Are vaccines the light at the end of the tunnel?

[nocl]

48 minutes ago, D C said:

Beyond what we were hoping for, isn't it?  Not in comparison to the mRNAs, but more than we hoped for when they were all in development.  Wasn't 60% considered to be an amazing accomplishment if they performed that well?

 

Still blows influenza vaccines out of the water.  And we need to remember that someone who tests positive and has the sniffles for a few days is one of those other 30% for which it 'failed'.  

not quite it is only 85% effective at preventing serious illness according to the info released. 

 

It is better than the original minimum acceptable value, but clearly worse than the Pfizer and Moderna vaccines.

 

 

[markeb]

41 minutes ago, Ken the cruiser said:

"After day 28, no one who got vaccinated needed hospitalization or died regardless of whether they were exposed to "regular COVID or these particularly nasty variants," Mammen said. When the vaccinated did become infected, they had a milder illness."

 

Of course, they don't say how many in the control group needed hospitalization...

 

Looks like good results, but those sorts of claims absent a comparison are great press releases, not necessarily great science. Not saying it's not encouraging or not supported by data, but the actual data should tell us how the vaccine truly performed.

[nocl]

13 minutes ago, cangelmd said:

This raises an interesting question that I have wondered about more and more as the vaccines began to rolled out.

What if, with some combination of natural immunity, acquired immunity from vaccination and mutation by the virus, Covid settles into a long term situation like flu - ongoing disease that is mild but annoying in most people, low but persistent death rate with most deaths being due to the acute infection starting a chain of events, but with a few people actually dying of overwhelming direct infection/immune response - can/will we as a society accept that and return to normal? Will masking and more importantly social distancing be required if Covid settles into a death/hospitalization rate comparable to flu? Can we tolerate that to have a normal life? Remember that you could see headlines “Death rate from infectious disease twice the rate in 2010”. - well of course, Covid didn’t exist then.

 I think we will reach an equilibrium point eventually where a new normal exists and the pandemic is declared over, just not sure what life will look like then

A lot of variables on how long that will take.  Probably another year or two.

[nocl]

2 minutes ago, markeb said:

 

Of course, they don't say how many in the control group needed hospitalization...

 

Looks like good results, but those sorts of claims absent a comparison are great press releases, not necessarily great science. Not saying it's not encouraging or not supported by data, but the actual data should tell us how the vaccine truly performed.

One of the things we don't know is how well the vaccines are doing in preventing all of those secondary impacts that the virus has demonstrated in even cases with mild symptoms. The cardio, neurological, etc impacts. I have not been able to see any data on those impacts in mild cases of those vaccinated.

[markeb]

14 minutes ago, cangelmd said:

 I think we will reach an equilibrium point eventually where a new normal exists and the pandemic is declared over, just not sure what life will look like then

 

It's been awhile, but there were some interesting news articles late in the fall looking back at 1918-1921 influenza. The arguments in most of them were that eventually the world had "pandemic fatigue" at some point in the equilibrium with the flu, and the population more or less declared the end of the flu pandemic, even though the virus was still circulating and there were still deaths, just fewer. I wouldn't be surprised to see the same here, I just don't know what that looks like in a relatively risk adverse 21st century. 

[nocl]

1 minute ago, markeb said:

 

It's been awhile, but there were some interesting news articles late in the fall looking back at 1918-1921 influenza. The arguments in most of them were that eventually the world had "pandemic fatigue" at some point in the equilibrium with the flu, and the population more or less declared the end of the flu pandemic, even though the virus was still circulating and there were still deaths, just fewer. I wouldn't be surprised to see the same here, I just don't know what that looks like in a relatively risk adverse 21st century. 

Of course one major difference is that in 1918 they had no effective treatment or any hope for one to be developed.  A major part of the strategy now is to buy time for the treatments and vaccines.

[Ken the cruiser]

I'm curious, were either of the Pfizer or Moderna Phase 3 trials approved by the FDA conducted in South Africa where this newly discovered variant evolved? If so, were those results included in their respective overall efficacy rate like what appears to be happening with the J&J vaccine trial?

Edited January 29, 2021 by Ken the cruiser

[TeeRick]

I would reason that the mRNA vaccines might be more effective than the Novavax vaccine against variants like S.Africa.  Why?  The Novavax vaccine is a purified protein subunit made against the original version of the SPIKE protein.  This has historically been a very good technical approach for generating a strong antibody response in many marketed vaccines.  But the mRNA vaccines synthesize the original SPIKE in your own cells and present it to your immune system.  They also generate a strong antibody response.  But what about T-Cell responses?   I would take an educated guess that the protective T-Cell response is at greater levels for the mRNA vaccines than for the protein subunit vaccines.  And the same might hold true for the vector-based vaccines like J&J.  Better at generating T-Cells too.  I would love to see all of the immune data - but I'm sure it is being studied in detail at this point by the groups involved.  All we know from the latest data release today is that J&J was 57% effective in S.Africa and Novavax was 49% effective - but much smaller small sample sizes.  

Edited January 29, 2021 by TeeRick

[deadzone1003]

58 minutes ago, Ken the cruiser said:

I'm curious, were either of the Pfizer or Moderna Phase 3 trials approved by the FDA conducted in South Africa where this newly discovered variant evolved? If so, were those results included in their respective overall efficacy rate like what appears to be happening with the J&J vaccine trial?

I don't think so as the mRNA's phase III trials were ending last Nov. or early Dec.  I don't think the trials were held outside of the USA & Europe.  So, the companies may not know very much about that variant at that time.  The formulas for the vaccines were developed back in Spring 2020, long before the variant could have existed. 

[TeeRick]

1 hour ago, Ken the cruiser said:

I'm curious, were either of the Pfizer or Moderna Phase 3 trials approved by the FDA conducted in South Africa where this newly discovered variant evolved? If so, were those results included in their respective overall efficacy rate like what appears to be happening with the J&J vaccine trial?

The J&J vaccine was very good overall but everybody will compare it to the 95% efficacy mRNA vaccines.  But all three vaccines keep you out of the hospital and prevent severe COVID.  That is good enough to say that I would take the J&J vaccine if I could get it right away.  Also it is possible that a two-shot version of the J&J vaccine could get higher efficacy in the future.  Likely they are examining this too.

[UnorigionalName]

2 hours ago, D C said:

Beyond what we were hoping for, isn't it?  Not in comparison to the mRNAs, but more than we hoped for when they were all in development.  Wasn't 60% considered to be an amazing accomplishment if they performed that well?

 

Still blows influenza vaccines out of the water.  And we need to remember that someone who tests positive and has the sniffles for a few days is one of those other 30% for which it 'failed'.  

 

The original goal of 60% was based on the estimated R0 at the beginning of the pandemic of slightly under 3.  With 60% effectiveness, and R0 <3, if 100% of the population got vaccinated, you reach herd immunity status, and the disease will not become endemic again.  So if that happened, we wouldn't have to have any lockdowns or changes in our lives, and sometimes someone would travel in with COVID and they would spread it to a handful of people, but it would eventually die out after not too long and you wouldn't have to do anything really.

 

The newer data though is showing that that might have been too optimistic.  The newer estimates for R0 are more in the 6+ range, wherw it would 100% of the population with 85% effective vaccine. (it's multiplicative, so if your vaccine was 100% effective would only need 85% of people to take it).  But this estimate was before the UK and SA strain, but it actually may or may not include them, because we really don't know what's going on in the US. 

 

Basically, if 100% of your population has a 70% effective strain, but the R0 is over 6, then those 30% not immune may be able to pass it on indefinitely (it will become permanent, since more people will be born and it will forever circle around).  70% might not be as bad as it sounds though, since it's 70% effective at reducing disease, but it is UNKNOWN how much it reduces transmittance.  So if it's 30% get the disease, but they are only half as good as transmitting it as an un-vaccinated person with COVID, then you are back at an acceptable range.

 

Basically, 70% isn't horrible, but you really wish it was more like 95%

[TeeRick]

2 minutes ago, UnorigionalName said:

 

The original goal of 60% was based on the estimated R0 at the beginning of the pandemic of slightly under 3.  With 60% effectiveness, and R0 <3, if 100% of the population got vaccinated, you reach herd immunity status, and the disease will not become endemic again.  So if that happened, we wouldn't have to have any lockdowns or changes in our lives, and sometimes someone would travel in with COVID and they would spread it to a handful of people, but it would eventually die out after not too long and you wouldn't have to do anything really.

 

The newer data though is showing that that might have been too optimistic.  The newer estimates for R0 are more in the 6+ range, wherw it would 100% of the population with 85% effective vaccine. (it's multiplicative, so if your vaccine was 100% effective would only need 85% of people to take it).  But this estimate was before the UK and SA strain, but it actually may or may not include them, because we really don't know what's going on in the US. 

 

Basically, if 100% of your population has a 70% effective strain, but the R0 is over 6, then those 30% not immune may be able to pass it on indefinitely (it will become permanent, since more people will be born and it will forever circle around).  70% might not be as bad as it sounds though, since it's 70% effective at reducing disease, but it is UNKNOWN how much it reduces transmittance.  So if it's 30% get the disease, but they are only half as good as transmitting it as an un-vaccinated person with COVID, then you are back at an acceptable range.

 

Basically, 70% isn't horrible, but you really wish it was more like 95%

Agree and good analysis.  We all want to see the pandemic go away and hoping these vaccines can get that done.  All these theoretical numbers are important - but of course not everybody will get vaccinated and there will be pockets of effectiveness globally.  So if the end result of vaccination campaigns in 1-2 years is to still have the SARS-CoV-2 around (non- pandemic ) but with a very significantly reduced number of hospitalizations, severe disease and deaths, that is a big win any day.  All 4 vaccines (Pfizer, Moderna, J&J and AZ) will be good weapons in this fight.

[cangelmd]

1 hour ago, markeb said:

 

It's been awhile, but there were some interesting news articles late in the fall looking back at 1918-1921 influenza. The arguments in most of them were that eventually the world had "pandemic fatigue" at some point in the equilibrium with the flu, and the population more or less declared the end of the flu pandemic, even though the virus was still circulating and there were still deaths, just fewer. I wouldn't be surprised to see the same here, I just don't know what that looks like in a relatively risk adverse 21st century. 

And no 24/7 news cycle. Overall, though, things haven’t changed that much because people haven’t changed and there is already huge pandemic fatigue.

[TeeRick]

20 hours ago, neilrr said:

 

Hi TeeRick -- Fancy meeting you on here... Sorry we didn't get to Iceland...😭 Maybe next year...😁 Hope you and your family are doing well.. Everything is status quo in S. FL... Hoping to take the sabbatical and retire out of that... I have had enough fun in school this year.. Take care and stay safe..

Hi Neil!  I have my eye on Iceland and Greenland but have not committed yet.  My next cruise if it goes will be Norway this August.  I'm not really betting on it happening at this point.  I am in the last group to qualify for a vaccine so maybe mid-summer at this point?  Probably not enough time to get two shots and wait for immunity to develop.  Good luck with the retirement plan!  Then you can stay home like the rest of us wishing you could travel!😄

[D C]

4 minutes ago, TeeRick said:

Agree and good analysis.  We all want to see the pandemic go away and hoping these vaccines can get that done.  All these theoretical numbers are important - but of course not everybody will get vaccinated and there will be pockets of effectiveness globally.  So if the end result of vaccination campaigns in 1-2 years is to still have the SARS-CoV-2 around (non- pandemic ) but with a very significantly reduced number of hospitalizations, severe disease and deaths, that is a big win any day.  All 4 vaccines (Pfizer, Moderna, J&J and AZ) will be good weapons in this fight.

Possibly a bit of semantics, but at what point does the virus become endemic?  Best I can tell is that there is no particular criteria for such.

 

 

 

 

 

[cangelmd]

23 minutes ago, UnorigionalName said:

 

The original goal of 60% was based on the estimated R0 at the beginning of the pandemic of slightly under 3.  With 60% effectiveness, and R0 <3, if 100% of the population got vaccinated, you reach herd immunity status, and the disease will not become endemic again.  So if that happened, we wouldn't have to have any lockdowns or changes in our lives, and sometimes someone would travel in with COVID and they would spread it to a handful of people, but it would eventually die out after not too long and you wouldn't have to do anything really.

 

The newer data though is showing that that might have been too optimistic.  The newer estimates for R0 are more in the 6+ range, wherw it would 100% of the population with 85% effective vaccine. (it's multiplicative, so if your vaccine was 100% effective would only need 85% of people to take it).  But this estimate was before the UK and SA strain, but it actually may or may not include them, because we really don't know what's going on in the US. 

 

Basically, if 100% of your population has a 70% effective strain, but the R0 is over 6, then those 30% not immune may be able to pass it on indefinitely (it will become permanent, since more people will be born and it will forever circle around).  70% might not be as bad as it sounds though, since it's 70% effective at reducing disease, but it is UNKNOWN how much it reduces transmittance.  So if it's 30% get the disease, but they are only half as good as transmitting it as an un-vaccinated person with COVID, then you are back at an acceptable range.

 

Basically, 70% isn't horrible, but you really wish it was more like 95%

Other unmeasurables are that if circulation of virus goes down, then generation of new strains will go down, giving more time for vaccine makers to tweak and respond to the new strains. Also, there is still data from early on that there was some pre-existing immunity out in the population, that suggests that there will be some immunity that will gradually build up in population that may carry over from strain to strain - again works much better if there is less virus circulating.

Stillmso much we don’t know, but we ignore what we do know that works - distancing.

[TeeRick]

1 hour ago, markeb said:

 

It's been awhile, but there were some interesting news articles late in the fall looking back at 1918-1921 influenza. The arguments in most of them were that eventually the world had "pandemic fatigue" at some point in the equilibrium with the flu, and the population more or less declared the end of the flu pandemic, even though the virus was still circulating and there were still deaths, just fewer. I wouldn't be surprised to see the same here, I just don't know what that looks like in a relatively risk adverse 21st century. 

The very good news is that Influenza in the US which should be peaking about now is at a very very low level.  Because more Flu vaccines given this year and of course masks and social distancing and working from home.  Covid hospitalizations and deaths are a reality but there are far fewer hospitalizations and deaths from influenza as opposed to other years.  So that is at least something to be happy about.

https://www.healthline.com/health-news/while-covid-19-is-raging-flu-cases-remain-unusually-low

[verizon]

2 hours ago, Crazy planning mom said:

Given that J & J and Novovax arent quite as effective as the MRNA vaccines, cant I get one of those less effective vaccines if thats what available to me but then later on get the Moderna booster?  If the Pfizer and Moderna vaccines are more effective wont going forward wont all the Covid vaccines be produced be MRNA vaccines?

Good thinking since you won't die of Coronavirus after you are vaccinated.

[D C]

31 minutes ago, UnorigionalName said:

 

The original goal of 60% was based on the estimated R0 at the beginning of the pandemic of slightly under 3.  With 60% effectiveness, and R0 <3, if 100% of the population got vaccinated, you reach herd immunity status, and the disease will not become endemic again.  So if that happened, we wouldn't have to have any lockdowns or changes in our lives, and sometimes someone would travel in with COVID and they would spread it to a handful of people, but it would eventually die out after not too long and you wouldn't have to do anything really.

 

The newer data though is showing that that might have been too optimistic.  The newer estimates for R0 are more in the 6+ range, where it would 100% of the population with 85% effective vaccine. (it's multiplicative, so if your vaccine was 100% effective would only need 85% of people to take it).  But this estimate was before the UK and SA strain, but it actually may or may not include them, because we really don't know what's going on in the US. 

 

Basically, if 100% of your population has a 70% effective strain, but the R0 is over 6, then those 30% not immune may be able to pass it on indefinitely (it will become permanent, since more people will be born and it will forever circle around).  70% might not be as bad as it sounds though, since it's 70% effective at reducing disease, but it is UNKNOWN how much it reduces transmittance.  So if it's 30% get the disease, but they are only half as good as transmitting it as an un-vaccinated person with COVID, then you are back at an acceptable range.

 

Basically, 70% isn't horrible, but you really wish it was more like 95%

Thanks for the thoughtful response. The relationship between rate of spread and effectiveness of a cure make sense.  I don't think we know well enough 

 

R0 and herd immunity are cringeworthy concepts when it comes to practice.  R0 is only a single factor among a multitude of parameters that are commonly used for modeling, and it's nearly impossible to calculate in an ongoing bases from the reports I've read (that have been focused on the math and statistics).   Likewise, herd immunity is a poorly understood concept based entirely on models that commonly take a homogeneous view of a population.   You can't determine in advance when you will hit herd immunity.  You can only observe through the rearview mirror.

[verizon]

1 hour ago, Ken the cruiser said:

I'm curious, were either of the Pfizer or Moderna Phase 3 trials approved by the FDA conducted in South Africa where this newly discovered variant evolved? If so, were those results included in their respective overall efficacy rate like what appears to be happening with the J&J vaccine trial?

Pfizer and Moderna efficacies may be lower than JNJ and It wont surprise me.

[nocl]

1 hour ago, Ken the cruiser said:

I'm curious, were either of the Pfizer or Moderna Phase 3 trials approved by the FDA conducted in South Africa where this newly discovered variant evolved? If so, were those results included in their respective overall efficacy rate like what appears to be happening with the J&J vaccine trial?

From what I have seen both Moderna and Pfizer phase 3 trials were US based.  And of course prior to the variants.

 

However, with J&J even the US trials only reached 70% and they were pretty much over before the two variants that impacted the numbers reached the US (the first of the worst variant just found in South Carolina this week).

 

The good news is that it appears that the J&J trials and analysis was well done with good demographics, and without the issues of the AZ trials.

[TeeRick]

16 minutes ago, D C said:

Possibly a bit of semantics, but at what point does the virus become endemic?  Best I can tell is that there is no particular criteria for such.

Very interesting question.  The terms of Outbreak --> Epidemic --> Pandemic are understood generally for incidents where a new or existing virus is on the increase.  Declared by the WHO among others.

Outbreak- local region.

Epidemic- outbreak spreads to multiple regions in a country or even continent.

Pandemic - global spread.

 

So how is this defined in reverse when the virus causing the Pandemic is receding? Does it go back through an Endemic phase by definition?  Or skip to just a baseline level of cases.  Maybe to the point of still being around in spots globally at a much reduced level?  When can victory be declared (ie, the Pandemic is over)?  Food for thought!  I would think we might see something like "The Pandemic is over in the US but the virus is still Endemic in the state of PA or in the City of Omaha".

[UnorigionalName]

46 minutes ago, D C said:

Possibly a bit of semantics, but at what point does the virus become endemic?  Best I can tell is that there is no particular criteria for such.

 

IIRC the current working term is that the communicable disease is present and self-sustainingly transmitting in a particular geographic location for over 1 year.  There are many places in the US measles is almost there or has briefly made it.

[markeb]

11 minutes ago, TeeRick said:

Very interesting question.  The terms of Outbreak --> Epidemic --> Pandemic are understood generally for incidents where a new or existing virus is on the increase.  Declared by the WHO among others.

Outbreak- local region.

Epidemic- outbreak spreads to multiple regions in a country or even continent.

Pandemic - global spread.

 

So how is this defined in reverse when the virus causing the Pandemic is receding? Does it go back through an Endemic phase by definition?  Or skip to just a baseline level of cases.  Maybe to the point of still being around in spots globally at a much reduced level?  When can victory be declared (ie, the Pandemic is over)?  Food for thought!  I would think we might see something like "The Pandemic is over in the US but the virus is still Endemic in the state of PA or in the City of Omaha".

 

Epidemiologically, a disease is endemic when it's occurring at a more or less expected prevalence in a population. We probably don't know what that is for SARS-CoV-2, but as the population (local and global) develops immunity, it's going to settle down, hopefully to the occasional case and rare localized outbreak. And that will become the baseline. And if transmission continues more than sporadically at that baseline, most people would consider it endemic.

 

The CDC has a pretty good principles of epidemiology course online. Their definition is:

 

Endemic refers to the constant presence and/or usual prevalence of a disease or infectious agent in a population within a geographic area.

 

Haven't seen the 1-year concept mentioned by UnoriginalName, but that makes sense in the context of a specific disease. 

[UnorigionalName]

2 hours ago, Ken the cruiser said:

I'm curious, were either of the Pfizer or Moderna Phase 3 trials approved by the FDA conducted in South Africa where this newly discovered variant evolved? If so, were those results included in their respective overall efficacy rate like what appears to be happening with the J&J vaccine trial?

 

I believe Moderna was 100% US.

 

This is pfizer:

 

I don't think they broke down the data by country, but the data from 2.0% of 80k or whatever will basically be statistically meaningless.