OT - the Delta and Booster Thing

Pfizer data

Bill Tindall, E.Tn.

The main reason I signed up for the Pfizer vaccine trial is that a year ago Pfizer published data that showed their vaccine prevented virus replication both in the nose and lungs. That was good enough for me.

For those reticent to get vaccinated there is enough data out there to find something to justify any position one cares to take. Fine with me. I am not interested in other's decisions or their reasons for making them.

Trial participants have been told that we will be notified when/if Pfizer determines the booster could be helpful. If Pfizer recommends it I will take it. I trust Pfizer or I would not be a trial participant.

Re: OT - the Delta and Booster Thing

Steve D, CT

I work in the medical industry and one of our senior management types was sharing that he has his antibody count tested weekly and it drops with time.

I had my antibodies tested for my annual health screening and it was in the ballpark I expected due to an anecdote told by the phlebotomist.

The story went that she had a reaction to shot #2 and her husband didn't and her antibody count was about 3X what hubby's was. I had a reaction while my wife didn't so I was expecting a similar difference. Unfortunately her doctor didn't order the antibody test so no results.

When I checked in with my HR person to see if we needed to go back for the test she shared that she had no reaction but still had high antibodies.

Bottom line, the vaccine will boost antibodies and they drop with time. As a nation we seem ill equipped to deal with what seems to be a half-axxed virus as opposed to stamping out polio or winning WWII. That nation is long gone.

His point is pretty clear...

John in NM

I just had to wade through the details to get it

Personally I disagree with the point David makes, but I do appreciate that analytical thinking requires one to seriously consider, even debate the merits of possibilities outside of the mainstream consensus.

In the interest of accuracy, I believe the US death toll to date is somewhere around 665K, not 1 million. Still a shocking figure, far exceeding the US's casualties in WWII, and of the same order of magnitude as US deaths from the 1918 flu pandemic. It will not surprise me if COVID deaths exceed the 1918 flu before its over, I imagine it would have done by now were it not for the rapid development and deployment of such effective vaccines.

Recorded vs. actual Covid deaths

Wiley Horne

See here:

http://www.healthdata.org/news-release/covid-19-has-caused-69-million-deaths-globally-more-double-what-official-reports-show

David is on the level. He is admirable. He is not political. I like his work. In this case, I was trying to lead him to see the fallacy in applying the Israeli data to the Booster proposal. Because no man is an island—any course of action that causes one to grow and shed new variants is affecting family and close acquaintances, even though greater personal immunity may result after the infection passes.

Wiley

Re: OT - the Delta and Booster Thing

Bill Tindall, E.Tn.

The person having his antibodies tested weekly needs to study up on immunity. What he is getting measured does not predict ability to ward off the disease. The ability to fight infection is more involved than simply an antibody count.

Absolutely

John in NM

True death toll is higher than recorded, as is the true cumulative case count by a much larger margin.

I remain a little skeptical that the true death toll is that much higher than the recorded, but I'm also not interested enough in that question to read up on it. Estimates such as these are analytically useless under most circumstances - I only find them interesting in a casual way.

It was not clear that you were referring to estimated deaths, I likely wouldn't have bugged you about this if it had been

I think.....

David Weaver

...this gets tracked back to the initial discussion of whether or not the first shots were a good idea. That's water under the bridge for me - the data was definitive.

Subsequent death and morbidity rates have been just as much so.

I'd have signed up for a trial if eligible - there were some early candidates here, but they never panned out and I never heard of anything. All of the folks I know who got in on the moderna trial (I don't know anyone who did pfizer) worked in healthcare (I don't) or had some connection to be polled.

So, that's not the issue (if it is for other people, they can still debate it). It's more about the long term - it's a curiosity to me because data collection is fine enough now to make more complex decisions that have no politics involved in them (and I don't mean like party politics, I mean people getting attached to strategies and wanting to win at the upper levels of decision making - not a fan).

Still, the point of this thread was to bring up my original comment in the prior thread - I hope we're wise enough to actually track the different cohorts and make strategy based on what actually works best, and not just something that works. At this point, I'll await a second group of data that agrees with the israeli study - I'm suspicious when the difference is that stark (7 to 1 for some bits and 27 to 1 for others). CDC and states could actually collect and provide this kind of information, like open source (it would be costly to actually do that because it's not just like posting a webpage - it would have to be secure enough that it couldn't be hacked).

measuring the outcomes...

David Weaver

..we have the ability now to measure outcomes rather than interim steps.

Much of the fear early on was that the antibodies fade and thus once they did, we'd be just as vulnerable as prior (i'm not in that we - I don't think I've had covid, but rather just two vaccine shots instead).

That didn't turn out to be the case, but since fading antibodies made a better story (it was negative), the lack of reinfection of serious cases in any numbers, even after antibodies fade was left out of general public knowledge. Nobody asks why as a group (they grip the story about antibodies fading instead - it's easier to understand).

While it's nice to hope that doctors would be thinking about all of these same things, it's also true that they can't be going off like loose cannons about their curiosities to patients, so they test antibodies. I'm guessing there's a strong correlation with large antibody counts and lack of reinfection - but then the question was poorly answered about "what happens when the antibody test shows nothing - and now that we know that it's not the same thing as someone who didn't have covid previously - there's still a significant amount of protection - what doesn't the antibody test answer if the goal is to protect from severe disease and death?"

The answer to doing the best we can sometimes is acting in some cases (the vaccine shots early on), and may not be acting again for everyone in the longer term (but the data should be able to tell us that). The issue of delta getting by in breakthrough cases illustrates why - the important question right now is whether or not the israeli study data can be seen elsewhere. If reinfection with the vaccine is actually 7 times as likely as vaccine and covid or just prior covid (but woe be to the person who gets immunity the hard way in many cases), then use of the booster may create a worse outcome in the intermediate term, and then another variant may come along where it flips around again.

I'm kind of interested in not getting severely sick, or really even moderately sick (I've had my share of bronchitis - more than a continuous year's worth of time in my life - I feel like I've done my shift with being short of breath), but especially not dying. Part of our society has the will to chide folks for not wearing a mask walking outside or not washing their hands continuously, and I don't think that part of society (the kind who never wants to go to the doctor and be told to wait to see if something resolves on its own) will ever pick the better answer if the better answer isn't "doing something". I like the do something when it makes the result better, and don't when it makes it worse. If it's hard to tell which is better, then it doesn't really matter, but it's important for us to keep our feelers out to catch the situations where doing nothing (perhaps even only for a segment of the population) is a better strategy.

What causes me to lose a little faith is the driving idea that we can always manipulate things and even when we know an outcome is likely going to be statistically worse, we bury that because people feel better if "they're doing something".

Still missing the point..

David Weaver

..what is the mortality and morbidity of groups who have already had two shots, but not a booster.

In the israeli study - the entire group (several hundred thousand) saw no deaths. They all had one shot, two shots or previously had covid.

If a cohort had been added that never had covid and never had any viable vaccine, there would almost certainly have been significant numbers of deaths.

The group that already had covid (if the numbers hold up) will have less covid of the delta variant, will be sick less and will pass less. The double vaccinated individuals who get a breakthrough case end up moving into that category, and 6 months from now, we'll have another dataset. Boosted vs. two shots and covid. These are important things to measure (mu will probably already be in the rearview mirror by then, so we can't really think of it just in the context of delta).

The CDC released that there were about 2,000 vaccinated deaths in the US through the beginning of august. This is the cohort we're talking about, not 600k plus deaths - I stay away from anyone wanting to say the first two shots of the vaccine do nothing or do harm.

nobody likes to see 2000 deaths since the beginning of the vaccinations, and it might be slightly undercounted, but if we're honest, we'll note that in a population of probably 150 million vaccinated individuals, there will be health basket cases who just don't respond to the vaccines (extremely elderly with nonfunctioning immune systems, etc). I'm surprised even that number would only be 2k.

In terms of playing a game, if we have the vaccine, instead of heading out into the battlefield with a tshirt on, we're headed out wearing armor and the battle at this point is only with bb guns.

To reiterate - the 700k or so large total sample in the israeli study showing no covid deaths is stark. The first two shots need no defending, but we have to be smart enough when talking about the third shot not to confuse it with someone who has had none. The data sets are a universe apart.

excess mortality...

David Weaver

.the CDC keeps mortality by cause records. I don't know when they'll roll up all of 2020, and maybe they have already, but I would guess that covid deaths are slightly understated. There's no trend to suggest that they're hugely understated in the states.

India is another story - it would appear so far that somewhere around 1 in 10 deaths or fewer have been recorded properly.

Mortality rates outside of something like covid are fantastically stable. If they waver by any significance due to any cause, that cause will show up on the CDC roster.

In the case of something like covid, if you're a betting person, you look through the list of deaths by cause and if you find something unassigned, especially if it's in older groups, you lump it over to covid. ..

....OK, I figured I had to track this down. See figure two down the page here (This is only in 2020, so the covid death count is around half of what it is now).

https://www.cdc.gov/mmwr/volumes/70/wr/mm7014e1.htm#T1_down

My point with this chart is that you can scale it against other years and see if it looks like other causes have gone up or if covid "stole" the deaths from several others.

https://www.cdc.gov/nchs/data/databriefs/db395-H.pdf

This is 2019, before covid. There could be some minor leakage from one category to the next (e.g, heart disease cases that would've occurred anyway), but this is pretty tight. Cancer and heart disease don't really change much year to year. I think cancer (don't quote me) death rates decline about 2% per year. Heart disease dropped drastically over the last several decades driven heavily by the decline in smoking, but it's stalled some.

What I'm saying is that if you look at these charts (kind of annoying that one is in nominal terms and the other is in rate terms), it suggests that covid was sort of "dropped in" and other categories don't show a lot of shifting. The death figures are probably slightly understated for covid, but there's no big group that didn't get assigned or got assigned in a pattern that doesn't match pre-covid.

Two mrna shots for all and covid likely doesn't show up on this chart - that's the short term. The question is what moves it off the chart and keeps it off in the long term. Before delta, the answer was "the vaccine". With delta, we don't know (carving out the people who won't get vaccinated despite being in an at risk group - that's for someone else to debate). What spins around in my head is what you can do with the compliant folks (and I'm compliant - if someone wants to label me as being noncompliant if I don't get a third shot, I think that's unfounded, but it's up to them). I haven't made that decision yet because the opportunity to make it isn't here for me yet. I'll evaluate the information that's out there (and that's reviewed or duplicated independently).

I feel that it's my obligation to do it - both to me, and to everyone else. Even though I can only play a small part as an individual.

Re: OT - the Delta and Booster Thing

Steve D, CT

To be fair, I did not hear that story first hand. There are a lot of doctors in the company and I am not privileged to what else or why they are taking for data.

I am sure that they know more about pandemics and immunity than I do.

Interim Parts vs. Outcomes

David Weaver

Measuring antibodies isn't a useless thing. If someone says they had covid and they test negative for antibodies a short time later, it's kind of an indication that they didn't (I know the tests aren't 100% accurate, but sometimes we have to deal with operating on what's likely as individuals).

The next question is a matter of outcomes and physicians know a whole lot more than I do about how things work, but sometimes you can reason yourself through what you know and come up with something that doesn't match outcomes. At that point, you have two reasonable choices.

Check the data (99% of good study work is making sure that whoever collected the data knew how to collect it so that it would make a good predictor after the fact, and that they also censored, truncated, adjusted for other factors as honestly and materially completely as they can).

If no fault is found with the data, then the next thing is to understand why the result didn't match the prediction.

It doesn't throw out the usefulness of the predictor, either, but it may throw out its usefulness in detecting certain outcomes (for example, we see extremely low death numbers for people who previously had covid - antibodies aren't a good predictor of death, but presence of them may be a great predictor of confirmed low chance of it).

I'm an outcome guy. Call me a dummy, that's kind of what I am. I posit what if scenarios to measure forward, and review information that's in the past. I rely on smart people to provide the why. Bill is a why guy (This is better than being a wise guy in most cases!). Sometimes, when I get a result that I can repeat, Bill will batter me with the why - I like to cede that part and wait for the answer from someone else. But being able to repeat the result is important - anything true can be repeated and I have a severe distaste for folks who say something was true but can't be proven when it's a simple issue.

I read info like bonkers early on (I know I said this already), because I felt it was an obligation not to die or become a burden for my family or cause that for other people. It turns out the thing I was concerned about (mild asthma, but that can lead to bronchitis - and a spastic cough early in the pandemic was especially un-stylish) was less impactful than something I thought was minor (being 205 pounds at 5'9" is a much greater risk than asthma). I hate politics but I was able to make two groups mad by suggesting that H and R (the two drugs that everyone wanted to rely on for a political win) probably wouldn't amount to anything because the Chinese data releases already showed controlled trial results. The MRNA vaccines were (depending on how religious one may be) a gift from above, and that's not to minimize our efforts. They are a gift not so much because they show interim test results to be something, but because my wheelhouse (looking at the data, the outcomes) shows that there's near zero chance that hundreds and hundreds of thousands of people are still alive in the US because of them.

For that, I am thankful.

Thanks for a good discussion...

Re: Pfizer data

Philip F Duffy

My experience, and my wife both had our vaccinations in Jan & Feb: she came back from a visit with my sis and in a day or 2 became sick as a dog. We both tested positive and I had no affects whatsoever. She is now fully recovered buy I am not looking forward to a flight to CA to visit our son - -tomorrow. It may be of interest that I received Pfister and she got brand X. P

Thank Goodness...

David Weaver

...she was vaccinated before contracting it.

Neighbor here is in her 40s and should be in the category of folks everyone says "oh...she doesn't need the vax" (fit, active, healthy). She didn't get it and spent 10 days in the hospital and is at home unable to get out of bed now. Nobody in the house escaped it and only the young ones recovered relatively quickly.

If you were vaxed and then had a mild/asymptomatic case, you're kind of in a class of super-immunity for your given cohort, at least for now. The odds are far in your favor.

Re: OT -How(!) memory falters with time

H Bruce McCrory

A recent non-science article

https://www.npr.org/sections/goatsandsoda/2021/09/07/1033677208/new-studies-find-evidence-of-superhuman-immunity-to-covid-19-in-some-individuals

brings up your questions of natural vs vaccine, and booster/third shot with interesting results. Apparently, some gain a super immunity to SARS viruses after a third vaccination; and, better with natural, plus double vaccinations.

However, I grew up in the polio vaccine era. There was no argument about protecting our children from bad science and denying even short-term, if not faulty, Salk vaccines. We continued with boosters and finally the last sugar pills. The whole time Mom continued to decline from childhood polio. She had no choice.

For some reason we think that choice to live potentially 70 more years in quadriplegia is a requirement. Covid damage doesn't just go away. For my part, I do everything possible to avoid danger to others on the vaccine front. I was raised that way. It's not selfish to protect others. It's an obligation.

Before the SARS vaccines, my family was paranoid and lived in a hermitage. Within a month of the second shot, the fear and caution faded. Now, the situation is worse, and we all are tired of the stress. I just figure I have eleven of the 7 morbidities (less pregnancy) and know a breakthrough will kill me, without the third stick.

But, pneumonia persists; Shingles is not as easy as having a Chickenpox party. Mumps nearly killed my mother, and would probably, unborn younger brother. I go in for the latest and a try to remember which I need in the fall.

Oh, flu!

Isn't it amazing?

John in NM

There was very little skepticism with polio vaccines as far as I know. From what my parents and grandparents told me years ago, everyone generally knew someone who had been impacted by the disease if they had not themselves. Parents were reportedly eager for whatever protection it offered their children as soon as it became available.

I don't hassle my vax-skeptical friends about this, but I think they are making a huge mistake. The ones my age and older are gambling with their lives, the younger ones with their expectation of the healthy middle age that I have enjoyed and the somewhat healthy old age that I still expect.

The difference in vaccine perception between my parent's generation and now is just amazing to me. It can't all be attributed to history like the Tuskegee experiment, I still wonder where it comes from.

Re: Isn't it amazing?

Wiley Horne

Yes, polio was different, at least in the south where I was born and raised. You’re right, everybody knew somebody—it was real. Parents sent their kids away during summers to isolated places—I went to my grandparents on Isle of Palms, S.C., off Charleston.

I incubated it, but was not stricken, other than slight spinal misalignment.

People understood it was carried by mosquitos. Big fogging trucks with DDT were a regular feature, and I remember our living room in Charlotte so full of DDT fog, you couldn’t see across the room. It was a total mobilization of society—like wartime—and of course our parents were the WWII generation, so they understood total mobilization. We seem to have lost that. Anyway, when the Salk vaccine came along, they didn’t ask us if we wanted it—they just told us to line up. We did.

Wiley

Re: Isn't it amazing?

Bruce, a MN Galoot

I know I had the Salk vaccine shot but I don’t recall it. I do remember getting the sugar cube in high school, lined up outside the basement of the Penney’s store in mid-January in North Dakota. The line went around the block and no one complained about the temperature.

Re: Not So Amazing, Rather Simple

Mark Mandell - Gone Round in New Jersey

If it weren't for vaccines and the science that created them, none of us would be here today.

I'm not surprised....

David Weaver

...that they showed covid plus vaccine has a wider coverage. I recall early on in covid that there was some mystery as samples from before the pandemic had reactive antibodies (I don't remember if they were sars cov1 or just people who had perhaps been exposed to other coronaviruses).

It's important to separate folks who weren't vaccinated at all from this discussion before we travel into who is protecting who, because we don't know if people who have two shots and then get "real covid" will protect society better in the future. I suspect they will vs. three shots, but time will tell.

Getting the right answer in the long run (or as right as possible) is the point - that's not a selfish thing, either.

People in my class (under 50 and vaccinated) make up 1 in 20 of the hospitalized folks in that cohort in our largest health system.

That article studied 14 people. One wonders why it was difficult to get information on 14 people who were vaccinated early on and then contracted covid later.

Or individuals who never got vaccinated but got covid twice. I will never be in that crowd and intended to never be in it (registered for the first two shots as soon as they were available and got them at a large public health event here).

clarity is needed....

David Weaver

..none of my questions had anything to do with vaccinated vs. unvaccinated. They are strictly related to the robust immune response of the vaccinated (or folks who have previously had covid and know by actual test results) in the long term if future exposure is by getting (or not getting, but being exposed to) covid vs. continued boosters.

A couple of times this has diverted into lectures toward me about being a vaccine skeptic and the irresponsibility in regard to that and the hundreds of thousands of deaths. All of that has no relevance to this discussion.

not to mention..

David Weaver

..I'm not a huge fan of the lectures toward the unvaccinated being pointed at me after clarifying half a dozen times that the unvaccinated cohort and the skeptics have zero overlap with this discussion. we're not talking about that, and I'm not in the unvaccinated group. Not even in the 1 shot group.

The overall response ...

David Weaver

..to covid would've been *drastically* different if it felled kids at a high rate and adults at a low rate rather than the other way around.

No civilized person can stand by and watch kids get sick in large numbers.

some of us...

David Weaver

..it's perhaps more accurate to say "some of us may not be here".