All Things Covid Library

A story on NPR reports that the most popular facebook post on the brief suspension of the Johnson and Johnson vaccine in April was not CNN or NYT or ABC News or Fox News. They were all in the top five, but number one was a conspiracy theorist called An0maly who describes himself as a “news analyst and hip hop artist.”

Experts continue to learn about Pfizer’s efficacy both in the laboratory and in the real world. Pfizer’s initial Phase 3 clinical data presented in December showed its vaccine to have 95% efficacy. In April, the company announced the vaccine had 91.3% efficacy against COVID-19, based on measuring how well it prevented symptomatic COVID-19 infection seven days through up to six months after the second dose. It also found it to be 100% effective in preventing severe disease as defined by the CDC, and 95.3% effective in preventing severe disease as defined by the FDA. Another study, not yet peer-reviewed, provided more new data that brought the efficacy number down to 84% after 6 months, although efficacy against severe disease was 97%.

Greater than 90% efficacy against cases of COVID-19 and more than 95% against severe cases, with approximately 6 months median follow-up after the second dose, according to the company. Earlier Phase 3 studies showed Moderna to be 94.1% effective at preventing symptomatic infection in people with no evidence of previous COVID-19 infection (although the efficacy rate drops to 86.4% for people ages 65 and older). In late March, a small CDC study that enrolled 3,950 health care personnel, first responders, and other essential and frontline workers showed the vaccine to be 90% effective upon full immunization (at least 14 days after the second dose) in real-world conditions.

[J&J vaccine]72% overall efficacy and 86% efficacy against severe disease in the U.S., according to analyses posted by the Food and Drug Administration in February. Experts are still learning about how the vaccine works in real-world conditions.

Among 1,129 patients who received 2 doses of a mRNA vaccine, no decline in vaccine effectiveness against COVID-19 hospitalization was observed over 24 weeks. Vaccine effectiveness was 86% 2–12 weeks after vaccination and 84% at 13–24 weeks. Vaccine effectiveness was sustained among groups at risk for severe COVID-19.

Data from randomized clinical trials and real-world observational studies show that all three COVID-19 vaccines currently authorized for emergency use by the Food and Drug Administration* are safe and highly effective for preventing COVID-19–related serious illness, hospitalization, and death (1,2). Studies of vaccine effectiveness (VE) for preventing new infections and hospitalizations attributable to SARS-CoV-2, the virus that causes COVID-19), particularly as the B.1.617.2 (Delta) variant has become predominant, are limited in the United States (3). In this study, the New York State Department of Health linked statewide immunization, laboratory testing, and hospitalization databases for New York to estimate rates of new laboratory-confirmed COVID-19 cases and hospitalizations by vaccination status among adults, as well as corresponding VE for full vaccination in the population, across all three authorized vaccine products. During May 3–July 25, 2021, the overall age-adjusted VE against new COVID-19 cases for all adults declined from 91.7% to 79.8%. During the same period, the overall age-adjusted VE against hospitalization was relatively stable, ranging from 91.9% to 95.3%. Currently authorized vaccines have high effectiveness against COVID-19 hospitalization, but effectiveness against new cases appears to have declined in recent months, coinciding with the Delta variant’s increase from <2% to >80% in the U.S. region that includes New York and relaxation of masking and physical distancing recommendations.

However, concerns about the potential for waning vaccine-induced immunity and the recent emergence of the highly transmissible SARS-CoV-2 B.1.617.2 (Delta) variant† highlight the need to continue to monitor VE (7). Weekly data reported by the Centers for Medicaid & Medicare (CMS)–certified skilled nursing facilities or nursing homes to CDC’s National Healthcare Safety Network (NHSN)§ were analyzed to evaluate effectiveness of full vaccination (2 doses received ≥14 days earlier) with any of the two currently authorized mRNA COVID-19 vaccines during the period soon after vaccine introduction and before the Delta variant was circulating (pre-Delta [March 1–May 9, 2021]), and when the Delta variant predominated¶ (Delta [June 21–August 1, 2021]). Using 17,407 weekly reports from 3,862 facilities from the pre-Delta period, adjusted effectiveness against infection for any mRNA vaccine was 74.7% (95% confidence interval [CI] = 70.0%–78.8%). Analysis using 33,160 weekly reports from 11,581 facilities during an intermediate period (May 10–June 20) found that the adjusted effectiveness was 67.5% (95% CI = 60.1%–73.5%). Analysis using 85,593 weekly reports from 14,917 facilities during the Delta period found that the adjusted effectiveness was 53.1% (95% CI = 49.1%–56.7%). Effectiveness estimates were similar for Pfizer-BioNTech and Moderna vaccines. These findings indicate that mRNA vaccines provide protection against SARS-CoV-2 infection among nursing home residents; however, VE was lower after the Delta variant became the predominant circulating strain in the United States. This analysis assessed VE against any infection, without being able to distinguish between asymptomatic and symptomatic presentations. Additional evaluations are needed to understand protection against severe disease in nursing home residents over time. Because nursing home residents might remain at some risk for SARS-CoV-2 infection despite vaccination, multiple COVID-19 prevention strategies, including infection control, testing, and vaccination of nursing home staff members, residents, and visitors, are critical. An additional dose of COVID-19 vaccine might be considered for nursing home and long-term care facility residents to optimize a protective immune response.

The Mayo Clinic preprint found that from January to July in Minnesota, both the Moderna and Pfizer vaccines were effective at protecting against COVID-associated hospitalization (91.6% vs 85%, respectively) and ICU admission (93.3% vs 87%, respectively). There were no deaths in either cohort.

Preliminary data from a small study from Israel's health ministry, published in the New England Journal of Medicine on July 28, suggest that the Pfizer-BioNTech vaccine's ability to protect against mild coronavirus infection may have diminished, despite remaining effective against severe illness and death from COVID-19. The study reported 39 breakthrough cases out of 1,497 vaccinated health care workers; most cases were mild or asymptomatic, although 19 percent (seven cases) had persistent symptoms for more than six weeks.

As in the United States, the delta variant is now the dominant strain in Israel where researchers have estimated the vaccine was just 39 percent effective at preventing infection in late June and early July, compared to 95 percent from January to early April. Importantly, however, the vaccine was more than 90 percent effective at preventing severe COVID-19 in both time periods.

Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, provided the immunological evidence supporting the case for a third shot during the briefing.

Antibody levels decline over time, he said, but mRNA booster shots would increase antibody titers by at least 10-fold.

Higher levels of antibodies are associated with better vaccine effectiveness and are likely required to protect against the Delta variant, he noted.

A paper published in Science showed that antibody levels peaked around 43 days after the second dose of Moderna, but fell by 209 days regardless of the variant involved.

Additionally, a preprint published in medRxiv based on phase III data from the Moderna trial looked at "correlates of immunity," finding that a serum neutralizing titer of 1:100 produces a vaccine efficacy rate of 91%. Thus, the higher the neutralizing titer, the higher the efficacy of the vaccine, Fauci explained.

The Science paper, as well as Pfizer data published in the New England Journal of Medicine, showed diminished levels of neutralizing antibody titers with Delta compared with other variants, Fauci noted.

Finally, another medRxiv preprint showed that a third dose of Moderna increased antibody titers at least 10-fold, he said, and Pfizer recently announced similar data.

The Moderna study showed a "remarkable increase in titers" 15 days after the third dose against wild-type virus, the Beta variant, and the Gamma variant, Fauci said, adding that Pfizer data also showed a good boost in levels against the Delta variant, which is expected to be similar for Moderna.

The plea from Mississippi’s top doctor to a state grappling with the nation’s second-lowest vaccination rate seemed simple: Do not take ivermectin — a drug intended for treating worms in livestock — to prevent or treat the coronavirus.

Despite no scientific evidence that ivermectin is effective at preventing or treating covid-19, State Health Officer Thomas Dobbs was left baffled this week after one person was hospitalized for ingesting the horse dewormer medication to treat the virus — a “kind of crazy” act he likened to getting chemotherapy at a feed store.

“Please don’t do that,” he said.

Cases of people consuming ivermectin to treat the coronavirus in Mississippi are drawing alarm, with the state’s health department issuing an alert Friday warning people not to take the drug, saying the state’s poison control center has “received an increasing number of calls from individuals with potential ivermectin exposure taken to treat or prevent covid-19 infection.” Mississippi State Epidemiologist Paul Byers wrote in a letter to the MS Health Alert Network that “at least 70 percent of the recent calls” have been related to the ingestion of ivermectin “purchased at livestock supply centers.”

td, what you and An0maly need to do is drill down into these articles with disparate headlines, instead of fanning flames of incoherent finger pointing. They were talking about different endpoints and different definitions. What they all show is that the mRNA vaccine was effective in each case in preventing serious illness, hospitalization and death.