COVID-19 treatment and vaccine update thread

[Ralph-Wiggum]

I've developed an occasional cough. And by occasional, I mean maybe a few bouts a day where I cough for a minute or two and then nothing. Otherwise I feel completely fine. Out of an abundance of caution I got a take-home quick test, which came out negative. Do we know about the accuracy of those tests?

[Smoove_B]

Sorry; long day. Daughter starts high school tomorrow and it's a bit...hectic. Even with masking mandates and the fact that she's vaccinated, I'm still nervous sending her in knowing ~50% of kids in her age range are likely vaccinated.

In additional not-great news:

https://twitter.com/FPizarro_DC/status/ ... 3472291847

Approval for COVID vaccine for kids 5-11 years-old unlikely before end of 2021, @NIHDirector Francis Collins tells @NPRinskeep on @MorningEdition. Data for it still not submitted to @US_FDA

[Zaxxon]

To be clear, that would be completely unacceptable. If the data is in at the end of Sept, that EUA better follow closer than 3 mo later.

[Smoove_B]

I cannot explain what's happening and so many public health people online are equally as confused.

[Zaxxon]

I cannot explain what's happening and so many public health people online are equally as confused.

Yeah, and it's not me (some dude) saying this. AAP, my relatives that include pediatric ID docs who have been following the studies, etc. It's just mind-boggling. The single biggest positive development that can actually occur is to get that shot out the door for kids.

[Victoria Raverna]

I cannot explain what's happening and so many public health people online are equally as confused.

Yeah, and it's not me (some dude) saying this. AAP, my relatives that include pediatric ID docs who have been following the studies, etc. It's just mind-boggling. The single biggest positive development that can actually occur is to get that shot out the door for kids.

Still it is important to make sure it is safe before you start inject it to kids. At this time with a lot of anti-vax propaganda, you want it to be very safe. You don't want incident that'll push people away from vaccination.

[Smoove_B]

I think I'm in the camp that believes that if we collectively knew kids under 12 weren't going to be vaccinated before 2022, why didn't we collectively then come up with alternative ways to get them educated or socialized or whatever? I'm by no means an early education specialist but it feels like everything went by the wayside at some point in May and everyone just said, "Eh, what are you going to do? Kids need to go back to school so that's what we're doing."

Completely ignoring masks for them. Completely ignoring masks for the community at large. Setting up online infrastructure options in each state to have remote learning, which I know isn't great but given Delta it might be a better option in some states now than in-person. We knew nationally by May that vaccine uptake was down significant as Delta was coming. Everything unfolding now was predicted. And I'm pretty confident there's going to be even more widespread closures and disruptions in the coming 30 days, nationwide.

It's like we fully committed to sending them all back under a variety of situations (based on state) no matter what happened between May and September.

I don't understand how we arrived at this point.

[Zaxxon]

I cannot explain what's happening and so many public health people online are equally as confused.

Yeah, and it's not me (some dude) saying this. AAP, my relatives that include pediatric ID docs who have been following the studies, etc. It's just mind-boggling. The single biggest positive development that can actually occur is to get that shot out the door for kids.

Still it is important to make sure it is safe before you start inject it to kids. At this time with a lot of anti-vax propaganda, you want it to be very safe. You don't want incident that'll push people away from vaccination.

Of course. The AAP is not suggesting anyone rush anything. They're suggesting we have enough data as of the (originally planned) September end data submission time planned by Pfizer. That waiting for additional data is not necessary in order to begin distribution to kids (but that additional data should then be reviewed as it comes in).

[Victoria Raverna]

I think I'm in the camp that believes that if we collectively knew kids under 12 weren't going to be vaccinated before 2022, why didn't we collectively then come up with alternative ways to get them educated or socialized or whatever? I'm by no means an early education specialist but it feels like everything went by the wayside at some point in May and everyone just said, "Eh, what are you going to do? Kids need to go back to school so that's what we're doing."

Completely ignoring masks for them. Completely ignoring masks for the community at large. Setting up online infrastructure options in each state to have remote learning, which I know isn't great but given Delta it might be a better option in some states now than in-person. We knew nationally by May that vaccine uptake was down significant as Delta was coming. Everything unfolding now was predicted. And I'm pretty confident there's going to be even more widespread closures and disruptions in the coming 30 days, nationwide.

It's like we fully committed to sending them all back under a variety of situations (based on state) no matter what happened between May and September.

I don't understand how we arrived at this point.

Kinda the same thing with the Afghanistan mess? It is decided that US has to get out of Afghanistan this year.

[Victoria Raverna]

I cannot explain what's happening and so many public health people online are equally as confused.

Yeah, and it's not me (some dude) saying this. AAP, my relatives that include pediatric ID docs who have been following the studies, etc. It's just mind-boggling. The single biggest positive development that can actually occur is to get that shot out the door for kids.

Still it is important to make sure it is safe before you start inject it to kids. At this time with a lot of anti-vax propaganda, you want it to be very safe. You don't want incident that'll push people away from vaccination.

Of course. The AAP is not suggesting anyone rush anything. They're suggesting we have enough data as of the (originally planned) September end data submission time planned by Pfizer. That waiting for additional data is not necessary in order to begin distribution to kids (but that additional data should then be reviewed as it comes in).

This is confusing to me. If the existing data is enough to be sure that the vaccine is safe for under 12, why need additional data at all?

But if the additional data can change the conclusion about the safety of the vaccine for under 12, then wait for the data before you start injecting it to kids. You don't want to say it is safe now then a few months later say it is not safe for under 12. A lot of people don't trust CDC and the government right now about vaccine, you don't want to say it is safe then change to it is not safe later.

[LawBeefaroni]

I cannot explain what's happening and so many public health people online are equally as confused.

Yeah, and it's not me (some dude) saying this. AAP, my relatives that include pediatric ID docs who have been following the studies, etc. It's just mind-boggling. The single biggest positive development that can actually occur is to get that shot out the door for kids.

Still it is important to make sure it is safe before you start inject it to kids. At this time with a lot of anti-vax propaganda, you want it to be very safe. You don't want incident that'll push people away from vaccination.

Of course. The AAP is not suggesting anyone rush anything. They're suggesting we have enough data as of the (originally planned) September end data submission time planned by Pfizer. That waiting for additional data is not necessary in order to begin distribution to kids (but that additional data should then be reviewed as it comes in).

This is confusing to me. If the existing data is enough to be sure that the vaccine is safe for under 12, why need additional data at all?

But if the additional data can change the conclusion about the safety of the vaccine for under 12, then wait for the data before you start injecting it to kids. You don't want to say it is safe now then a few months later say it is not safe for under 12. A lot of people don't trust CDC and the government right now about vaccine, you don't want to say it is safe then change to it is not safe later.

Well, that's what science should always be doing. Make decisions based on existing data and adjust if/when contradictory data comes in. Granted for FDA approval you have to have sufficient data to make the initial decision but you can't just be done with it upon approval.

[Lorini]

And that's been the case throughout this pandemic right? At first they didn't recommend masks. Then they did. Then they said outdoor transmission was a thing. Now it's not. Then they said we shouldn't need boosters, now we do. It's how science works in real time.

[Zaxxon]

And that's been the case throughout this pandemic right? At first they didn't recommend masks. Then they did. Then they said outdoor transmission was a thing. Now it's not. Then they said we shouldn't need boosters, now we do. It's how science works in real time.

Absolutely. And that's why questions like...

If the existing data is enough to be sure that the vaccine is safe for under 12, why need additional data at all?

...are self-defeating. There's a point at which we have enough data to confidently say the vaccine is safe enough to begin distributing it to kids under 12. That it's highly likely to be a net safety improvement vs the status quo of exposing all our kids to Delta at schools. But there is no point at which we say it's safe, 100%, full stop, with no future re-evaluation based upon incoming data.

The question isn't 'is it absolutely safe, with no exceptions, for eternity.' It's 'are we helping or hindering the net safety of our under-12 population by waiting for further data before approving?' Some folks, like the AAP, think that waiting is a hindrance. Not all will agree.

[Smoove_B]

FWIW, it's not just the safety, it's the dosage ( which does tie into to safety). More specifically, they're trying to figure out just how much of the vaccine is necessary to give to kids as it relates to the immunological response it provokes.

[El Guapo]

FWIW, it's not just the safety, it's the dosage ( which does tie into to safety). More specifically, they're trying to figure out just how much of the vaccine is necessary to give to kids as it relates to the immunological response it provokes.

Does the nutballs approach taken to COVID in many red states / jurisidictions factor into the FDA's approval process? Like, given what we know about Delta and the vaccines you'd think it wouldn't take a lot of data to reach the conclusion that vaccinating kids before we have a lot of data is safer than sending lots of kids into small poorly ventilated schools and prohibiting masks (and probably mandatory "breathing into each others faces for 30 minutes" classes soon in Florida). But that may not be safer than sending kids to school outdoors wearing masks with lots of space between them. Does that matter?

Honestly seems like we should give emergency approval for kids at least in red states.

[Smoove_B]

My take on all this is two fold. First, it's nothing short of amazing that a vaccine was developed and released in ~12 months; given full approval in ~18.

Second, I don't think there's any way for the current system to address what's happening with Delta. My impression (right or wrong) is that this FDA process exists in a vacuum, seemingly unbeholden to anyone or any influence - which is probably by design. I don't know if it's accurate to say, but to me it seems like they're ignoring or are unmoved by what's happening now with kids in southern states and what we can likely expect with kids elsewhere in the coming month.

In fairness to the FDA, ending the pandemic (and mitigating the impacts) isn't entirely on their shoulders. In order for all kids to be safe, these vaccinations would have needed to be approved in June (or close to it) to have kids fully immunized and ready to start school in August - assuming there was going to be broad uptake (I suspect it's going to be about 30%).

The bigger issue is everyone (including the federal government) has their eyes on these vaccines and they're unwavering in any other solution. Someone online explained it *perfectly* over the weekend - we keep pushing binary solutions. Masks on / Masks off. Vaccinated / Unvaccinated. Instead, we need to think of infection control as more of a dial - a series of options on a continuum that we can activate and park as circulating virus levels drop. And that's the problem right now - vaccines are critically important for 5-11 year old kids right now, but even if we vaccinate them all tomorrow, there's going to be another 5 week where the virus can still spread. So we need to be using so many other tools to suppress spread and protect those that aren't immune.

And the FDA has nothing to do with that. It's the CDC and federal officials recommending local policies for states to enact, then governors and local officials actually using said plans to control the virus. Instead you have 50 different states doing 50 different things and everyone is just asking for the vaccine. We're not helpless - there are so many other things we could be doing. But defiant oppositional lunatics have the ear of the public officials in charge of those decisions and so nothing is happening.

Even in my own state - cases are hovering around 1700 a day, we just crossed 1000 people hospitalized and about 20 deaths a day. Is my own (D) governor doing anything? Nope. Just asking people to get vaccinated. Absolutely refuses to require masking in public because of the backlash from vocal maniacs. Zero consideration for a short-term ban on indoor dining and bars (it's Labor Day weekend soon at the Shore!).

So even in the next cohort (12-17), those kids are ~25% immunized nationwide (as of July; looking for more current numbers). So even though vaccines have been approved for them for months, we're still heading in to school environments where about half the kids aren't protected. It's going to be a nightmare and if anyone thinks schools are going to continue uninterrupted for 2021/22, they're fooling themselves. Vaccines aren't going to keep 8-12 school open - it's going to require additional layers of protection.

It's beyond frustrating.

[El Guapo]

That's all fair, but it also sounds like you don't really agree with the FDA's approach to the approval process here?

[Smoove_B]

I am not really sure how I feel. They're tasked with making sure it's safe. I can't expect them to release something for use when they're not convinced it is or under what conditions it can be used. I am not sure where they are with the numbers. If they're in review stage, then do what you can to speed that up. If they're still in collection phase (getting data), that isn't going to be rushed.

It's a horrific position to be in as kids are going to die as a result of not being vaccinated - no doubt. But as I said, there are other ways to keep kids safe right now, but no one (broadly, generally) is doing that. Instead, it's quite the opposite - which then causes everyone to point at the FDA and ask what the hold up is - as if they are going to be the only way to protect kids.

[El Guapo]

I am not really sure how I feel. They're tasked with making sure it's safe. I can't expect them to release something for use when they're not convinced it is or under what conditions it can be used. I am not sure where they are with the numbers. If they're in review stage, then do what you can to speed that up. If they're still in collection phase (getting data), that isn't going to be rushed.

It's a horrific position to be in as kids are going to die as a result of not being vaccinated - no doubt. But as I said, there are other ways to keep kids safe right now, but no one (broadly, generally) is doing that. Instead, it's quite the opposite - which then causes everyone to point at the FDA and ask what the hold up is - as if they are going to be the only way to protect kids.

Gotcha - that makes sense.

[Zaxxon]

It's a horrific position to be in as kids are going to die as a result of not being vaccinated - no doubt. But as I said, there are other ways to keep kids safe right now, but no one (broadly, generally) is doing that. Instead, it's quite the opposite - which then causes everyone to point at the FDA and ask what the hold up is - as if they are going to be the only way to protect kids.

I hear you. it's definitely a 'yes, and' situation. But the 'and' part is largely out of the control of individual parents, so the vaccine is of paramount importance. In other words, I agree with everything you said. Now, back on Planet 'Murica where infection control as a dial in 2021 is a pipe dream, the vaccine cannot come soon enough.

I'm actually shocked at how well our district has done, moving since June (with a lot of prodding by us parents in the district, and against a lot of ignorant bullying by more than 50% of the county's vocal population and its commissioners) from 'we're going to try normal again this school year' to 'we highly recommend but don't require masks,' to 'we're requiring masks and GTFO if you won't comply.' But I am not confident that the wall will hold until fall break, much less 6 weeks into 2022.

In any event, my issue won't really hit (despite all my caterwauling here in recent weeks) unless/until the trial data is in and the FDA is still slow-rolling at that point. We're obviously not there yet, but the folks in high places laying expectations of midwinter also need to GTFO.

[El Guapo]

In any event, my issue won't really hit (despite all my caterwauling here in recent weeks) unless/until the trial data is in and the FDA is still slow-rolling at that point. We're obviously not there yet, but the folks in high places laying expectations of midwinter also need to GTFO.

I'm hoping that this is a case of underpromising and overdelivering. In any event, even while the FDA's process is meant to be resistant to political pressure (for good reason), I have to imagine that the public pressure on the FDA from all corners once the data is in is going to be deafening.

[Zaxxon]

I'm hoping that this is a case of underpromising and overdelivering.

Fingers crossed.

[Max Peck]

I'm no expert, but I'm starting to think that the COVID-19 vaccines actually work.

[Daehawk]

Im looking forward to my booster. I dont think I can get it until Jan though as my last shot was May. My only side effects were a sore arm and life without Covid.

[Smoove_B]

Update from earlier today on kids:

https://twitter.com/megtirrell/status/1 ... 4103625728

Just now on @FaceTheNation Pfizer board member @ScottGottliebMD lays out more specific potential timeline for Pfizer #covid19 vaccine for kids:

-clinical trial results in Sept for ages 5-11, potential FDA clearance late Nov, early Dec

-results for ages 2-5 in Nov

Availability of vaccine for kids 5-11 depends in part on length of FDA’s review process, @ScottGottliebMD points out, including how much safety follow-up time the regulator requires before clearance. Says he expects this will be weighed against backdrop of urgency of pandemic

On timeline for vaccine for ages 5-11, @ScottGottliebMD says with data in Sept, Pfizer may file application w FDA in Oct, and notes typical review time has been 4-6 weeks, getting to late Nov, early Dec for potential FDA clearance.

[Blackhawk]

If kids are vaccinated at the same rate as adults (in other words, the kids of adults who vaccinated also vaccinated their kids, while those who didn't... don't), where does that put us as far a percentage of the population once the 5-11s are cleared?

[Smoove_B]

The last info I saw suggested somewhere around 30% of all 12-17 year olds were fully vaccinated, but it really varies wildly by region and state (not surprisingly). I would expect even fewer 5-12 year olds are going to be vaccinated.

I don't think it will change until this shot is added to official CDC recommended childhood vaccination list (which hasn't even been floated yet) and then required at a state level for K-12 instruction.

I don't think we're ever going to reach a % of the population vaccinated in a meaningful time frame. Instead, there's going to be cluster outbreaks in different parts of America for years as additional variants circulate through various cohorts and more children are born that aren't being vaccinated. So news stories are going to switch to "High rates of COVID-19 seen in Ohio this week as the nation waits to see how they handle it...."

Might look pretty similar to when we have a random measles outbreak, usually associated with international travel.

As near as I can tell then, this coming Winter is shaping up to be rather similar to Winter 2020. If we can start vaccinating more kids in December, there's hope then that maybe the Spring of 2022 will be better. It's entirely possible that Delta will burn out (as some have predicted), but my money from Day One has been on the virus. Like water coming in your house and raptors, SARS-CoV-2 finds a way. I am in the camp that believes there will be another surge associated with schools resuming (widely) nationwide. Then the various holidays and carrying us into January.

For the overall picture and how things then look going into the Spring of 2022? Hopefully better, but if something else like Delta comes along? It's anyone's guess.

[Max Peck]

It's entirely possible that Delta will burn out (as some have predicted)

Most of the chatter I saw about Delta burning out quickly was based on how things looked in the UK in late July and early August. Unfortunately, things there stopped getting better and infection rates started climbing again. Even without that, though, comparing the UK and the US (or Canada) is sort of an apples an oranges undertaking, given the differences in vaccine uptake and types.

[Lorini]

The last info I saw suggested somewhere around 30% of all 12-17 year olds were fully vaccinated, but it really varies wildly by region and state (not surprisingly). I would expect even fewer 5-12 year olds are going to be vaccinated.

I don't think it will change until this shot is added to official CDC recommended childhood vaccination list (which hasn't even been floated yet) and then required at a state level for K-12 instruction.

I don't think we're ever going to reach a % of the population vaccinated in a meaningful time frame. Instead, there's going to be cluster outbreaks in different parts of America for years as additional variants circulate through various cohorts and more children are born that aren't being vaccinated. So news stories are going to switch to "High rates of COVID-19 seen in Ohio this week as the nation waits to see how they handle it...."

Might look pretty similar to when we have a random measles outbreak, usually associated with international travel.

As near as I can tell then, this coming Winter is shaping up to be rather similar to Winter 2020. If we can start vaccinating more kids in December, there's hope then that maybe the Spring of 2022 will be better. It's entirely possible that Delta will burn out (as some have predicted), but my money from Day One has been on the virus. Like water coming in your house and raptors, SARS-CoV-2 finds a way. I am in the camp that believes there will be another surge associated with schools resuming (widely) nationwide. Then the various holidays and carrying us into January.

For the overall picture and how things then look going into the Spring of 2022? Hopefully better, but if something else like Delta comes along? It's anyone's guess.

I have read a couple of serious articles interviewing epidemiologists who say that we cannot vaccinate our way out of Covid to get to herd immunity. Also that until the global population gets significantly vaccinated, these flare ups will continue. I bet the only thing that could make anti-vaxxers even madder is if the US gave away a significant portion of vaccine supplies to nations that are either not vaccinated at all or that have way lower rates of vaccination than the US does. We need to consider this as variants will just keep coming (from what they are saying) until we do.

[Smoove_B]

Nope - vaccination as a strategy has long sailed. Which is why the doubling (tripling? quadrupling?) down of vaccination as the only strategy is beyond puzzling at this point.

As much smarter people than I am have stated - we're vaccinating to reduce hospitalizations and deaths. We're masking to stop spread.

We're also adding in other things (more recommendations to stop / slow spread), but it's all shouting into the void since the CDC raised the "Mission Accomplished" banner back in May and said once you're vaccinated go ahead and just pretend like the pandemic is over.

Years. It's going to be *years* at the rate we're going.

[Zaxxon]

There's another family that has kids in both my kiddos' grades at the same school, who also went remote last year. The mother is a grade-school teacher who homeschooled her girls last year and just went back in-person this year along with her kids. Her kids and mine were some of the low percentage that actually masked this year from the start. I just talked to her and found out that after one week in class without masks (as our district instituted the mask mandate a couple of weeks into the year, like a bunch of dummy-heads), she got the COVIDs.

Beyond frustrating.

[Rumpy]

With the Province of Ontario now moving forward with vaccine passports via an app, my hope is that they'll have some other method for those who aren't so technologically inclined, and ironically, it's also those first vaccinated (elder age groups) who will need something like this. Both my parents don't have mobile devices, for instance and we're wondering where that leaves them.

Just saw this: For people with a green photo OHIP card, a PDF receipt of COVID-19 vaccination is available online.

We've got our printout from the last vaccination, I think that's what they need in this case.

[Daehawk]

The news reported on some family around here I think it was that their maskless child was not allowed in class and made to return home. The school has a strict mask mandate in place and they are wondering why. All I can say to them is a big DUH.

[LawBeefaroni]

The news reported on some family around here I think it was that their maskless child was not allowed in class and made to return home. The school has a strict mask mandate in place and they are wondering why. All I can say to them is a big DUH.

If they made the news they will soon, if they don't already, have backing from some group or another to rally troops to go after the local school board(s). Astroturfing at its finest.

[Jeff V]

So one of my wife's friends was infected by an antivaxxer brain slug, and while I wasn't too crazy about our kids spending weekends at their house for this reason, I hoped for the best since the wife and I are both vaccinated. Their house is designed to host perpetual parties (they have a good half-dozen gazebos plus a large event tent in their yard, plus a pool). Wife didn't want to make the effort getting our house in tip-top shape for the kids upcoming birthdays, so we planned on her friend to host it this coming Saturday.

Today 2 of 2 COVID tests on her came back positive. Wife and kids spent last Saturday night at their house. Even though my wife is scheduled for a 3rd shot next week, the kids are still unvaccinated and now we need to keep a close eye on them. I briefly saw her last weekend, I had a party to attend elsewhere and just dropped them off and picked them up. Now I have a couple of days to get the house/yard ready to host a party, which will be smaller by 5 now. And that is assuming nobody starts having symptoms before then...wife already gets tested twice a week but is requesting a test this evening when she goes to work.

[Isgrimnur]

https://twitter.com/ahandvanish/status/ ... 2688184320

https://twitter.com/ahandvanish/status/ ... 8887316486

[Blackhawk]

Yikes.

[LawBeefaroni]

That's a really bad graph for several reasons.

[Unagi]

So, basically - there are people that don't seem to 'get COVID' very strongly, but then they also don't ever become immune to it naturally. And hence: are more likely to get it again, and keep it alive and mutating?


Is that the general idea from this?

[Isgrimnur]

The fact that a considerable fraction of RT-PCR positive persons fail to seroconvert has practical implications. Such persons remain undetected in seroprevalence studies, including in vaccine studies that assess protection from asymptomatic infection by measuring antibodies to antigens not included in the vaccine. Seroconverters and nonseroconverters will probably also respond differently to vaccination. Recent studies revealed that seropositive persons have a heightened antibody response after the first, but not the second, dose of an mRNA vaccine, suggesting that a single dose is sufficient (11–13; Samanovic et al., unpub. data, https://doi.org/10.1101/2021.02.07.21251311External Link). Serologic nonresponders might not exhibit a similarly heightened anamnestic response, but resemble SARS-CoV-2 naive persons, as was observed for 1 previously infected vaccinee who never seroconverted (14). Finally, RT-PCR positive persons who experienced COVID-19 symptoms might be less inclined to seek vaccination, believing they are protected, but our results caution against this assumption.