Lunchtime Pandemic Reading, 14-June-2021

Booster time

Lunchtime pandemic reading.

Standard disclaimer: this is a roundup of informative pieces I've read that interest me on the severity of the crisis and how to manage it. I am not a qualified medical expert in ANY sense; at best I am reasonably well-read laity. ALWAYS prioritize advice from qualified healthcare experts over some person on Facebook.

This is also available as an email newsletter at https://lunchtimepandemic.substack.com if you prefer the update in your inbox.

You are welcome to share this.

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Delta is more dangerous. "On May 19, 2021, the Delta Variant of Concern (VOC), formerly known as the Indian VOC or B 1.617.2, became the dominant strain of SARS-CoV-2 in Scotland. The Alpha VOC (formerly known as the Kent VOC, B.1.1.7, or S gene negative) had been the dominant strain previously, but it has rapidly been replaced (appendix p 1).

Samples were analysed using ThermoFisher's TaqPath RT-PCR, which tests for the presence of three target genes from SARS-CoV-2. S gene-negative samples had a deletion in S gene of B.1.1.7 (Alpha VOC) at position 69-70, with cycle threshold (Ct) values less than 30 for at least one of the OR and N genes. S gene-positive samples had Ct values less than 30 for the S gene and valid Ct values for the other two genes. In contrast, a weak S gene-positive sample had a Ct of 30 or less for S. Sequencing data from Scotland has found that for April 1 to May 28, 2021, the latest date until which data were available, 97% of S gene positive cases sequenced in Scotland were the Delta variant and that 99% of Delta variants were S gene positive.

In summary, we show that the Delta VOC in Scotland was found mainly in younger, more affluent groups. Risk of COVID-19 hospital admission was approximately doubled in those with the Delta VOC when compared to the Alpha VOC, with risk of admission particularly increased in those with five or more relevant comorbidities. Both the Oxford–AstraZeneca and Pfizer–BioNTech COVID-19 vaccines were effective in reducing the risk of SARS-CoV-2 infection and COVID-19 hospitalisation in people with the Delta VOC, but these effects on infection appeared to be diminished when compared to those with the Alpha VOC. We had insufficient numbers of hospital admissions to compare between vaccines in this respect. The Oxford–AstraZeneca vaccine appeared less effective than the Pfizer–BioNTech vaccine in preventing SARS-CoV-2 infection in those with the Delta VOC. Given the observational nature of these data, estimates of vaccine effectiveness need to be interpreted with caution."

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01358-1/fulltext

Commentary: Delta caused twice as many hospital admissions of unvaccinated people as Alpha. The vast majority of cases and hospital admissions were of unvaccinated people in this study.

The bottom line is that the vaccines are holding the line now, and we need to get as many people vaccinated, planet-wide, as possible. In the meantime, for people under age 12, keep them safe! The pandemic is not over, and the Delta variant is running rampant in unvaccinated populations. For the unvaccinated, masks, ventilation, and avoiding large crowds is still the way to go - and N95 masks or better, please, double-masking preferred.

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Get an mRNA booster if available and you had an adenovirus vaccine (J&J or AstraZeneca): "I'm very concerned about the delta variant. It's still not clear to me that it's more pathogenic, but it is more transmissible, including among people who are partially vaccinated.

This got me thinking about the J&J vaccine, and how maybe it's time to think about mRNA boosters.

We've known for a while that J&J isn't as effective against infection as mRNA vaccines (probably because it's one dose).

As it stands, J&J does provide great protection against symptomatic COVID-19, and that's important. But we need to think about protecting against infection.

We know 2 doses of mRNA vaccines provide strong protection against the delta variant, but the incidence of severe disease seems high in partially vaccinated people, including with AstraZeneca in the UK. That suggests that it might be an issue for people fully vaccinated with J&J.

We are also getting new data that heterologous vaccination with mRNA after a prime dose of AstraZeneca ("mix and match") is safe and induces robust immune responses.

This has now been found in a couple studies. We have no efficacy data, but it does appear that mRNA following an initial dose of an adenovirus-vectored vaccine is safe and immunogenic.

This data was sufficiently convincing for Canada's National Advisory Committee on Immunization (NACI) to recommend giving 2nd doses of mRNA to people who received a 1st dose of AstraZeneca.

While J&J is authorized in Canada, virtually nobody here has gotten in due to supply issues, so NACI has not addressed whether J&J recipients should get a boost or not. But given the delta variant's spread in the UK, this is something that other countries should address.

In places with an adequate supply of vaccines (the US and now increasingly in Canada and the UK), regulators should consider making recommendations for mRNA boosting of people receiving adenovirus-vectored vaccines that are lower efficacy than mRNA.

The delta variant is not an "escape" variant. Full mRNA vaccine regimens provide excellent protection against delta. But viruses that can infect partially vaccinated people will evolve under immune selection pressure. We should aim to prevent infections altogether.

I think it's time to consider mRNA boosters for people vaccinated with adenovirus-vectored vaccines. As we push the US government to export more vaccines, we need to consider heterologous regimens elsewhere in global immunization efforts as well."

Source:

Commentary: If you've had the J&J or AstraZeneca shots, and you live in an area where there is plentiful supply of Pfizer or Moderna, go and get a Pfizer or Moderna shot as a booster. There is good clinical evidence that it's safe, and the mRNA vaccines are very, very effective.

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01115-6/fulltext

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A reminder of the simple daily habits we should all be taking.

1. Wear the best mask available to you when you'll be around other people, even after you've been vaccinated. Respirators are back in stock at online retailers, too. Wear an N95/FFP2/KN95 that's NIOSH-approved or better mask if you can obtain it. If you can't get an N95 mask, wear a surgical mask with a cloth mask over it.

2. Get vaccinated as soon as you're able to, and fulfill the full vaccine regimen. Remember that you are not vaccinated until everyone you live with is vaccinated.

3. Wash/sanitize your hands every time you are in or out of your home.

4. Stay home as much as practical. Minimize your contact with others and avoid indoor places as much as you can; indoor spaces spread the disease through aerosols and distance is less effective at mitigating your risks.

5. Get your personal finances in order now. Cut all unnecessary costs.

6. Replenish your supplies as you use them. Avoid reducing your stores to pre-pandemic levels in case an outbreak causes unexpected supply chain disruptions.

7. Ventilate your home as frequently as weather and circumstances permit, except when you share close airspaces with other residences (like a window less than a meter away from a neighboring window).

8. Masks must fit properly to work. Here's how to properly fit a mask:

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Common misinformation debunked!

There is no basis in fact that COVID-19 vaccines can shed or otherwise harm people around you.

Source: https://www.reuters.com/article/factcheck-covid19vaccine-reproductivepro-idUSL1N2MG256

There is no mercury or other heavy metals in the Pfizer mRNA vaccine.

Source: https://www.technologyreview.com/2020/12/09/1013538/what-are-the-ingredients-of-pfizers-covid-19-vaccine/

There is no basis in fact that COVID-19 vaccines pose additional risks to pregnant women.

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2104983

There is no genomic evidence at all that COVID-19 arrived before 2020 in the United States and therefore no hidden herd immunity:

Source:

There is no evidence SARS-CoV-2 was engineered, nor that it escaped a lab somewhere.

Source: https://www.washingtonpost.com/world/2020/01/29/experts-debunk-fringe-theory-linking-chinas-coronavirus-weapons-research/

Source: https://www.nature.com/articles/s41591-020-0820-9

Source: https://www.nationalgeographic.com/science/2020/05/anthony-fauci-no-scientific-evidence-the-coronavirus-was-made-in-a-chinese-lab-cvd/

Source: https://www.smh.com.au/national/are-we-ignoring-the-hard-truths-about-the-most-likely-cause-of-covid-19-20210601-p57x4r.html

There is no evidence a flu shot increases your COVID-19 risk.

Source: https://www.factcheck.org/2020/04/no-evidence-that-flu-shot-increases-risk-of-covid-19/

Source: https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa626/5842161

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Disclosures and Disclaimers

I declare no competing interests on anything I share related to COVID-19. I am employed by and am a co-owner in TrustInsights.ai, an analytics and management consulting firm. I have no clients and no business interests in anything related to COVID-19, nor do I financially benefit in any way from sharing information about COVID-19.

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A common request I'm asked is who I follow. Here's a public Twitter list of many of the sources I read.

https://twitter.com/i/lists/1260956929205112834

This list is biased by design. It is limited to authors who predominantly post in the English language. It is heavily biased towards individual researchers and away from institutions. It is biased towards those who publish or share research, data, papers, etc. I have made an attempt to follow researchers from different countries, and also to make the list reasonably gender-balanced, because multiple, diverse perspectives on research data are essential.

This is also available as an email newsletter at https://lunchtimepandemic.substack.com if you prefer the update in your inbox.