Coronavirus thread

[Karl Henning]

Good on your booster, PD!

[Karl Henning]

Should 'fully vaccinated' now include a booster dose? Here's what the experts say

By Amanda Kaufman Globe Staff, Updated November 22, 2021, 2 hours ago

The Centers for Disease Control on Friday expanded COVID-19 booster eligibility to include all adults, clearing the way for millions more Americans to shore up protection against the virus.

Friday's decision, coupled with data showing that immunity due to the vaccines wanes over time, has raised questions about whether the expansion could pave the way for boosters to become part of the standard COVID-19 vaccination regimen.

Multiple experts said they think the COVID-19 vaccination program will eventually include three doses of an mRNA vaccine or two Johnson & Johnson doses — just not right away. They also emphasized that a more pressing matter is changing the course of the pandemic: Vaccinating those who remain unvaccinated, not deepening the level of protection for those who have already received shots of vaccines that are effective in preventing severe illness.

Under the current CDC guidelines, a person is considered fully vaccinated two weeks after their final shot in a two-dose mRNA vaccine regimen or after one dose of the Johnson & Johnson vaccine. Before last week, the CDC limited its recommendation for boosters to certain groups, including people 65 and older, those who received a Johnson & Johnson shot, people 50 and older with certain medical conditions, and adults who live in long-term care settings. The agency also said adults with certain medical conditions or those who live or work in high-risk settings may get them.

Dr. Anthony Fauci, the nation's top infectious disease expert, has made the case for boosters to be used more widely, telling Axios that he envisions boosters becoming part of the vaccination series at some point.

"In my opinion, boosters are ultimately going to become part of the standard regimen and not just a bonus," Fauci told the publication.

Dr. Sabrina Assoumou, an infectious disease physician at Boston Medical Center and professor at Boston University School of Medicine, said she agrees, but stressed that the boosters are particularly important for certain vulnerable groups like those outlined in the CDC recommendations.

[Pohjolas Daughter]

Good on your booster, PD!

Thanks Karl!  Thankful that I was able to get it despite a bit of a wait; at one point, I was afraid that I would be waiting in vain, but it all turned out well, so I'm grateful!

PD

[Karl Henning]

There are reasons to still avoid the office, but health concerns aren't among them

By Anissa Gardizy Globe Staff, Updated November 23, 2021, 2 hours ago

For the past six months, Massachusetts residents have been emerging from their pandemic shells, eating inside restaurants, going to concerts and sporting events, sweating at the gym again, and being around more people in close quarters of all kinds.

Some venues require face masks or proof of vaccination, but for the most part, in-person activities are relatively unrestrained compared with last year, even with a recent increase in virus cases as the weather cools and people move indoors.

Amid all this interpersonal activity, however, many offices remain empty.

Businesses have said they are monitoring COVID-19 metrics to decide when to bring their employees back, a mindset that led to a string of reopening delays in September due to the Delta variant of the virus. But health experts say there's nothing particularly risky about working in an office anymore, challenging the long-held belief by some that the coronavirus alone is a reason to continue to working from home.

"Implying that there is something different or more dangerous about offices is totally not true," said Dr. Shira Doron, an infectious disease physician and hospital epidemiologist at Tufts Medical Center

Health care workers, first responders, retail employees, and many others never stopped working in-person. Students and faculty, from elementary schools to colleges, are back in-person, too. And it's been nearly six months since state officials deemed that the pandemic warranted occupancy limits and social distancing for businesses.

Doron acknowledged the recent uptick in coronavirus cases in Massachusetts, but said it's a good sign that deaths and hospitalizations have not taken off on the same trajectory. To her, the state has moved into a "post-vaccination phase," where cases should be expected and not something that prohibits activities such as going to an office.

"I think this is what our new world is," Doron said. "If you are not willing to come into the office now, then one has to ask oneself, what would need to happen, and is that ever going to happen, for you to be comfortable?"

Dr. Andy Pekosz, a virologist at the Johns Hopkins Bloomberg School of Public Health in Baltimore, said determining whether an office is safe "starts and almost ends with vaccination," since it's the best way to reduce risk. Of the more than 4.8 million vaccinated individuals in Massachusetts, just over one percent has experienced a breakthrough COVID-19 case, according to the latest data from the Department of Public Health.

Pekosz believes masks are still a good idea in group settings, and while people can't wear masks while eating in cafeterias or break rooms, that "shouldn't prevent us from going to the workplace."

It's no surprise that Joseph Allen of Harvard's T.H. Chan School of Public Health thinks people can be back in offices. In his book "Healthy Buildings," he essentially wrote the manual for keeping people safe indoors. A building with a mostly vaccinated workforce and ventilation system that routinely refreshes the air is a low risk environment, according to Allen.

Martin Bazant, a professor at the Massachusetts Institute of Technology, said office buildings are one of the safest places for people to be, so avoiding them for health reasons doesn't make sense.

"Modern offices are likely safe to occupy fully right now, in many cases, without masks," said Bazant, who teaches chemical engineering and mathematics.

His assessment is based on an online tool he helped create last year that uses models to calculate probabilities of COVID-19 transmission in indoor spaces. It allows users to input various factors such as local prevalence of the virus and type of ventilation system.

"Given current levels of vaccination and infection prevalence in Boston today, the risk of actually dying during your transit to work from any other source, like a car accident, may be worse than dying of COVID," he said. "We have to make more quantitative assessments to decide whether we can resume normal life."

Several health experts said the fear of going back into the office solely because of health concerns is based on an irrational risk evaluation, not science. And when the Biden administration's vaccination and testing mandate for large employers goes into effect in January, they said, it will offer even more assurance that being around coworkers is not a health issue.

"There absolutely will be a time when someone really won't be justified to say, 'I'm not going to come into work because I'm afraid of the risk,'" said Pekosz, noting that Immunocompromised people and those who do not respond well to vaccines still must exercise caution

Most experts said working in an office isn't much different than other activities people are already engaging in, although it depends on how people behave in a specific situation. For instance, Doran said large meetings with food in an office would likely be riskier than wearing a mask in a grocery store, but safer than dining indoors where the vaccination status of other guests is usually unknown.

For some workers, it's getting to work by bus, subway, or train that is more worrisome than being in an office with colleagues. But Bazant said the fact that most people are vaccinated, can wear a mask, and are typically on public transportation for a short period of time, makes commuting less risky than it might seem.

"We all know how crowded the T can get, so certainly there are elevated risks, [but] the level of risk is not the same as it was a year ago," he said.

There are, of course, other reasons why employees may not want to go back to in-person work, at least not in the same way as they did before the pandemic. Doron, who consults with companies on back-to-work plans, said employers need to understand whether employees are worried about catching COVID-19 in a cubicle, or if their concerns involve issues such as childcare, the loss of flexible work schedules, and having to return to spending money and time commuting.

"[Companies] tell me that they have employees that are nervous about coming back...I'm sure they also have employees that are going to nightclubs," Doron said. "They may just like working from home."

[Karl Henning]

COVID cases in US children have risen 32% from two weeks ago, pediatricians say

[Pohjolas Daughter]

COVID cases in US children have risen 32% from two weeks ago, pediatricians say

Shudder!  Any idea what they translates to in terms of numbers Karl?

PD

[Karl Henning]

Shudder!  Any idea what they translates to in terms of numbers Karl?

PD

Not yet, looks like there's an article in the NY Times

[Mandryka]

To top it all off: AZ does not appear to be the best vaccine.

No. Arguably not using AZ so much is one of the causes of the EUs woes at the moment.

https://www.ft.com/content/4492746e-6a14-4993-9c21-cd9c9f37eca4

[Mandryka]

What's happening in France -- and I am keen to say that the only figures I can find are reported +ve test results -- but what's happening there suggests to me that in cold countries mask mandates aren't effective. Haven't checked Italy, Greece, Spain etc.

[Pohjolas Daughter]

Not yet, looks like there's an article in the NY Times

I did find this on CNN's website (no paywall):  https://www.cnn.com/2021/11/22/health/covid-19-children-cases-up-again/index.html

PD

[Karl Henning]

I did find this on CNN's website (no paywall):  https://www.cnn.com/2021/11/22/health/covid-19-children-cases-up-again/index.html

PD

Thanks!

[Mandryka]

No. Arguably not using AZ so much is one of the causes of the EUs woes at the moment.

https://www.ft.com/content/4492746e-6a14-4993-9c21-cd9c9f37eca4

And this

https://www.theguardian.com/world/2021/nov/23/astrazeneca-chief-links-europes-covid-surge-to-rejection-of-firms-vaccine?fr=operanews

[Karl Henning]

COVID-19 cases have jumped 59 percent in New England in the past 2 weeks

By Martin Finucane, Felice J. Freyer and Ryan Huddle Globe Staff, Updated November 23, 2021, 7 minutes ago

The number of COVID-19 cases reported across New England has taken a sudden turn upward in recent weeks as the coronavirus has returned with a vengeance to the region after devastating the South this summer.

Seven-day average daily case numbers have increased over the past two weeks by 117 percent in Connecticut, 83 percent in Massachusetts, and 34 percent in Maine. Cases are up in Rhode Island by 32 percent, in New Hampshire by 29 percent, and in Vermont by 15 percent, according to data collected by the US Centers for Disease Control and Prevention.

The seven-day average of daily new cases for all New England states combined has doubled in less than a month. In just the past two weeks, the number is up 59 percent, reaching 5,442 cases per day, according to CDC data updated Monday.

On a case per capita basis, every New England state is now above the national average, with New Hampshire more than twice as high — 65.0 cases per 100,000 residents — compared with the national average of 27.4 cases per 100,000.

The increases come after a September spike in New England had appeared to be subsiding. They are arriving as the weather is turning colder, national case numbers are turning up, and officials are calling for all adults to get boosters to shore up the waning immunity from their original shots.

"Heading into the winter months when respiratory viruses are more likely to spread and with plans for increased holiday season travel and gathering, boosting people's overall protection against COVID-19 disease and death was important to do now," Dr. Rochelle Walensky, director of the US Centers for Disease Control and Prevention said in a White House briefing Monday.

Experts and officials are hoping that, because of high vaccination rates in New England, case increases will not result in the same level of hospitalizations and deaths as they have in previous COVID surges.

Dr. David B. Banach, hospital epidemiologist at UConnHealth in Farmington, Connecticut, said that cases are milder, especially among vaccinated people. "Hospitalization rates have not been increasing at the same rate as new cases. That provides good evidence that the vaccine is working," he said.

That's why a COVID-19 case in November 2021 is viewed differently from a COVID-19 case in November 2020. "We're not seeing the severe infections rise at the same rate," Banach said.

Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said no one knows why cases are increasing in the Northeast.

"This is part of the mystery of the surges we see with COVID-19, why they start and why they stop — we don't know," he said. "We do know that vaccination and mitigation can reduce the impact of the surge."

"There is less severe illness, less deaths," he said. "At the same time, it points out the fact that this virus is still extracting a very large toll on us."

"The vast majority of us are done with this pandemic," Osterholm said. "The problem is, it's not done with us."

Connecticut Governor Ned Lamont, referencing a national map of new cases at a briefing Monday, said, "It's a sort of a mirror image of where you were, say, 90 days ago where the South — Florida and Georgia, Texas, Alabama — were on fire, and we were, you know, very, very low infection. Now, given seasonality and the flu season as such, that has shifted around a little bit.

"We're much better prepared than we were a year ago, much better prepared than we've been. We've got the vaccine. We've got the boosters. We've got the masks. We're going to get through this, no question about it. Let's make sure that the next wave is the most mild of all," said Lamont, whose state currently has the highest increase in daily cases in the country but still has the lowest per capita rate in New England, 20.7 cases per 100,000.

Officials have warned that unvaccinated people face much higher risks. The CDC says that, according to data collected from about two dozen US jurisdictions, unvaccinated people had 5.8 times the risk of contracting COVID-19 and 14 times the risk of dying from the disease.

"Infections among the unvaccinated continue to drive this pandemic — hospitalizations, and deaths — tragically, at a time when we have vaccines that can provide incredible protection," Walensky said at the White House briefing.

Asked last week about case increases in Massachusetts, Governor Charlie Baker's administration emphasized the successes of the state's vaccination program. "Massachusetts leads the nation in getting residents vaccinated with 95% of all adults with one dose, and has one of the lowest COVID hospitalization rates in the country," a Department of Health and Human Services spokeswoman said in a statement.

[Florestan]

No. Arguably not using AZ so much is one of the causes of the EUs woes at the moment.

https://www.ft.com/content/4492746e-6a14-4993-9c21-cd9c9f37eca4

And this

https://www.theguardian.com/world/2021/nov/23/astrazeneca-chief-links-europes-covid-surge-to-rejection-of-firms-vaccine?fr=operanews

The AZ vaccine was the closest one could get to a classical vaccine (the ones we all got in our childhood)*, was developed by an Anglo-Swedish venture and was the cheapest of them all. Three more than enough reasons to kill it.

Btw, it would be interesting to see if and how the ongoing scandal about the dubious contracts Ursula von der Leyen signed on behalf of the EU with Pfizer, and the huge conflict of interest of her husband in this respect, will develop.

*not that it is perfect and without problems, mind you

[Que]

And this

https://www.theguardian.com/world/2021/nov/23/astrazeneca-chief-links-europes-covid-surge-to-rejection-of-firms-vaccine?fr=operanews

The

The AZ vaccine was the closest one could get to a classical vaccine (the ones we all got in our childhood)*, was developed by an Anglo-Swedish venture and was the cheapest of them all. Three more than enough reasons to kill it.

*not that it is perfect and without problems, mind you

Interesting! Sofar it seems a claim that is met with scepticism, but it could be an important development.

[Florestan]

a claim that is met with scepticism,

(I assume you refer to the von der Leyen family / Pfizer scandal)

By who?

but it could be an important development.

I for one eagerly await it.

[Que]

(I assume you refer to the von der Leyen family / Pfizer scandal)

No. Haven't read anything about.

By who?

Read the linked Guardian article.

[Florestan]

No. Haven't read anything about.

https://www.politico.eu/article/ursula-von-der-leyen-pfizer-text-messages-ombudsman/

https://www.nytimes.com/2021/04/28/world/europe/european-union-pfizer-von-der-leyen-coronavirus-vaccine.html

Plus, a Romanian parliamentary party has filed an official complaint to the office of the European Chief Prosecutor asking for the matter to be thoroughly investigated (Romanian only, Google Translate may help):

https://www.agerpres.ro/politica/2021/11/23/aur-solicita-parchetului-european-sa-investigheze-modul-in-care-s-a-facut-contractarea-vaccinurilor-anti-covid-19--819109

[SimonNZ]

quoting in full:

Treatments will change the pandemic, but they can't end it alone
Antiviral pills will be a key part of a large toolkit needed to manage the coronavirus, not a silver bullet

"A year after coronavirus vaccines dangled visions of an end to the pandemic, science has delivered inspiring results again: two antiviral pills that dramatically reduce the risk of hospitalization and death.

The notion that a fearsome infection could soon be treatable with a handful of pills is an exhilarating idea nearly two years into a pandemic that has killed more than 5 million people, at least 770,000 in the United States. But experts — who are thrilled about the prospect of two powerful new medicines — worry that enthusiasm for the idea of treatments may distract from their limitations and the necessity of preventing illness in the first place.

If regulators deem the five-day treatment courses from Pfizer and Merck and its partner Ridgeback Biotherapeutics safe and effective in coming weeks, as most people expect, the drugs could make getting sick far less scary. The United States has already prepurchased millions of treatments. The good news arrives like an echo of last year, when two remarkably effective vaccines were authorized in the middle of the holiday season as a winter surge in new cases loomed.

But these treatments alone aren't likely to close the book on the coronavirus. Instead, they will be a valuable addition to an armamentarium that the world is going to have to keep building and maintaining in the long run: vaccines, booster shots, more antiviral pills, virus-fighting antibodies engineered to stick around in people's bodies and fast-turnaround testing linked to treatment options.

"It's a huge part of the toolbox; if we can move everything upstream, instead of trying to treat hospitalized patients with late-stage severe disease," said David Boulware, an infectious-disease physician at the University of Minnesota Medical School. "I'm an optimist. Six months from now, I think things are going to be great."

Drugs that can be taken at home to keep mildly sick people from ending up in the hospital will be a turning point. But a major lesson of the pandemic has been that around each corner are more corners.

Remember, the vaccines were better than anyone expected. But more people in the United States, where vaccines are plentiful, have died of covid-19 in 2021, after shots became available, than in the year before.

Antivirals, too, will be powerful but won't be a get-out-of-jail-free card by themselves.

Initially, they will be available to people at increased risk of severe illness due to age or other factors. People will need to recognize their symptoms early, get tested and start treatments right away.

The drugs are good, but not perfect: Merck and Ridgeback's molnupiravir slashed hospitalization and death by half in a clinical trial, but that means some people still ended up in the hospital. Pfizer's Paxlovid reduced hospitalization and death rates by an impressive 89 percent, but it must be taken within days of symptoms.

And scientists have learned not to underestimate the virus. As soon as treatments become widespread, scientists will be watching for signs of resistance.

"There's always a sense of optimism with a new strategy that comes along, and I'm optimistic, too, that this is one additional thing that is going to help in our fight against this disease," said Erica Johnson, chair of the Infectious Disease Board of the American Board of Internal Medicine and a physician at the Johns Hopkins Bayview Medical Center. "But I'm also cautious that it is just a single strategy, and it really only works if all the other strategies are healthy and working, too."

Carl Dieffenbach, director of the Division of AIDS at the National Institutes of Health, has spent decades battling a different virus, overseeing a $1 billion global research portfolio focused on HIV. Although the long quest for a vaccine has been unsuccessful so far, the disease has been transformed by treatments and prevention strategies. Now, he is trying to apply some of that thinking to covid-19.

No one is willing to outline a minimum threshold of treatments needed against a virus that has been so continually surprising, but when pressed, Dieffenbach says that coronavirus treatments that will soon be reviewed by regulators are "a good start" — not the end.

It's important to build an arsenal of drugs that use different techniques to stop the virus. One class of drugs can block the coronavirus from entering cells, as monoclonal antibodies already in use are designed to do. Another class, like Pfizer's drug, could interfere with proteases, enzymes that the virus uses to process its proteins. A third, like Merck and Ridgeback's molnupiravir, could interfere with a different enzyme the virus uses to make copies of itself.

Dieffenbach thinks all three angles of attack will be needed, as well as backups for each strategy and cocktails that combine them, to avoid allowing the virus to sneak past the protection given by any individual treatment.

"Six [treatments] at a minimum. Nine would be better. Twelve would be even better," Dieffenbach said. "We need the companies to make the drugs at scale, as available as aspirin and Tylenol — metric kilotons."

Both Pfizer and Merck have begun scaling up their pills before they have received a regulatory green light. Pfizer plans to make 50 million treatment courses in 2022. Merck projects having 10 million treatment courses ready by the end of this year, and more in 2022. The United States has pre-purchased about 3.1 million treatment courses from Merck and 10 million from Pfizer.

The question now on many scientists' mind is how the virus will respond as those drugs go into widespread use. Akiko Iwasaki, an immunologist at Yale University School of Medicine, sees combinations of drugs as the future — particularly for people with compromised immune systems who can have covid-19 infections that simmer for weeks or months, allowing the virus to mutate.

"If we have a combination, an antiviral cocktail, it might protect against the emergence of these mutations," Iwasaki said.

Iwasaki and colleagues recently reported a preprint case study of a woman in her 70s whose cancer had weakened her immune system. The patient was sick for six months with persistent covid-19, and during her treatment received a course of remdesivir, an intravenous antiviral medication. At first, her fever resolved and levels of the virus dropped — until a mutation that gave the virus resistance to remdesivir allowed it to surge back.

In this case, the resistant virus that was able to thrive in the presence of remdesivir wasn't going to take over the world — it was less adept at multiplying than the original strain. But the case illustrates the risk of new variants arising after treatment.

To protect immunocompromised people, other companies — including AstraZeneca and Adagio Therapeutics — are trying another angle of attack: laboratory-brewed monoclonal antibodies that have been engineered to stick around in the blood for a long time, with the idea that they could provide a shot of long-term protection, similar to a vaccine. Regeneron recently released data showing that its monoclonal antibody cocktail, currently authorized as a treatment for people infected or recently exposed, remains about 80 percent effective against symptomatic infections eight months later, bolstering the case for its drug as a preventive for people who don't respond well to vaccines.

"For us, vaccination has been the jailbreaker; it has allowed us to live life normally," said Hugh Montgomery, a professor of intensive care medicine at University College London leading a trial of the AstraZeneca drug, which has been submitted to U.S. regulators for emergency authorization. "My sister, who has breast cancer and has just got 18 weeks of chemotherapy and can't mount an antibody response to the vaccine — as we've lifted our lockdown, she's become a prisoner in her house."

Instead of one drug or one solution, there will probably be treatment niches — and the market opportunity isn't a one-time flare; it's what pharmaceutical executives call "durable."

On a recent earnings call, Pfizer chief executive Albert Bourla said that he sees a years-long market for antiviral pills. As long as the world needs vaccines, it will also need treatments.

"As long as you have covid around, you will have a need to vaccinate and protect and then you will have a need to treat and save lives," Bourla said.

Alongside medical tools, Dieffenbach is calling for a societal shift — a new normal in which people with respiratory symptoms test as soon as symptoms appear and start drugs within three to five days.

"What I'm advocating for is a fundamental change in approach," Dieffenbach said. "In the future, we don't require people to go to the doctor if they're feeling sick to get tested. There's a rapid test you do at home. People are motivated to get a prescription, or already have a prescription so they can start taking it right away. That's where we're going to have to get to."

Even as experts anticipate the arrival of lifesaving drugs, they worry. Will people use the existence of medicines as an excuse to avoid vaccination or boosters? Will people who could clearly benefit — those who have avoided the vaccines — seek out testing at the first sign of a sore throat and get access to drugs quickly enough?

Doctors are hopeful that people will realize that avoiding sickness altogether is the best option. Boulware said one colleague puts it this way: Syphilis is treatable with penicillin. But it is far better to not get it in the first place.

"It's almost like applying the correct tool for the task at hand. Treatments are going to play a backup role to vaccines," said Rajesh Gandhi, an infectious-diseases physician at Massachusetts General Hospital.

The existence of treatments could also trigger the start of a philosophical discussion on how to deal with sickness itself. Pre-covid, people hopped on flights and went to school and work with runny noses and coughs. If people go back to old habits, it may be hard to identify and treat people early enough in their illness.

"I don't think we're going back to just ignoring people who are sick," said Larry Corey, a virologist and past president of the Fred Hutchinson Cancer Research Center in Seattle. "Coming to school or coming to work and just assuming that no matter what, it's not going to hurt you."

[Que]

Even as experts anticipate the arrival of lifesaving drugs, they worry. Will people use the existence of medicines as an excuse to avoid vaccination or boosters? Will people who could clearly benefit — those who have avoided the vaccines — seek out testing at the first sign of a sore throat and get access to drugs quickly enough?

Doctors are hopeful that people will realize that avoiding sickness altogether is the best option. Boulware said one colleague puts it this way: Syphilis is treatable with penicillin. But it is far better to not get it in the first place.

Good to have medication to clear the hospitals and have a treatment for cases in which people cannot be vaccinated or vaccination is not effective. But the risk this will undermine the vaccination effort and will be used by people as an excuse not to be vaccinated, is my concern as well.