalization. VE exceeded 90% against SARS-CoV-2 infection when at least one dose was an mRNA vaccine, but was lower at ~70% when both doses were ChAdOx1. Estimates were similar by age group (including adults =70-years-old) and for Delta-variant outcomes. VE was significantly higher against both infection and hospitalization with longer 7-8-week vs. manufacturer-specified 3-4-week interval between doses. Two-dose mRNA VE was maintained against hospitalization for the 5-7-month monitoring period and while showing some decline against infection, remained =80%. Interpretation Two doses of mRNA and/or ChAdOx1 vaccines gave excellent protection against hospitalization, with no sign of decline by 5-7 months post-vaccination. A 7-8-week interval between doses improved VE and may be optimal in most circumstances. Findings indicate prolonged two-dose protection and support the use of mixed schedules and longer intervals between doses, with global health, equity and access implications in the context of recent third-dose proposals. I also wonder if the shorter time between prime boost plus a later 3rd shot booster is a good compromise between more effective longer time between prime boost and getting the population to full vaccination faster during an ongoing pandemic (since just the prime has lower effectiveness).
BCSnob 10/27/21 06:37am Around the Campfire
RE: 2019–2022 CORONAVIRUS PANDEMIC POSTINGS

Here is a good example of a study that the popular press would love to report. But also an example where "the devil is in the details". Outbreak of SARS-CoV-2 B.1.617.2 (Delta) variant in a Nursing Home 28 weeks after two doses of mRNA anti-Covid-19 vaccines: evidence of a waning immunity MedRxiv preprint 26 Oct 2021 At this nursing home where there was high vaccination rates among the staff and residents (82% and 91%) there was a breakthrough infection 28 weeks after full vaccination which lead to additional breakthrough infections. Antibody testing was performed within 48hrs of the first breakthrough case on all residents and staff. The titer levels were corrected to whether or not a breakthrough infection occurred; lower antibody titers correlated to higher risks of breakthrough infections. The authors claim this as evidence of waning vaccine effectiveness from decreasing antibody titers.Conclusion Low levels of SARS-CoV-2 neutralizing anti-Spike IgG in serum 28 weeks after the administration of the second dose parallels the waning of vaccine protection. But they did not present data showing the antibody titers post vaccination; only the titer levels 28 weeks after vaccination. So, did the titer levels decrease overtime or were they stable but low post vaccination (weak seroconversion)? Did the breakthrough infection occur because of low antibody titers to the wild type virus spike (what is used in this antibody test) or did they occur because the vaccine is less effective to the variant in circulation at the time of infections (Delta)? Or some combination of decreasing antibody titers and a more infectious variant.
BCSnob 10/26/21 09:17am Around the Campfire
RE: 2019–2022 CORONAVIRUS PANDEMIC POSTINGS

Long-term health-related quality of life in non-hospitalised COVID-19 cases with confirmed SARS-CoV-2 infection in England: Longitudinal analysis and cross-sectional comparison with controls MedRxiv Preprint 25 Oct 2021 Prospective cohort study of SARS-CoV-2(+) cases aged 12-85 years and followed up for six months from 01 December 2020, with cross-sectional comparison to SARS-CoV-2(-) controls. Results: Of 548 cases (mean age 41.1 years; 61.5% female), 16.8% reported physical symptoms at month 6 (most frequently extreme tiredness, headache, loss of taste and/or smell, and shortness of breath). Cases reported more limitations with doing usual activities than controls. Conclusions: One in 6 cases report ongoing symptoms at 6 months, and 10% report prolonged loss of function compared to pre-COVID-19 baselines. This study followed non hospitalized Covid-19 cases (which occurred while the wild type and Alpha were the dominate variants) for 6 months to assess the impact of the infections on their quality of life. It has been oft reported that most people survive this infection; however, this study suggests that a significant number people have lingering health issues (6months) caused by this infection. Lingering issues for much longer than the flu.
BCSnob 10/26/21 08:43am Around the Campfire
RE: 2019–2022 CORONAVIRUS PANDEMIC POSTINGS

Question Has the Pfizer vs Moderna comparison been peer reviewed and confirmed? Some of the statements were vague and confusing. When a manuscript is updated and upload to MedRxiv and BioRxiv these sites provide a link to to newer version. When it is published (peer reviewed) MedRxiv/BioRxiv provides a citation to the publication.
BCSnob 10/26/21 08:26am Around the Campfire
RE: 2019–2022 CORONAVIRUS PANDEMIC POSTINGS

This study from Japan investigated if breakthrough infections from Delta were due to waning immunity (lower amounts of antibodies) or if the Pfizer vaccine is just less effective against Delta. COVID-19 breakthrough infections and pre-infection neutralizing antibody MedRxiv Preprint 20Oct2021 The researchers measured antibodies and virus neutralization titers in healthcare workers after vaccination and through several waves of Covid-19; one wave was due to Alpha (1-2 months post vaccination) another wave was due to Delta (2-4 months post vaccination). There were no breakthrough infections due to Alpha; there were 18 breakthrough cases due to Delta. There were no differences in antibody titers against the wild type (Wuhan), Alpha, and Delta variants between the breakthrough infection cases and matched vaccinated coworkers with no infection. All virus neutralization titers were lower for Alpha and Delta than the wild type (the antigen used in vaccines). These results are contrary to those from the study conducted in Israel. One difference between this study and the one from Israel is when the serum samples were collected from the controls and cases; this study collected prior to infection (>62days post vaccination) while the study from Israel collected after infection. I think the contradictory results from studies (this one, the ones from Israel and Vietnam, and the US VA) correlating breakthrough infections to vaccination time, antibody titers, neutralization assays, and circulating variants suggest we don’t have the full picture on what leads to a breakthrough infection. Taking all of the studies together suggest it may be more than just waning immunity.
BCSnob 10/26/21 07:36am Around the Campfire
RE: 2019–2022 CORONAVIRUS PANDEMIC POSTINGS

Agreed One last comment; this mask effectiveness study is analogous to the “real world” vaccine effectiveness studies coming from places like Israel.
BCSnob 10/25/21 07:16am Around the Campfire
RE: 2019–2022 CORONAVIRUS PANDEMIC POSTINGS

IMO, you are being optimistic thinking these types of studies will have much effect at dispelling rumors on the lack of effectiveness of masks. But one can hope.
BCSnob 10/25/21 07:01am Around the Campfire
RE: 2019–2022 CORONAVIRUS PANDEMIC POSTINGS

Predictors of SARS-CoV-2 infection following high-risk exposure: a test-negative design case-control study MeRxiv preprint 23Oct2021 This study assessed the effects of various precautions that were taken during a high-risk exposure (exposure to a suspected or confirmed case of Covid-19) on preventing infection. Between February 24 and September 26, 2021, we enrolled 2541 participants, including 1279 cases and 1262 controls. In total, 847 participants, including 643 cases (50% of 1279) and 204 controls (16% of 1262), reported high-risk exposure within 14 days before testing, including 694 (82% of 847) with confirmed and 153 (18% of 847) with suspected exposure (Table 1; Table S2). Most participants reported their high-risk exposure occurred within a household (55% of 847) or workplace (14% of 847) (Table S3). A majority of these participants (69%, 582/847) listed high-risk exposure as a motivation for testing; additionally, 280 (33% of 847) participants sought testing due to symptoms (Table S4). The majority (82%, 694/847) of participants who had high-risk exposure reported both they and their contact did not wear a mask during the interaction (Table 3). Most participants were unvaccinated (70%, 591/847) at the time of testing; 9% (72/847) and 19% (158/847) were partially or fully vaccinated, respectively. Note that this study occurred while Delta was becoming the dominate variant. These results are not unexpected due to duration of time in an environment containing airborne virus. The difference between household vs non-household contacts is likely the duration and proximity of the exposure to the virus. 2.94-fold (95% confidence interval: 1.66-5.25) higher when high-risk exposures occurred with household members (vs. other contacts)2.06-fold (1.03-4.21) higher when exposures occurred indoors (vs. not indoors)2.58-fold (1.50-4.49) higher when exposures lasted <= three hours (vs. shorter durations) among unvaccinated and partially-vaccinated individuals Vaccination reduced the odds of becoming infected by 68% (32-84%) and 77% (59-87%) for partially- and fully-vaccinated participants compared to being unvaccinated. Mask usage by participants or their contacts during high-risk exposures reduced the odds of becoming infected by 48% (8-72%). Benefits of mask usage were greatest when exposures lasted <= three hours, occurred indoors, or involved non-household contacts. In other words, masks are not 100% effective at blocking the virus; they reduce the amount of virus released into the environment by an infected person and/or reduce the amount of virus inhaled from the environment. The longer one is in a virus containing environment or in environment where the amount of airborne virus is high, the less effective masks are at preventing one from inhaling enough virus to cause an infection.
BCSnob 10/25/21 06:38am Around the Campfire
RE: 2019–2022 CORONAVIRUS PANDEMIC POSTINGS

Here is a study where the prevalence of Covid antibodies was measured in rural Peru after one of the waves to estimate how many were infected. High SARS-CoV-2 seroprevalence in rural Peru, 2021; a cross-sectional population-based study MedRxiv preprint 23Oct2021 The study enrolled 563 persons from 288 houses across 10 provinces, reaching 0.19% of the total rural population of San Martin. Screening for SARS-CoV-2 IgG antibodies was done using a chemiluminescence immunoassay (CLIA) and reactive sera were confirmed using a SARS-CoV-2 surrogate virus neutralization test (sVNT). The survey found An overall 59.0% seroprevalence (95% CI: 55-63%) corroborated intense SARS-CoV-2 spread in San Martin. Seroprevalence rates between the 10 provinces varied from 41.3-74.0% (95% CI: 30-84). Higher seroprevalence was neither associated with population size, population density, surface area, mean altitude or poverty index in spearman correlations. The reason I posted this study is because it highlighted why one needs to know what antibody tests measure in order to know what the results mean. Validation using pre-pandemic sera from two regions of Peru showed false-positive results in the CLIA (23/84 sera; 27%), but not in the sVNT…. This particular antibody test yielded positive results for seasonal coronavirus that cause common colds. The researchers evaluated this test for cross reactivity to those antibodies and used another test (surrogate virus neutralization test) to correct for the false positive results in this antibody test.
BCSnob 10/24/21 08:54am Around the Campfire
RE: Coal-Rolling Teen Pickup Truck Driver Hits Six Cyclists

Perhaps that is not the case everywhere in MI The state isn’t required to rate local, non-federal aid roads, but 79 local road agencies submitted ratings for 16,968 lane miles of non-federal-aid roads in 2018. Of those, 53% were rated “poor.” Since that is only a fraction of local roads, TAMC determined “it is probably safe to assume that, as a class, non-federal-aid roads are in worse condition than federal-aid roads.” Michigan roads: how bad are they, how are they funded, and how on Earth can they be fixed? MI Radio As someone who trained and raced for many years in SC; I have experienced harassment even while riding solo (not taking up an entire lane). I also experienced harassment while riding solo in during college in MI (get off the road; ride on the pedestrian path).
BCSnob 10/21/21 07:05am Around the Campfire
RE: Coal-Rolling Teen Pickup Truck Driver Hits Six Cyclists

My point is what you see in a vehicle and what a cyclist sees on their bike as extenuating circumstances (ie hazardous road conditions) may be different. A piece of broken glass or gravel which will have no impact on vehicle tires can lead to punctures on bike tires. What is the likelihood that there will be hazardous conditions along the edges of MI roads such that the exceptions make cyclists entitled to use more of the lane than “against the curb”?
BCSnob 10/21/21 06:37am Around the Campfire
RE: Coal-Rolling Teen Pickup Truck Driver Hits Six Cyclists

There are exceptions in the MI code you posted A person operating a bicycle upon a highway or street at less than the existing speed of traffic shall ride as close as practicable to the right-hand curb or edge of the roadway except as follows: (a) When overtaking and passing another bicycle or any other vehicle proceeding in the same direction. (b) When preparing to turn left. (c) When conditions make the right-hand edge of the roadway unsafe or reasonably unusable by bicycles, including, but not limited to, surface hazards, an uneven roadway surface, drain openings, debris, parked or moving vehicles or bicycles, pedestrians, animals, or other obstacles, or if the lane is too narrow to permit a vehicle to safely overtake and pass a bicycle. (d) When operating a bicycle in a lane in which the traffic is turning right but the individual intends to go straight through the intersection. (e) When operating a bicycle upon a 1-way highway or street that has 2 or more marked traffic lanes, in which case the individual may ride as near the left-hand curb or edge of that roadway as practicable. (f) When riding as close as practicable to the right-hand curb or edge of the roadway would block, delay, or otherwise interfere with the movement of a streetcar on a streetcar track. Just how good are the edges of the roads in MI?
BCSnob 10/21/21 05:53am Around the Campfire
RE: Coal-Rolling Teen Pickup Truck Driver Hits Six Cyclists

There’s a “link” to an article with updates in my previous post
BCSnob 10/20/21 04:23pm Around the Campfire
RE: 2019–2022 CORONAVIRUS PANDEMIC POSTINGS

Here is a small study that may be of interest as we are moving towards EAUs of vaccines for children. Reduced seroconversion in children compared to adults with mild COVID-19 MedRxiv Preprint 18 Oct 2021 108 SARS-CoV-2 PCR-positive participants that were either asymptomatic or had mild symptoms (i.e. coryza, 116 headaches, nausea, fever, cough, sore throat, malaise and/or muscle aches) were recruited for assessing antibody levels and B & T cell levels at 7-14days, 41days, and 94days after the positive PCR tests. There were 57 children (median age: 67 4, IQR 2-10) and 51 adults (median age: 37, IQR 34-45) in this study. Fewer SARS-CoV-2-infected children (40.4-40.7%) produced antibodies as compared to adults (61.4-73.7%); all tested using 3 different antibody assays. The researchers invested likely causes for SAR-CoV-2 infections not leading to antibody production and the differences between the number of children vs adults producing antibodies. Individuals were more likely to be seropositive with higher viral loads and longer viral clearance time (based on those with multiple swabs collected), but there were no differences in these parameters between children and adults who were seronegative or seropositive. When examining the relationship between symptomatic infection and antibody response, a higher proportion of seronegative adults were asymptomatic compared to seropositive adults (4/10, 40% vs. 2/32, 6.3%; p=0.02) (Fig. 2H). Symptomatic adults on average had three times more antibodies than asymptomatic adults (median 227.5 IU/mL, IQR 133.7-521.6 vs. median 75.3 IU/mL, IQR 36.9-113.6) and higher viral load (not statistically significant) than asymptomatic adults, although the number of adults who were asymptomatic and seropositive was small (Fig. 2I-J). In contrast, a higher proportion of seropositive children were asymptomatic compared to seronegative children (although not statistically significant) (Fig. 2H), and similar levels of antibodies and viral load were observed in children regardless of whether they had any symptoms (Fig 2I-J). Notably, viral load correlated with antibody levels (Fig. 2K) but not age (Fig. 2L) in both children and adults. Asymptomatic adults were more likely to not produce antibodies than adults that had symptoms; in children the reverse was true (but by a minimal margin). The researchers found that there was evidence of cellular immunity in adults who seroconverted but not in children who seroconverted. This small study suggests that COVID-19 infected children (asymptomatic or mild symptoms) may not develop natural immunity against SARS-CoV-2.
BCSnob 10/20/21 10:07am Around the Campfire
RE: Coal-Rolling Teen Pickup Truck Driver Hits Six Cyclists

This news article (Link)has an update on the “hurt feelings” of the cyclists. T he six cyclists who were run over by a pickup truck driver in Waller County, Texas, on September 25 are all now recovering at home, according to an update posted by Bike Law and the cyclists’ retained attorneys on October 2. Their physical injuries include “broken vertebrae, cervical and lumbar spinal injuries, broken collarbones, hands, and wrists—many of which require surgical intervention—as well as multiple traumatic brain injuries, lacerations, soft tissue damage, road rash, and extensive bruising”. And yet there have been no charges This article also indicates the driver is connected The D.A.’s statement also confirmed that the driver is in some way connected to Waller city officials. “At this point we can confirm there are some connections, but have yet to see evidence of a city official directing the officer on the scene as to how to handle this particular situation. We will continue to look for any such criminal interference as the investigation proceeds.”
BCSnob 10/19/21 12:35pm Around the Campfire
RE: Interesting dog names

Two brothers on their way Two brothers on their way Two brothers on their way One wore blue And one wore grey One wore blue and one wore grey As they marched along the way A fife and drum began to play All on a beautiful morning….. We have litter brothers named Grant and Lee born on our farm that is next to the South Mountain Battlefield.
BCSnob 10/19/21 09:35am RV Pet Stop
RE: 2019–2022 CORONAVIRUS PANDEMIC POSTINGS

Here is another study estimating the change in vaccine effectiveness over time. Time-varying effectiveness of the mRNA-1273, BNT162b2 and Ad26.COV2.S vaccines against SARS-CoV-2 infections and COVID-19 hospitalizations and deaths: an analysis based on observational data from Puerto Rico MedRxiv Preprint 18 Oct 2021 We estimated time-varying vaccine effectiveness against SARS-CoV-2 infections by fitting a statistical model that adjusts for time-varying incidence rates, age, gender, and day of the week. At the peak of their protection, mRNA-1273, BNT162b2, and Ad26.COV2.S had an effectiveness of 87% (85% - 89%), 85% (82% - 87%), and 65% (58% - 70%), with Ad26.COV2.S reaching this peak 32 days after the being considered fully vaccinated. After four months, effectiveness waned to about 73%, 58%, and 32% for mRNA-1273, BNT162b2, and Ad26.COV2.S, respectively. All vaccines had a lower effectiveness for those over 85 years, with the decrease in effectiveness particularly low for the Ad26.COV2.S vaccine. We found no clear evidence that effectiveness was different after the Delta variant became dominant. I have one issue with the study method. The authors assessed vaccine effectiveness before and after delta by looking at two different time ranges and then claimed that all of the decrease in effectiveness was due to time from vaccination. To evaluate whether the Delta variant affected vaccine effectiveness, we considered two periods: before and after June 15, 2021. The mRNA-1273 and BNT162b2 vaccines remained steady at over 75% effective after the Delta variant gained dominance and a decrease in vaccine effectiveness was not detected due to the Delta variant (Supplementary Figure S2). I read this statement as, vaccine effectiveness decreased up until the time when delta was dominant. I feel the math to assess vaccine effectiveness with time and variant prevalence is more complicated than a simple cutoff date. The data needs to be broken down into which variant caused the infection (or at least which variant was dominant at the time of infection) and what was the time from full vaccination; both of these may impact vaccine effectiveness. The authors did estimate the impact on the population had no one been vaccinated. Using the rates observed for the unvaccinated we would have observed 6,109 and 2,071 hospitalizations and deaths among the vaccinated population but we instead observed 728 and 164, respectively.
BCSnob 10/19/21 06:25am Around the Campfire
RE: In a quandary

There are too many variables for anyone of us to provide guidance based upon our circumstances that would be appropriate for yours. Here are some things I would suggest you consider. What underlying conditions do family members have that make them more susceptible to getting sick and/or getting a severe case? My father is a lung cancer survivor with part of his lung removed and is prone to bronchitis. We will be more cautious than a family where members don’t have underlying conditions. What are the case rates where people will be coming from? We would be hesitant for our family member in AK to come compared to family members in MD. What are the behaviors of those coming when they are in indoor public spaces? Will they be going to bars & restaurants (where mask wearing is very difficult) to celebrate with friends and coworkers before them come for the holidays or do they always wear a mask indoors in public spaces and do take out or eat outdoors at restaurants? This is especially important if case rates are high.
BCSnob 10/18/21 04:38am Around the Campfire
RE: 2019–2022 CORONAVIRUS PANDEMIC POSTINGS

Here is a study where the researchers collected 252 unique antibodies from 5 Covid-19 patients. These antibodies were screened (using live virus and pseudovirus) for neutralization of Wuhan strain of SARS-CoV-2 and about 1/5 were neutralizing and 19 were found to be highly neutralizing. Next the researchers screened these same 252 antibodies for neutralization of SAR-CoV (using live virus and pseudovirus). They found 1 of the SARS-CoV-2 antibodies was neutralizing of SARS-CoV. They identified where this antibody binds to SARS-CoV-2 and SARS-CoV; a specific location (epitope) on the RBD that is common in both viruses AND is present in all the SARS-CoV-2 variants AND in bat AND pangolin coronaviruses (the sources of SARS-CoV, SARS-CoV-2 & MERS). Again using live virus, the researchers found this antibody neutralizes all of these viruses (to varying degrees). Several very important findings here. An antibody that can be used to treat SARS-CoV-2 (all current variants). A location in the RBD that has not changed as SARS-CoV-2 has mutated. A location in the RBD that is common to SARS-CoV-2, SARS-CoV, and MERS. A location in the RBD that is common to corona viruses of bats and pangolins; the reservoir of future zoonotic corona viruses that could cause the next pandemic. A monoclonal antibody that neutralizes SARS-CoV-2 variants, SARS-CoV, and other sarbecoviruses BioRxiv Preprint 14 Oct 2021
BCSnob 10/15/21 06:07am Around the Campfire
RE: 2019–2022 CORONAVIRUS PANDEMIC POSTINGS

Antibody tests can be used to distinguish between immunity from vaccination and immunity from previous infection. Differentiation of SARS-CoV-2 naturally infected and vaccinated individuals in an inner-city emergency department MedRxiv preprint October 14, 2021. Using 1914 samples of known exposure status, we developed an algorithm to differentiate previously infected, vaccinated, and unexposed individuals using a combination of antibody assays. We applied this testing algorithm to 4360 samples ED patients obtained in the springs of 2020 and 2021. Previous infection induced antibodies to all parts of the virus including the nucleocapsid while vaccines only induced antibodies against the portions of the virus in the vaccine (typically just the spike including the RBD). Results: For the algorithm, sensitivity and specificity for identifying vaccinated individuals was 100% and 99%, respectively, and 84% and 100% for naturally infected individuals. Among the ED subjects, seroprevalence to SARS-CoV-2 increased from 2% to 24% between April 2020 and March 2021. Vaccination prevalence rose to 11% by mid-March 2021. These results were for an emergency department (ED) in Baltimore.
BCSnob 10/14/21 04:18pm Around the Campfire
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