Coronavirus

[haltz]

And please don’t take this as I’m blaming the vaccinated for the variants either. Those getting vaccinated are doing what they think is best for them to stay safe, and they are listening to the official agencies as guidance to what is best. The first news on the subject by the official agencies was that there’s no way the vaccine is causing variants, then as time went on even the official news sources admitted that it could play a role.

The news story you posted at some point about this said that a vaccine-resistant strain will become dominant in a vaccinated population (of course), but not that the vaccinated are causing them. That's a subtle but pretty big distinction.

The virus isn't a hive mind. Think of it more like a slot machine. The unvaccinated are much more likely to be playing the game at this point, even more so if they aren't taking other precautions.

[ghostrunner]

Yeah I remember variants being discussed well before the vaccine was widespread. B117 was the one going through India iirc. The South African variant I remember being discussed a lot. The UK had a lot of one of those this past spring.

I'm not sure that it's right to say one group or another is "driving" variants, just that variants are going to occur and it's a tossup whether or not they're going to spread or be as treatable or as vulnerable to the vaccine. This is my layperson understanding, but with any disease the virus is going to attack in it's normal form and if it meets up with a host that is protected, any mutations that aren't as vulnerable are going to win out and then those may be passed on to others rather than the version that was immunized against. That's not the vaccine causing the variant though, it's just how viruses and vaccines work. That doesn't mean you should let the virus proceed unchallenged, because it will still mutate no matter what and you increase your chances at stopping it completely or lessening the effects.

[cardinalkarp]

[SHOW]

Here's the weekly update from Mrs. AW's work. SSS and all. But, I post this because it is so out of line with all the data I've seen on how likely breakthrough infections are, it's worth noting. And, the numbers are remaining relatively consistent.

1/3 of people ventilated is vaxxed.
3/10 in the ICU are vaxxed
64% hospitalized (11 in this group) not in ICU are vaxxed (seems like an outlier, this has been around 26% the past two weeks)
22% of outpatients are vaxxed

Statewide, according to the NYT map, 46.5% of the adult population (useful since this is a veterans hospital) in Arkansas is fully vaxxed.

https://www.nytimes.com/interactive/202 ... doses.html

Thanks for posting these AW. I know it doesn’t fit within the official narrative so we’re not getting many responses (granted this is just one hospital out of thousands), but it does beg the question about how the information we’re being provided by the CDC and MSM is being collected. Because those are definitely different than what we’re being told.

[haltz]

AW, I'm assuming that's a pretty highly vaccinated population, even in Arkansas (veterans with health care, elderly) those numbers are pulling from, which means a larger percentage of cases will be among the vaccinated, and you're getting 80% unvaccinated positives. We also know the Delta variant is running rampant in Arkansas - I read it accounts for 90% of cases. I've read everything from 75-88% effective in terms of the vaccines against Delta.

I'm sure positive means they've tested positive for covid, but did all of those people admit for covid reasons or did some get tested as part of being admitted for something else?

[AWvsCBsteeeerike3]

AW, I'm assuming that's a pretty highly vaccinated population, even in Arkansas (veterans with health care, elderly) those numbers are pulling from, which means a larger percentage of cases will be among the vaccinated, and you're getting 80% unvaccinated positives. We also know the Delta variant is running rampant in Arkansas - I read it accounts for 90% of cases. I've read everything from 75-88% effective in terms of the vaccines against Delta.

I'm sure positive means they've tested positive for covid, but did all of those people admit for covid reasons or did some get tested as part of being admitted for something else?

Yes, all the patients in med/surg and ICU are in the covid wing and being treated for covid symptoms, and have tested positive.

You hit the nail on the head, though, because if you want to know, truly, how effective the vaccines are against infections/hospitalizations/death against the delta, you need a variety of instantaneous data points that just isn't available. If it were up to me, and it's not, but when I look at information trying to determine efficacy of the vax against those three things, I'd like to know:
1. What time frame are we in. Data pre-delta is of no concern, at least, at this point. It's pretty well established what the efficacy was against the alpha or UK or South America or whatever variant. I want to see data that is current (within the past month, if not shorter) which is very tough to find.
2. What is the defined subset of people and what is the vaccination rate of that particular subset. In this case, it's really tough to tell what the vax rate is of VA patients. It could be higher than the state average, it could be lower, who knows? I don't. But, obviously, this is important because a subset of people that is 80% fully vaxxed where 30% of hospitalized patients is still a pretty effective vaccine, where as a subset of people that is 30% fully vaxxed where 30%o f hospitalized patients is not effective. Two different numbers need to be known, and it's tough to find just one of the numbers in most cases if not both.
3. How do those numbers (infections/hospitalizations/death) compare between the vaxxed and unvaxxed.

From the screen shot, we get 1 and 3, but importantly, we don't know 2.

Here's a link to the data a lot of people are using, but almost all this data includes January 2021 onward, one subset I think is May onward. Regardless, all that is arguably out of date.

https://www.kff.org/policy-watch/covid- ... he-states/

After scouring the internet, I found a tweet that San Diego County does a good job keeping data and looked them up. Not only do they do a great job proving all 3 points, but the information is incredibly promising.

https://www.sandiegocounty.gov/content/ ... tatus.html

And, here's the pertinent info.

https://www.sandiegocounty.gov/content/ ... Status.pdf



From their website, San Diego County has 2.8M people, and 2M+ fully vaxxed as of today. Over the past month, vaxxed have accounted for 10% infections, 3% hospitalizations, and 25% deaths. So, that's good.

Looking a little more, they've had 17268 cases which is .... let's see if I can do math...17268 cases/28 100K people = 617 cases / 100K people and divide that by 30 to get the per day = 21 new cases per 100K people per day. Covidactnow.org has San Diego County at 29 over the past 7 days so that checks out, looks like cases are increasing at about a rate you'd expect with delta. And, wala. I wish we had about 100 more counties like this to analyze. But, that seems like pretty legit data. I'd be lying if I said I expected that type of efficacy, but who am I to judge. One interesting thing is the efficacy at preventing cases decreases (actually don't know if that's correct, but the % of vaxxed as part of total cases increases) with each age group except the 80+ and reaches as high as 21% in the 70-79 group. So, 21% of cases in the 70-79 age group are of vaccinated people. I didn't find an age breakdown but you'd expect the percent vaccinated of each age group would increase as well, so, there's that.

Hopefully more states/counties start providing data like this as I find it pretty helpful.

[AWvsCBsteeeerike3]

I may not be smart enough to fully follow all of this. Maybe AW can. But this clearly shows the mutation paths were happening and being tracked WAY before the vaccines were publicly available:

https://www.medrxiv.org/content/10.1101 ... 1.full.pdf

Ha, I don't have the foggiest idea what that's showing, but I would concur we've been tracking variants since the beginning. At first, I remember hearing that the mutations were occurring more slowly than the flu, though, I'm not sure if that is still true or if it was even true back then.

Regarding variants, in general, it's all speculation at this point. I mean, can a variant pop up that causes ADE? Probably, sure, I guess anything is possible. Could a variant pop up that kills everyone regardless of vax/nat infection/naive status? Sure. Anything seems possible at this point, no?

I still go back to the very basic understanding I have of the virus which is the spike protein allows the virus to attach to the ace2 receptor is critical. It's the site targeted by the mRNA vaccines (not sure about others) and it's what the body builds antibodies against via natural infection as well. Both cases inform the adaptive arm of the immune system so they can make more antibodies on the ready which should prevent further infections from becoming serious. I've yet to see anyone posit an explanation as to how the virus will mutate in such a way the spike protein binds to the ace2 and evades antibodies (which are only one part of the body's defense).

That's not to say it can't happen, obviously I don't know. But it seems like a tall task. And I say that even with the Peru variant possibly showing the ability to do that. Time will tell, but I wouldn't spend too much time worrying about it. One thing is for certain, the less chances it has to mutate, the less variants there will be. So, yeah, it's probably time to get back to masking and distancing for all and that sucks.

[G. Keenan]

Variants have been widely discussed since Day 1. The vaccines absolutely do not "create" variants. All viruses mutate into variants with our without vaccines.

AW, I wish those hospital numbers from your wife told you something about the vaccinated patients hospitalized because what I think we see broadly is that fully vaccinated people who get a serious enough breakthrough to require hospitalization are mostly the older, immunocompromised groups or those with a multitude of underlying health conditions. AKA, the group you would always expect to be most vulnerable even when vaccinated.

It would be nice if we had numbers on breakthrough infections that don't require hospitalization. We don't seem to have those, just numbers on vaccinated people who show up to hospitals. Still, the best available data shows the vaccines performing very well against Delta, both at preventing a symptomatic infection and serious illness.

This is a good piece from a very legit, very smart, non-controversial public health person: The delta variant is surging. How should that change how we live?

Someone who is vaccinated, generally healthy, and either living alone or sharing a household with others who are also vaccinated and healthy might decide that they are protected enough that they won’t change anything. According to CDC data, the vaccinated are approximately eight times less likely to become infected than the unvaccinated. Even if they contract covid-19, chances are excellent that a vaccinated person will experience symptoms akin to the common cold; after all, the vaccines reduce the chance of severe illness by a whopping 25-fold.

But isn’t that the cautionary tale from Provincetown, Mass. — didn’t revelers letting their guard down lead to around 965 people becoming infected, including many who were vaccinated? The CDC directly cited this outbreak in urging the vaccinated to resume masking.

That’s one interpretation of the data — it’s true that vaccines are not bulletproof armor and breakthrough infections can happen. Consider, though, that an estimated 60,000 people gathered in Provincetown over the Fourth of July holiday. Restaurants, bars and house parties were packed to the brim. Some of the infected reported prolonged close contact with others. Another conclusion is that this was the ultimate stress test of the vaccines and they passed with flying colors: Only about 1.6 percent were infected, just seven were hospitalized, and no one died.

If the attendees were told of these odds in advance, it’s likely that many who have underlying medical problems or are more risk-averse would have taken additional precautions. Some might not have gone. But there will be those who would still say that the value of the get-together was so high that they would have taken the risk and not changed anything.

Remember that vaccinated people are safest around others who are fully vaccinated, too. The CDC has not said this, but I believe a workplace that enforces a vaccine requirement can make masks optional if it’s located in a jurisdiction where that is permitted. If others around me have an eight-fold lower chance of getting infected, and I have an eight-fold lower chance of contracting covid-19 from them, that’s low enough risk for me. This applies in social settings, too; I’d attend an indoor dinner party with all vaccinated people, even if someone there might be engaged in high-risk behavior. But I wouldn’t have this person around my children unless they first quarantine and test. The only adults in close contact with our kids are those who also have a low-risk lifestyle — who spend time with only vaccinated people and mask in indoor public places.

[haltz]

One interesting thing is the efficacy at preventing cases decreases (actually don't know if that's correct, but the % of vaxxed as part of total cases increases) with each age group except the 80+ and reaches as high as 21% in the 70-79 group. So, 21% of cases in the 70-79 age group are of vaccinated people. I didn't find an age breakdown but you'd expect the percent vaccinated of each age group would increase as well, so, there's that.

I don't think it decreases, you're looking at what is called the base rate fallacy. If that 70+ group was fully vaccinated, like 100%, you'd be looking at 100% of covid cases for that subset being fully vaxxed. That doesn't mean 0% efficacy, it means we need to look at denominators. I alluded to this in my last post but the more a population is vaxxed, the higher the percentage of positives will be among vaxxed.

[haltz]

Regarding variants, in general, it's all speculation at this point. I mean, can a variant pop up that causes ADE? Probably, sure, I guess anything is possible. Could a variant pop up that kills everyone regardless of vax/nat infection/naive status? Sure. Anything seems possible at this point, no?

I'd be curious to know what the worst case scenario is. What the theoretical limits are for a virus in this category and how effectively the vaccines can be re-targeted. It does seem like anything is possible, but I'd be curious what a virologist would say.

I guess when the mask resistant variant shows up we can all start to really pile on Karp.

[cardinalkarp]

I guess when the mask resistant variant shows up we can all start to really pile on Karp.

Why stop the fun, right!

I have enjoyed the discussion (even though I’m sure it’s frustrating for both sides)….but I’m going to take a step back and just read and listen. I think everyone knows where we stand at this point.