COVID VACCINE - The Megathread

Would you get the Pfizer vaccine if it were available to you?


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EpiEMS

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mgr22

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As more and more side effects show up, do you think it's possible we reach the point of the risk of the vaccine outweighs the risk of Covid, and why do you think so? Here we have a low risk of a lifelong side effect in the younger population, which is generally at lower risk of the worst effects of Covid.
Just looking at the current situation, I don't think the risk of the vaccine outweighs the risk of COVID. To quote the article you linked, "Nearly all the cases [of myocarditis] recover quickly with limited treatment..." The same cannot be said for many COVID "long-haulers" -- i.e., those with long-term disability secondary to COVID. I've accumulated lots of literature on the topic if anyone's interested.

Should we continue to study the prevalence of myocarditis or any other side effects among vaccinated patients? Of course.
 

Akulahawk

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As more and more side effects show up, do you think it's possible we reach the point of the risk of the vaccine outweighs the risk of Covid, and why do you think so? Here we have a low risk of a lifelong side effect in the younger population, which is generally at lower risk of the worst effects of Covid.
My bottom-line answer to your question at this point in time is no, I don't think the risks of the vaccine will prove to outweigh the risks (in terms of both mortality and morbidity) over the long-term.

I think that the older or more co-morbidities you have, the more you should consider getting vaccinated and though younger folks tend to NOT get severe disease, they can spread it reasonably well, so if that population remains relatively unvaccinated, it'll remain a viable reservoir. Therefore, I suggest that while older folks get the vaccine to prevent severe illness/long-term problems/death, younger folks should get it to remove themselves from becoming a reservoir.
 

FiremanMike

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So there’s been lots of discussion about annual boosters.. I wonder if those boosters will suck as bad as the original vaccine..
 

Carlos Danger

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As more and more side effects show up, do you think it's possible we reach the point of the risk of the vaccine outweighs the risk of Covid, and why do you think so? Here we have a low risk of a lifelong side effect in the younger population, which is generally at lower risk of the worst effects of Covid.
I think it's pretty clear right now that on a population level, the benefits of the vaccine very much outweigh the negatives of it. It is very much a net positive that so many Americans voluntarily took the vaccine as soon as it was available to them.

No one ever said that there would be zero side effects or that it would be 100% effective. Now that we're actually seeing those things though, maybe some people will start to have more interest in a risk-based approach to managing the next pandemic rather than the ham-fisted one that we've been using. But I'm not holding my breath.
 

MackTheKnife

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MackTheKnife

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So there’s been lots of discussion about annual boosters.. I wonder if those boosters will suck as bad as the original vaccine..
Good guestion. One of the important unknowns is how long antibodies last. Early on it was thought to be possibly 3-6 weeks, then it was maybe several months. I had COVID last year and when I donate blood, they check for antibodies. Last donation, no antibodies.
 

DrParasite

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The vaccine is still under emergency approval, not full. 4000 people in Massachusetts that were vaccinated now have COVID. Go figure.
sure... and how many millions don't? how many people get the flu shot and still get the flu? It's more common than you might want to admit, and with covid, it's likely the 4000 people were infected under similar circumstances. Let's not forget the JJ vaccine was only 70% effective, at least compared to the 90% rates shown by moderna and pfizer (or something like that, my numbers might be off).
Just looking at the current situation, I don't think the risk of the vaccine outweighs the risk of COVID. To quote the article you linked, "Nearly all the cases [of myocarditis] recover quickly with limited treatment..." The same cannot be said for many COVID "long-haulers" -- i.e., those with long-term disability secondary to COVID. I've accumulated lots of literature on the topic if anyone's interested.

Should we continue to study the prevalence of myocarditis or any other side effects among vaccinated patients? Of course.
absolutely we should. there WILL be side effects, for almost any drug. most are manageable, and people recover quickly with few long-term after effects. the elderly people who contracted covid were not at lucky.
 

mgr22

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Yeah, but it's a group in one geographic location. Interesting, to say the least.
I wonder if those doses were manufactured, shipped, or stored together. Massachusetts probably knows by now.

I'm thinking of an ex-employer who froze a batch of flu vaccine instead of refrigerating it. If we hadn't caught that error, there would have been hundreds of people vaccinated with a less effective product.
 

Summit

Critical Crazy
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Yeah, but it's a group in one geographic location. Interesting, to say the least.
A state with a large population is not really a geographic location of interest unless the results are unexpected.

So, no, it's NOT at all interesting unless you tell me there is some correlation with a new variant or if you told me that all the breakthrough cases got vaccinated at the same location or from the same lot indicating improper handling of the vaccine... THEN that would be interesting. Otherwise, 60% of an entire state is fully vaccinated, >4M people, so a breakthrough incidence of 0.1% is completely uninteresting and expected.
 

Summit

Critical Crazy
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So there’s been lots of discussion about annual boosters.. I wonder if those boosters will suck as bad as the original vaccine..
Unknown, and there is better opportunity to do some dose finding now which might manage adverse effects vs efficacy.

Looks like Pfizer gives 79% reduction in risk for Delta (B.1.617.2 India) infection vs 92% against Alpha (B.1.1.7 UK) and protection against hospitalization is halved from 99% to 96%.

So that is good individual coverage still against Delta (similar better than we think it might be for Gamma Brazil P1 and Beta SA B1351, but some people need higher protection. The primary individual beneficiaries for boosters is going to be the highest risk individuals: those with risk factors for severe illness (especially nursing home residents and workers) or with risk factors for poor vaccine response (immunocompromised).

For population protection (herd immunity) the drop in coverage with the variant is concerning because you have less Ve against a variant with a higher R0 (more contagious) so you need better vaccine uptake (or a higher Ve in the form of a booster). I am concerned with plateauing vaccination rates and the virtual elimination of masking/distancing rules vs the reduced efficacy against Delta and its imminently becoming the dominant variant by prevalence.

Good guestion. One of the important unknowns is how long antibodies last. Early on it was thought to be possibly 3-6 weeks, then it was maybe several months. I had COVID last year and when I donate blood, they check for antibodies. Last donation, no antibodies.
tldr; We think that immunity is very long lived, at least a year, perhaps lifetime, although natural infection appears somewhat less protective than the mRNA vaccines, particularly against variants, if you had been infected with the original China Wuhan Wild Type. Remember that immunity is not solely based on antibodies and negative qualitative antibody tests absolutely do not rule out immunity for someone previously infected.

Longer Read: I wrote this up for a similar question on another forum...


In Feb/March when they were investigating thousands and thousands of suspected reinfection in SA. Dr. Swaminathan (WHO Chief) was announcing the worry and there was also super concerning serology data from the Novavax placebo arm indicating previous infection was not protective in SA. We had plenty of in vitro data showing lower neutralization rates... this was following the January SA case spikes and partial collapse of the SA heatlhcare system. A few colleagues had family practicing back home and the stories of catastrophic surges were heartbreaking.

The questions was whether N501Y variants with the Eek mutation (E484K) like Beta Brazil and Gamma SA were going to have concerning reinfection rates... I did a lite review! There are some interesting case studies but no great epi data to give rates except the inferred data from the Novavax serology.

Some things I did find.... Manaus Brazil where high seroprevalence in didn't stem the surge, but was this due to reinfection or better transmission in the (more fit than wild type) Beta P1 variant? This preprint suggested 28% of cases were reinfections, and they accounted for the higher tranmission rates, but it was model based, so whatever, potential for weaksauce study in my book is strong. Was it the same thing in SA? And the same story appears in Dhaka where they surged with the Gamma B1351 variant and they had high rates of previous infection with reports of reinfection.

This was an interesting read in Cell.
Cross neutralizing between variants across 4 waves in Japan showed the weakest final reactivity against the Gamma B1351 SA variant.

This preprint shows great (96% relative reduction) protection at 13 months after infection against reinfection but suggests reduced anti-S for Gamma B1351.

Preprint Theory on CD4/CD8 response "picking up the slack" with the Gamma B1351 variant in the face of reduced antispike activity from antibodies.

There are so many limitations. The lack of WGS availability... lack of validation of previous infection... limitation on knowing if previous infections were wild type or something else... surmising with time/location based inference based on previous prevalence rates. All that makes it hard to put an efficacy rate on previous infection against particular variant... but the vulnerability exists and MAYBE (likely?) it is higher for certain variants.

SINGLE DOSE FOR PREVIOUS INFECTIONS?

For those previously infected, it does really seem that a single dose of mRNA vaccine is all that is needed. The idea is a popular one.

Few studies I read on this topic were this one from the Lancet:
"Among previously uninfected, seronegative individuals, anti-S titres after one vaccine dose were comparable to peak anti-S titres in individuals with a previous natural infection who had not yet been vaccinated. Among those with a previous SARS-CoV-2 infection, vaccination increased anti-S titres more than 140-fold from peak pre-vaccine levels (figure). This increase appears to be at least one order of magnitude greater than reported after a conventional prime-boost vaccine strategy in previously uninfected individuals.3"

Nature Medince
"spike-specific IgG antibody levels and ACE2 antibody binding inhibition responses elicited by a single vaccine dose in individuals with prior SARS-CoV-2 infection (n = 35) were similar to those seen after two doses of vaccine in individuals without prior infection (n = 228)"

IJID article:
"One dose boosts NtAbs in previously infected more than two doses in uninfected HCWs."

And this preprint:
"A single dose of BNT162b2 mRNA vaccine up to 15 months after SARS-CoV-2 infection provides neutralizing titers exceeding two vaccine doses in previously uninfected individuals. "

I thought there was another one that did a reanalysis of some subgroups from another large dataset, but can't find it... ah here it is in a NEJM letter.

This is a preprint addressing in a limited way vaccination vs previous infection:

Their data shows that vaccines work very very well and previous infection is protective.
2139 infection in the unvaccinated uninfected group (n=22777 attack rate 9.4%)
15 infections in the vaccinated uninfected group (n=26882, attack rate 0.56%)
0 infection in the vaccinated previously infected group (n=1220)
0 infection in the UNvaccinated previously infected group (n=1359)

A safe conclusion is that while vaccine is in short supply, previous infection should offer sufficient protection. What was the prevalent variant in Ohio (study site) during their study period of Dec '20 through May '21? Alpha B117 (UK) appears dominant by April. But Gamma B1351 (SA) and Beta P1 were not very prevalent and Delta India was not present.
 
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Summit

Critical Crazy
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For myocarditis AE, as per the article posted:

"The highest case rate was for males ages 12 to 17, which had a crude estimate of 66.7 cases per million mRNA doses given."

So pretty similar to the chance that you will get struck by lightning in your life...

Know what has a way way way higher risk of myocarditis? COVID-19 infection!

Myocarditis is interesting and worth studying in terms of expectation and treatment. That it is spawning risk vs benefit conversations is ****ing laughable.
 

MackTheKnife

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A state with a large population is not really a geographic location of interest unless the results are unexpected.

So, no, it's NOT at all interesting unless you tell me there is some correlation with a new variant or if you told me that all the breakthrough cases got vaccinated at the same location or from the same lot indicating improper handling of the vaccine... THEN that would be interesting. Otherwise, 60% of an entire state is fully vaccinated, >4M people, so a breakthrough incidence of 0.1% is completely uninteresting and expected.
Thanx for telling me what I find interesting is NOT. Didn't say there any SIGNIFICANCE to it, just interesting as it has NOT been seen elsewhere. I suppose if I find the clots and the myocarditis interesting, even if it's not clinically significant, it's not unless you say it is. I'll keep that it mind.
 

DrParasite

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What is this?
spam.jpg
 

MackTheKnife

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ffemt8978

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Another possible side effect from the J&J vaccine. As more and more issues like these crop up, at what point do we realize that the testing for vaccines was rushed through before we understood all the possible issues with them?
 

DrParasite

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Another possible side effect from the J&J vaccine. As more and more issues like these crop up, at what point do we realize that the testing for vaccines was rushed through before we understood all the possible issues with them?
from the article:
100 people developing the syndrome after receiving the one-dose vaccine. Almost all of were hospitalized and one person died, the FDA said.
Sounds serious
oh wait...
The number of cases reported in connection with J&J’s vaccine represents a tiny fraction of the nearly 13 million Americans who have received the one-dose shot.
that means, you have a 0.00076923076% chance of being affected by this, with 0.0000076923076% having a fatal reaction.

To put this in perspective, 150 people die every year from Tylenol, and research found that there were 12.7 events per 1,000 person-years among those who took aspirin. but I don't see anyone advocating for the removal of tylenol and aspirin from the shelves.
 

mgr22

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Another possible side effect from the J&J vaccine. As more and more issues like these crop up, at what point do we realize that the testing for vaccines was rushed through before we understood all the possible issues with them?
I realize the testing was rushed. I got vaccinated anyway, because I felt COVID was more risky than the vaccine. I haven't changed my mind about that, given the chances of death or disability from COVID.
 
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