COMMENTS FROM MY NOTES TAKEN FROM DR. JOHN MOORE DURING A JAMA WEBINAR REGARDING VACCINES LAST WEEK. DR. MOORE IS A PhD RESEARCHER FROM THE WEIL MEDICAL COLLEGE OF CORNELL UNIVERSITY IN NY. HE HAS YEARS OF EXPERIENCE IN VIROLOGY AND VACCINE DEVELOPMENT (FOR HIV-AIDS). I FOUND HIM TO BE TRUSTWORTHY AND WELL INFORMED.
1. Take the first vaccine you get offered. Even the Russian and Chinese vaccines are good, and are, in fact, both better than the Oxford variety. ALL VACCINES PREVENT DEATH.
2. The SECOND dose of vaccine is very significant to boast antibody formation and attack mutants. TAKE IT FOR SURE.
3. It is possible that Covid survivors could do without the second vaccine dose, but they seem to be able to take it without additional side effects, so far.
4. Johnson and Johnson vaccine might work better used with younger patients to decrease viral load.
5. Do not mix and match vaccines. Manufacturers will add boosters as needed to their formulas and are already doing so.
6. Seemingly paradoxically, the sickest patients have the highest antibody levels.
7. Variants: (I call them MUTANTS): Treatment and prevention still not well studied. The “B-17” UK virus is not resistant to vaccine and treatment. The South African mutant should be managed with the antibodies stimulated by the second dose of the various vaccines. (JNJ vaccine not studied yet.) The Brazilian mutant has many sequence changes and may be somewhat resistant, and it is very transmissible, although less transmissible than the S. African virus.
8. There are many kinds of “immunocompromised patients” and none have been well studied yet. Prolonged viremia, however, can lead to increase mutation formation. There is probably no risk in vaccinating this class of patients and, generally, they might respond to treatment with hyperimmune plasma (from prior Covid patients).
9. Why don’t children get sicker? They have stronger natural immunity. However, they usually have a higher viral load than adults which makes them very contagious, often without anyone even knowing the kids are sick. Vaccine studies on children and pregnant women will have to wait until the ultimate degree of safety of the vaccines in over 16 Y/O is determined.
10. Dr. Moore thinks that the US might be able to safely open up in August 2021, but he warns: DO NOT OPEN UP YET.
(J. Harris: What do I think about the JNJ Vaccine (with additional help from the NYT): What’s the bottom line? A single Johnson & Johnson shot may indeed allow a somewhat larger number of mild Covid cases than two shots of Moderna or Pfizer. It’s hard to be sure. And it isn’t very important…What’s the bottom line? IT WORKS AND IT IS SAFE. If offered this vaccine, I’d take it and I’d give it to my family, asap)
“Dissent. Deliberation. Distrust. Indifference. Vaccine hesitancy is not one thing. It’s a portfolio. And we’re going to need a portfolio of strategies to solve it…You shouldn’t say that people are idiots for believing false or misleading information because they’re not idiots…That’s part of what makes this such a hard problem to solve…online enrollment has left behind older Black [and White and Hispanic] citizens without access to a home computer or an understanding of the often Byzantine rules required to sign up for an appointment. Community volunteers have stepped in to help seniors navigate the vaccine websites or print the requisite forms and deliver the papers to their front door. They’re calling it an ‘Underground Railroad’ to help older Black citizens get access to the vaccines….The share of Black and Latino Americans who say that they plan on taking the vaccine has increased from about 40 percent to roughly 60 percent in the past three months.”
(J. Harris: If Covid is a LOCAL disease, then vaccination is a LOCAL problem. In the next few weeks and months, we will all need to expedite community vaccination programs and provide individual help for some of the old folks.)
GOOD HOPKINS CITED COVID SUMMARY FROM JAMA:
Outcomes and Mortality Among Adults Hospitalized With COVID-19 at US Medical Centers (JAMA Network Open) The objectives of our study were to examine the characteristics and outcomes among adults hospitalized with COVID-19 at US medical centers and analyze changes in mortality over the initial 6-month period of the pandemic. Among 192,550 adults hospitalized with COVID-19 who were discharged from 555 US medical centers, 101,089 (52.5%) were men, 83,567 (43.3%) were White, and 125,543 (65.2%) had Medicare or Medicaid insurance. The most common comorbidities included hypertension (118,418 [61.5%]), diabetes (73,939 [38.4%]), and obesity (52,759 [27.4%]). Of patients in this cohort, 55,593 (28.9%) were admitted to the ICU, 26,221 (13.6%) died during the index hospitalization, and 5839 (3.0%) were transferred to hospice care. In-hospital mortality increased in association with increasing age; 179 of 12,644 patients (1.4%) aged 18 to 29 years died, and 8277 of 31,135 patients (26.6%) 80 years or older died. Of the patients admitted to the ICU, 15,431 of 55,593 (27.8%) died.
CURRENT UPDATE ON VARIANTS (MUTANTATIONS)-EXCELLENT
EXCERPTS FROM HOPKINS CITATIONS OF VARIOUS MEDICAL ARTICLES:
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As global attention on emerging variants continues to increase, this week we will look at globaldata on several of the prominent variants of concern (VOCs): B.1.1.7, B.1.351, and P.1. In many (if not most) countries, surveillance systems are not fully capturing the spread of emerging variants, but epidemiological data are increasing in many parts of the world. Unlike general COVID-19 incidence and mortality, which are tracked via countless official and unofficial databases and dashboards, obtaining quality data on emerging variants is more difficult. Efforts to track the geographic and community spread of these variants are growing, however.
While traditional diagnostic and serological testing are designed to generally identify current or past infection, genomic sequence data are often required to identify the specific variant causing the infection. Some traditional diagnostic tests do target specific sections of the viral genome that can vary between variants—such as the S-gene target failure (SGTF) in specimens infected with the B.1.1.7 for certain PCR-based tests—which can enable them to serve as a “proxy” for sequencing. The values reported below are certainly underestimates of the prevalence of these variants, and sequencing capacity varies considerably between and within countries.
The B.1.1.7 variant is the most geographically widespread of the 3 primary VOCs. In total, more than 121,000 sequences of the B.1.1.7 variant have been reported worldwide, and infections have been reported in at least 94 countries (84 with sequence data). The variant was first reported in the UK, and it was then detected throughout Western Europe and Australia.
Canada, India, and the US were among the next countries to report the variant. More recently, several countries in South America, across Eastern Europe and the Eastern Mediterranean region, Southeast Asia, and Russia have reported cases. Several countries in Africa have also reported the variant. The UK still leads all countries in terms of the number of reported sequences, with more than 100,000 (nearly 90% of the global total). Notably, the proportion of sequenced specimens containing the B.1.1.7 variant is increasing on nearly every continent.
The B.1.351 variant appears to be much less pervasive than the B.1.1.7 variant, with only 2,515 total sequences globally across 48 countries (41 with sequence data). The variant first emerged in South Africa, followed by several other countries in Southern Africa and Australia. These countries were followed by Western Europe and then Canada, the US, Japan, and South Korea.
While the relative proportion of B.1.1.7 in sequenced specimens is increasing, the B.1.351 appears to be remaining more consistent across most continents. In total, 429 infections with the P.1 variant have been reported across 25 countries (19 with sequence data). The variant was first reported in Brazil, which has reported more than 60% of the global sequences to date. The variant has been reported in several other South American countries, Western Europe, Canada, the Faroe Islands, Japan, South Korea, Turkey, and the US.
The relative proportion of the P.1 variant among sequenced specimens is relatively low outside of South America (approximately 20-40%); however, it appears to be increasing slowly in Europe.
In the US, the CDC is utilizing multiple surveillance systems and networks to gather genomic data from positive SARS-CoV-2 tests, including the SARS-CoV-2 Sequencing for Public Health Emergency Response, Epidemiology, and Surveillance (SPHERES) consortium and the National SARS-CoV-2 Strain Surveillance (NS3) system. The US has reported 2,672 infections of the B.1.1.7 variant across 46 states; Washington, DC; and Puerto Rico. Most of the cases involving the B.1.1.7 variant have been identified in Florida (642), Michigan (421), and California (250).
Independent analysis by a private sector laboratory company, Helix, shows the highest incidence of the B.1.1.7 variant in Florida, California, Georgia, and Pennsylvania. The US CDC has reported considerably fewer cases involving other VOCs, including 68 infections of the B.1.351 variant across 16 states and Washington, DC, and 13 infections with the P.1 variant across 7 states. These totals are certainly an underestimate of the total impact of these variants, as only a small portion of specimens undergo genomic sequencing or other genetic analysis. In fact, even the best-performing state, Wyoming, has only sequenced 3.5% of its positive specimens, and more than half of all US states have sequenced fewer than 0.5%. As discussed below, researchers and health officials in the US are identifying newly emerging variants as well, including the B.1.526 variant, first reported in New York, and the B.1.427/429 variants, first reported in California, but the US CDC is not yet reporting data on those variants.
In mid- February, Center experts published a report on policy recommendations to identify and manage variants of concern…
EMERGING VARIANTS Novel SARS-CoV-2 variants, and associated surveillance data, continue to emerge around the world. Several high-profile variants—including B.1.1.7, B.1.351, and P.1— have gained attention due to concerns about their ability to transmit more efficiently, evade immune responses from therapeutics and vaccines, and increase disease severity. While the world focused on these variants, others continue to emerge, including in the US. Recently, researchers identified the B.1.526 variant in New York and the B.1.427 and B.1.429 variants in California.
The B.1.526 variant emerged in New York in November 2020, and 2 recent studies by researchers at the California Institute of Technology (Caltech) and Columbia University (New York)—both preprints—provide preliminary analysis of the variants’ characteristics relative to existing strains. The B.1.526 variant currently includes 2 versions of the virus, with one exhibiting the E484K mutation—found in the P.1 and B.1.351 variants—that helps the virus evade vaccine-induced immune response and the other exhibiting the S477N mutation that is believed to “affect how tightly the virus binds to human cells.”
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