Not to pile on, but my second argument is important - like the NFL, the Pfizer trial design (and, I assume, the Moderna trial) do NOT simply accept "Confirmed COVID" as equal to "positive test result". In Pfizer trial, a positive test and at least one symptom is required:
A confirmatory hint: a lot of the news coverage says the vaccine are good at preventing people from getting "sick with COVID". Careful and accurate, IMHO.
1. You focused on people who get vaccinated. What about people who actually got Covid? I just recovered about a week ago, and find it hard to believe that I would spread it, at least for a 3-6 month period. In general, how much talk about what the vaccine does applies to what antibodies from the actual disease does?
2. Does the fact that different strains exist factor into today's post? Does the vaccine prevent you getting different strains and/or carrying them asymptomatically?
If these seem a bit off-topic, I apologize. I'm reevaluating things now that I've recovered. The biggest reason why I was fine with mask mandates was because I didn't want to spread it if I had it, and that's off the table for a little while, so I'm trying to see what's left.
Glad you are providing a accurate message rather than the hype that the MSM is trumpeting. Fearporn is is their standard. Politics is driving the coverage now.
Respectfully disagree. From what I've read (IANA doctor) this is the issue: the FIRST battlefield of COVID infection is the mucosal membrane of the upper respiratory tract (nose/throat.) A nasal-spray type vaccine would be great for preventing infection there; the intramuscular vaccines provoke a much weaker mucosal membrane response.
However, people aren't dying of a runny nose! COVID gets serious when it circulates in the bloodstream to other organs - lungs, kidneys, etc. The intramuscular shot-in-the-arm vaccines from Moderna and Pfizer do a great job of preventing COVID from expanding beyond the initial beachhead. Serious disease and death avoided!
My takeaway - a mild asymptomatic upper respiratory infection is entirely possible even after the vaccine has provoked antibodies. How long and how transmissible? Probably not long and not very, but who knows?
Your point is that during the trials some of the vaccinated arm should have been getting tested for other reasons and been a stray asymptomatic positive. Definitely maybe!
But in the placebo arm, the chart stops with 2% infected. Presumably they were detected either because they had COVID symptoms or they had 'something else' which prompted a COVID test. We don't know the breakdown of that number but the 2% total is still small. Your argument (as I follow it) is to that *IF* the vaccine fails to prevent initial infection there should be some detectable number of people having (eg) a heart attack overlapped with a transient mild COVID infection in the vaccine arm.
I have not pushed any numbers around but if I were inclined I'd try some assumptions and modeling about what proportion of the placebo group would need to be COVID positive but otherwise asymptomatic to produce a notable result if that proportion carries over into the vaccine arm. Well within your scope! My *suspicion* is that if I modeled it I'd come away thinking asymptomatic infection in the vaccinated could still be a thing. I'd take a stab at modeling it but I'd have more confidence in your result anyway.
I can't find my favorite article on this topic but this article is a start.
"It is not clear if the vaccine elicits formation of different kinds of antibodies – like IgE or IgA – in addition to IgG. IgG is the main antibody in circulation and was the one that was measured in the trials, but IgA is the main antibody defense in mucosal surfaces. Theoretically, one could be immune systemically but still have viruses on the mucosal surfaces, like the upper respiratory airway, and could be infectious to others. Research is ongoing on this question."
Thank you so much for this newsletter. I have forwarded this post to my dad after my uncle sent him an article by an anti-vaxer on how the Covid vaccines are not legally vaccines and won't do anything to stop transmission or illness. I was much too upset to do anything but flip out and go "this article is garbage and goes against everything I have read for a year by people I trust. Stop reading the garbage he sends you." This helped re-enforce what I was saying.
A thread by doctor summarizing the reasons to believe vaccinated people would not be infectious and opining as you do that returning to normal is a central part of the pitch for vaccines and shouldn't be undermined by theoretical quibbles. https://twitter.com/AaronRichterman/status/1349003751823175685
****And you’ve got me there. This is why the headlines say “Vaccines *may* not stop the virus” instead of “Vaccines do not stop the virus”. They couch this in a language of uncertainty because “proof” has a very specific definition.****
This happened over the summer as well with numerous reports about COVID maybe reinfecting people ~3-4 months after recovery, with antibody defense disappearing. What had actually been found in the studies being quoted was that there was evidence that immunity lasted AT LEAST ~3-4 months, because that's how long we had been able to observe people following recovery. Ultimately it's very irresponsible reporting in search of fear-driven clicks.
Absence of evidence =/= absence of evidence and all that.
1. Calling immunity after two weeks from first shot is irresponsible. The data rolling out of Israel appears to show it's not quite as effective as that for seniors, which makes sense both from the perspective of antibody titers and from the side effects (fever-like side effects suggest immune response). For both vaccines, both of these indicators are stronger for younger patients. Older patients really need that second shot. Maybe you can say for younger patients two weeks is good to go, but complex messaging turns into hash, and probably better to say the line is 7-days after the second dose, which is, after all, the vaccine study endpoint.
2. I think you overstate the Pfizer chart. While it's true that the protocol resulted in lots and lots of people being tested, there are likely missed completely asymptomatic people in both groups, and this means less than the 90%+ efficacy for suppression. The protocol practically required everyone with so much as a sniffle to get tested, but if the vaccine permits some people to culture the virus for a while but at a low asymptomatic level, this would be missed because the protocol wasn't set up to detect it. Or to put it another way: participants were not randomly selected to be swabbed, but only those with symptoms consistent with an infection; the protocol was not designed to look for how much of the iceberg was submerged.
Imagine a test of fire-retardant lumber where the evaluation occurs whenever the fire department was called and the endpoint is whether the insurance company deemed the structure a total loss and observing a dramatic reduction in total loses. And then concluding that fire-retardant lumber prevents *all* fires within dwellings. Well, no it doesn't--at least not to the same efficacy--because we simply didn't record kitchen fires and small fires remedied with a fire extinguisher. Telling people with fire-retardant lumber to throw out their fire extinguishers would be a mistake!
This is why people point instead to the Moderna study for the protective effect. The Moderna protocol tested everyone at the point of the second shot, and this showed a statistically significant difference, strongly suggestion complete suppression of the disease for some portion of the participants at some point after the first dose, but probably not as high as the 94% topline. And this makes sense--it makes sense that some people are not bulletproof immune, but have a sufficiently tuned-up immune response to keep the infection at a very low level.
3. All that said, I tend to agree that the message should be that the vaccines are hugely efficacious, and that once enough people have them, mask rules can fall aside. The real issue is that we already have people walking into Walmart and claiming to be a sovereign citizen or whatever, and a rule that post-vaccine and you're vine is unmanageable (either unenforceable if we go by people's say-so, or something Americans will viscerally reject, if we're talking about vaccine passports). I agree that public health should try to communicate this as adults and not through white lies and just say: we won't need masks once there's enough community immunity, but until then in public places it only works to have one rule for everyone.
4. I'd like to know how a double-blind study with masks can be performed.
Excellent. Thank you. I also almost lose my mind at how crazy our health care professionals have made so many people during this entire cluster you now what. I had an argument with a guy whgo said, of the vaccines, "but there's still a 5% chance of catching the disease, which isn't nil." OK, you've reduced the possibility by 95% of maybe (maybe not, not everyone would get this anyway) getting the disease, plus 80% of the people who do get it basically don't even know they do have it, plus of the people who do get it and aren't over 75 or really fat or have a few other known issues something like 99.7% survive. The odds of being struck by lkightening aren't much lower than the odds of dying of COVID after getting two shots of the vaccine. A bit of an exageration, I know.
Not to pile on, but my second argument is important - like the NFL, the Pfizer trial design (and, I assume, the Moderna trial) do NOT simply accept "Confirmed COVID" as equal to "positive test result". In Pfizer trial, a positive test and at least one symptom is required:
• Fever;
• New or increased cough;
• New or increased shortness of breath;
• Chills;
• New or increased muscle pain;
• New loss of taste or smell;
• Sore throat;
• Diarrhea;
• Vomiting.
Their protocol, p. 55/6 of text.
https://pfe-pfizercom-d8-prod.s3.amazonaws.com/2020-11/C4591001_Clinical_Protocol_Nov2020.pdf
A confirmatory hint: a lot of the news coverage says the vaccine are good at preventing people from getting "sick with COVID". Careful and accurate, IMHO.
Thanks for this. Two questions:
1. You focused on people who get vaccinated. What about people who actually got Covid? I just recovered about a week ago, and find it hard to believe that I would spread it, at least for a 3-6 month period. In general, how much talk about what the vaccine does applies to what antibodies from the actual disease does?
2. Does the fact that different strains exist factor into today's post? Does the vaccine prevent you getting different strains and/or carrying them asymptomatically?
If these seem a bit off-topic, I apologize. I'm reevaluating things now that I've recovered. The biggest reason why I was fine with mask mandates was because I didn't want to spread it if I had it, and that's off the table for a little while, so I'm trying to see what's left.
- Brendan (TallBlondeGuy on Twitter)
Glad you are providing a accurate message rather than the hype that the MSM is trumpeting. Fearporn is is their standard. Politics is driving the coverage now.
Respectfully disagree. From what I've read (IANA doctor) this is the issue: the FIRST battlefield of COVID infection is the mucosal membrane of the upper respiratory tract (nose/throat.) A nasal-spray type vaccine would be great for preventing infection there; the intramuscular vaccines provoke a much weaker mucosal membrane response.
However, people aren't dying of a runny nose! COVID gets serious when it circulates in the bloodstream to other organs - lungs, kidneys, etc. The intramuscular shot-in-the-arm vaccines from Moderna and Pfizer do a great job of preventing COVID from expanding beyond the initial beachhead. Serious disease and death avoided!
My takeaway - a mild asymptomatic upper respiratory infection is entirely possible even after the vaccine has provoked antibodies. How long and how transmissible? Probably not long and not very, but who knows?
Your point is that during the trials some of the vaccinated arm should have been getting tested for other reasons and been a stray asymptomatic positive. Definitely maybe!
But in the placebo arm, the chart stops with 2% infected. Presumably they were detected either because they had COVID symptoms or they had 'something else' which prompted a COVID test. We don't know the breakdown of that number but the 2% total is still small. Your argument (as I follow it) is to that *IF* the vaccine fails to prevent initial infection there should be some detectable number of people having (eg) a heart attack overlapped with a transient mild COVID infection in the vaccine arm.
I have not pushed any numbers around but if I were inclined I'd try some assumptions and modeling about what proportion of the placebo group would need to be COVID positive but otherwise asymptomatic to produce a notable result if that proportion carries over into the vaccine arm. Well within your scope! My *suspicion* is that if I modeled it I'd come away thinking asymptomatic infection in the vaccinated could still be a thing. I'd take a stab at modeling it but I'd have more confidence in your result anyway.
I can't find my favorite article on this topic but this article is a start.
https://www.frontiersin.org/articles/10.3389/fimmu.2020.611337/full
Same points in a Q&A. "Research is ongoing":
"It is not clear if the vaccine elicits formation of different kinds of antibodies – like IgE or IgA – in addition to IgG. IgG is the main antibody in circulation and was the one that was measured in the trials, but IgA is the main antibody defense in mucosal surfaces. Theoretically, one could be immune systemically but still have viruses on the mucosal surfaces, like the upper respiratory airway, and could be infectious to others. Research is ongoing on this question."
https://ampiopharma.com/news/qa-with-dr-david-bar-or-on-the-covid-19-vaccines-and-the-variants/
Thank you so much for this newsletter. I have forwarded this post to my dad after my uncle sent him an article by an anti-vaxer on how the Covid vaccines are not legally vaccines and won't do anything to stop transmission or illness. I was much too upset to do anything but flip out and go "this article is garbage and goes against everything I have read for a year by people I trust. Stop reading the garbage he sends you." This helped re-enforce what I was saying.
A thread by doctor summarizing the reasons to believe vaccinated people would not be infectious and opining as you do that returning to normal is a central part of the pitch for vaccines and shouldn't be undermined by theoretical quibbles. https://twitter.com/AaronRichterman/status/1349003751823175685
****And you’ve got me there. This is why the headlines say “Vaccines *may* not stop the virus” instead of “Vaccines do not stop the virus”. They couch this in a language of uncertainty because “proof” has a very specific definition.****
This happened over the summer as well with numerous reports about COVID maybe reinfecting people ~3-4 months after recovery, with antibody defense disappearing. What had actually been found in the studies being quoted was that there was evidence that immunity lasted AT LEAST ~3-4 months, because that's how long we had been able to observe people following recovery. Ultimately it's very irresponsible reporting in search of fear-driven clicks.
Absence of evidence =/= absence of evidence and all that.
A few comments:
1. Calling immunity after two weeks from first shot is irresponsible. The data rolling out of Israel appears to show it's not quite as effective as that for seniors, which makes sense both from the perspective of antibody titers and from the side effects (fever-like side effects suggest immune response). For both vaccines, both of these indicators are stronger for younger patients. Older patients really need that second shot. Maybe you can say for younger patients two weeks is good to go, but complex messaging turns into hash, and probably better to say the line is 7-days after the second dose, which is, after all, the vaccine study endpoint.
2. I think you overstate the Pfizer chart. While it's true that the protocol resulted in lots and lots of people being tested, there are likely missed completely asymptomatic people in both groups, and this means less than the 90%+ efficacy for suppression. The protocol practically required everyone with so much as a sniffle to get tested, but if the vaccine permits some people to culture the virus for a while but at a low asymptomatic level, this would be missed because the protocol wasn't set up to detect it. Or to put it another way: participants were not randomly selected to be swabbed, but only those with symptoms consistent with an infection; the protocol was not designed to look for how much of the iceberg was submerged.
Imagine a test of fire-retardant lumber where the evaluation occurs whenever the fire department was called and the endpoint is whether the insurance company deemed the structure a total loss and observing a dramatic reduction in total loses. And then concluding that fire-retardant lumber prevents *all* fires within dwellings. Well, no it doesn't--at least not to the same efficacy--because we simply didn't record kitchen fires and small fires remedied with a fire extinguisher. Telling people with fire-retardant lumber to throw out their fire extinguishers would be a mistake!
This is why people point instead to the Moderna study for the protective effect. The Moderna protocol tested everyone at the point of the second shot, and this showed a statistically significant difference, strongly suggestion complete suppression of the disease for some portion of the participants at some point after the first dose, but probably not as high as the 94% topline. And this makes sense--it makes sense that some people are not bulletproof immune, but have a sufficiently tuned-up immune response to keep the infection at a very low level.
3. All that said, I tend to agree that the message should be that the vaccines are hugely efficacious, and that once enough people have them, mask rules can fall aside. The real issue is that we already have people walking into Walmart and claiming to be a sovereign citizen or whatever, and a rule that post-vaccine and you're vine is unmanageable (either unenforceable if we go by people's say-so, or something Americans will viscerally reject, if we're talking about vaccine passports). I agree that public health should try to communicate this as adults and not through white lies and just say: we won't need masks once there's enough community immunity, but until then in public places it only works to have one rule for everyone.
4. I'd like to know how a double-blind study with masks can be performed.
5. Fun fact for the article you screenshot, Liz Szabo wrote the most widely-reprinted article in America last January about the virus. It has not aged well. https://khn.org/news/flu-far-deadlier-than-wuhan-virus/
(PS sorry for deleting and reposting. I wish comments could be edited.)
Excellent. Thank you. I also almost lose my mind at how crazy our health care professionals have made so many people during this entire cluster you now what. I had an argument with a guy whgo said, of the vaccines, "but there's still a 5% chance of catching the disease, which isn't nil." OK, you've reduced the possibility by 95% of maybe (maybe not, not everyone would get this anyway) getting the disease, plus 80% of the people who do get it basically don't even know they do have it, plus of the people who do get it and aren't over 75 or really fat or have a few other known issues something like 99.7% survive. The odds of being struck by lkightening aren't much lower than the odds of dying of COVID after getting two shots of the vaccine. A bit of an exageration, I know.