Autumn 22 Covid Booster

[redsturgeon]

If celibacy gives immunity and vaccination gives immunity does vaccination make you celibate?

Best wishes,

Steve

Or perhaps celibacy can be due to vacillation.

John

[servodude]

If celibacy gives immunity and vaccination gives immunity does vaccination make you celibate?

Best wishes,

Steve

Or perhaps celibacy can be due to vacillation.

John

Indecision on "in" decision?

[XFool]

I have a question.

I am curious why some are now deciding against the booster vaccinations. For those who are reluctant to have the latest COVID booster or speak of the need to weigh up "the balance of risks".

What actually is the issue here? Plus, how in practice do you "weigh the balance of risks"? By reading extensive literature and using spreadsheets? Or intuitively? What are these risks, how high do you think they are, and how do they compare, quantitively, with the risks of COVID itself?

One thought has occurred to me. For some, who are badly affected by vaccinations, the balance of risks might include the cost of these side effects whereas, for someone like myself who never seems to be affected, there is no immediately apparent cost to vaccination. Could this be a significant contributor to these 'cost'/benefit decisions?

[pje16]

I have a question.

I am curious why some are now deciding against the booster vaccinations. For those who are reluctant to have the latest COVID booster or speak of the need to weigh up "the balance of risks".

Me too
I had Covid back in April and had had all the vaccinations I had been offered, My symptoms were very mild and lasted 4 days
Of course there is no way of knowing whether that was the jabs at work, though I do know my blood tests showed positive antibodies as a result of having them.
I had my 4th jab last month and had no qualms about having it
For me there is no risk (as I see it) in having it

[staffordian]

I have a question.

I am curious why some are now deciding against the booster vaccinations. For those who are reluctant to have the latest COVID booster or speak of the need to weigh up "the balance of risks".

Me too
I had Covid back in April and had had all the vaccinations I had been offered, My symptoms were very mild and lasted 4 days
Of course there is no way of knowing whether that was the jabs at work, though I do know my blood tests showed positive antibodies as a result of having them.
I had my 4th jab last month and had no qualms about having it
For me there is no risk (as I see it) in having it

I had no hesitation about having the booster. I had Covid (and felt quite rough for a few days) early in October so had to postpone until recently. My wife had her Covid booster before me and though we tried to keep apart when I came down with it, she contracted it but only knew through deciding to take a test. She was positive around the time I finally tested negative but had been asymptomatic. I suggest this is quite likely due to her having been jabbed a few weeks earlier.

And neither she nor I have had any significant reaction to the jabs, so in our eyes, they are definitely worth having.

[redsturgeon]

I have a question.

I am curious why some are now deciding against the booster vaccinations. For those who are reluctant to have the latest COVID booster or speak of the need to weigh up "the balance of risks".

What actually is the issue here? Plus, how in practice do you "weigh the balance of risks"? By reading extensive literature and using spreadsheets? Or intuitively? What are these risks, how high do you think they are, and how do they compare, quantitively, with the risks of COVID itself?

One thought has occurred to me. For some, who are badly affected by vaccinations, the balance of risks might include the cost of these side effects whereas, for someone like myself who never seems to be affected, there is no immediately apparent cost to vaccination. Could this be a significant contributor to these 'cost'/benefit decisions?

I think I have been through it in my case and have stressed it is an individual decision.

It is impossible to be sure one way or another but the situation as I see it now is different to the early days.

- We now have the Omicron variant that is less virulent than earlier variants.

- Almost everyone has some level of immunity either natural, vaccine induced or both.

- treatments are more effective

The risks of serious harm/death from the vaccine are not zero but small.
The risks of serious harm/death from covid are not zero but also small.
The risks vary considerably between individuals.
The effects on transmission of taking the vaccines have not been quantified.

I have not caught covid in nearly three years of the pandemic, as measured by blood testing my existing immunity levels are high, I am in good health and not overweight nor have any other factors that might contribute to a bad outcome with covid.

My own risk/benefit analysis (by gut) is not to have the vaccine.

John

[scotia]

I think I have been through it in my case and have stressed it is an individual decision.

And I understand your reasons. At my age (78) the risk of death or serious illness from Covid is considerably larger than that for a young person, and I have had no ill effects from my multiple vaccinations. So I saw it as a no-brainer - get the booster, and my wife (age 76) made the same decision.
But if I were in a much younger age group, would I have made the same decision? Possibly. I have a close relative who is Immunocompromised, and I still test before visiting. To be doubly assuring that I was not passing on a Covid infection, I think I would probably also wish to have a full vaccination record.
On the lighter side, we have another immunocompromised friend in her upper 70s, who took all the vaccinations, and also took great care to avoid possibly infectious activities. Then a few weeks ago she took an extended bus journey to the nearest city, and the result was Covid. But the effect was no worse than a very mild cold, so she is now fully vaccinated and boosted by the infection. And she told us that she is now looking forward to a more active social life.

[Hallucigenia]

It is impossible to be sure one way or another but the situation as I see it now is different to the early days.

- We now have the Omicron variant that is less virulent than earlier variants.

- Almost everyone has some level of immunity either natural, vaccine induced or both.

- treatments are more effective

Omicron is causes somewhat less acute disease - but not by much. You'll often hear it compared to delta, which it's about half has virulent as - but delta was a "nasty" one, somewhat more virulent than the original strain.

Omicron is still very capable of causing nasty disease, and in particular it still seems to be pretty good at causing long Covid. And since the omicron family tends to be quite immune-escapy, you may find the "less virulent" omicron causing more disease than the "more virulent" delta, just because of the immune escape thing. For instance, in the latest variant briefing :

Oxford University report neutralisation studies on serum collected 28 days following a third dose of Pfizer BNT162b2 vaccine, and in vaccinated cases infected with BA.1, BA.2 and BA.4/5. Data show significant reductions in neutralisation titres against BA.2.75.2, BA.2.3.20 and BJ.1, compared to BA.2 and BA.4/5, which may suggest they have been selected to escape pre-existing immunity to earlier waves of Omicron infection.

I wouldn't get too complacent about treatments continuing to work either, especially the antibody-based ones, for instance :
https://www.biorxiv.org/content/10.1101 ... 787v4.full
COV2-2196+COV2-2130 (Evusheld) 26,29 is vulnerable to F486, R346, and K444-G446 mutations, evaded or highly impaired by BJ.1 (R346T), XBB (R346T+V445P+F486S), BA.2.75.2/CA.1/BM.1.1/BM.1.1.1/CH.1.1 (R346T+F486S), CJ.1 (R346T+F486P), BR.2 (R346T+F486I), BA.4.6.1 (R346T+F486V), BA.5.6.2/BQ.1 (K444T+F486V), BU.1 (K444M+F486V), and BQ.1.1 (R346T+K444T+F486V).

LY-CoV1404 (Bebtelovimab) remains potent against BF.16 (K444R) and BA.5.5.1 (N450D) and shows reduced potency against BA.5.1.12 (V445A) 27 (Extended Data Fig. 1a). However, LY-CoV1404 was escaped by BJ.1, XBB, BR.1, CH.1.1, BA.4.6.3 and BQ.1.1 while exhibiting strongly reduced activity against BA.2.38.1, BA.5.6.2, and BQ.1 due to K444N/T mutations and the combination of K444M/G446S or V445P/G446S

BA.1/2/4/5 are the current UK official variants of concern, the designated variants (generally the up and coming ones) are the B.1.617.2 lineage from the delta family and from the omicron family XE, BA.2.12.1, BA.2.75, BA.4.6, BQ.1 and XBB. A month ago it was 87% BA.5 with BA.2.75 and BA.4.6 bubbling under, but lab studies suggest that the BQ.1 group has a significant growth advantage and it looks like it will be the next "big one" by Christmas.

And immunity to this thing falls away pretty quickly :
https://www.nature.com/articles/s41564-022-01163-3
Between 3 and 20 weeks after the second vaccine dose [of Pfizer] , neutralizing antibody titres [to the original Wuhan strain] fell 4.9-fold to a median titre of 21.3 (neutralization dose 80%), with 21.6% of individuals having no detectable neutralizing antibodies at the later time point.

They then looked at responses to different spike proteins, and found "substantial antigenic escape" especially for omicron and delta among others.
Nineteen sera from the same individuals boosted with a third dose of BNT162b2 contained higher neutralizing antibody titres, providing cross-protection against Omicron BA.1 and BA.2. Despite SARS-CoV-2 immunity waning over time in older adults, booster vaccines can elicit broad neutralizing antibodies against a large number of SARS-CoV-2 variants in this clinically vulnerable cohort.

Boosters work, and just because you've had two jabs doesn't mean you have much residual immunity left, particularly to immune-escaping variants like omicron.

And we seem to be losing some treatments altogether, for instance MSD's molnupiravir (Lagevrio) was approved by the UK a year ago based on an interim analysis of 762 patients and we bought a billion quid's worth of it. The European Medicines Agency still hasn't approved it. and a bigger trial suggests that it's no better than placebo :
https://www.bmj.com/content/379/bmj.o2441
The Panoramic study, sponsored by the University of Oxford, found that 0.8% of patients in the molnupiravir group (103 of 12 516) and 0.8% in the usual care group (96 of 12 484) were admitted to hospital or died in the first 28 days (adjusted odds ratio 1.061 (95% bayesian credible interval 0.80 to 1.40)).
Preprint : https://papers.ssrn.com/sol3/papers.cfm ... id=4237902

Also the latest from NICE :
https://www.nice.org.uk/guidance/gid-ta ... uments/129
https://www.bmj.com/content/379/bmj.o2759

NICE has recommended three drugs—nirmatrelvir plus ritonavir (Paxlovid), tocilizumab (RoActemra), and baricitinib (Olumiant)—for the treatment of covid-19 in adults, as part of draft guidance.1
NICE has not recommended other covid-19 treatments, including casirivimab plus imdevimab (Ronapreve), molnupiravir (Lagevrio), remdesivir (Veklury), sotrovimab (Xevudy), and tixagevimab plus cilgavimab (Evusheld).
NICE said that while there was evidence suggesting molnupiravir and remdesivir were effective, the current pricing means they are not likely to be a cost effective use of NHS resources.
In the case of casirivimab plus imdevimab, sotrovimab, and tixagevimab plus cilgavimab, the committee said it was highly uncertain whether these treatments were effective against the omicron variant and that they were not a cost effective use of resources.

And just to hammer home the point that "less virulent than delta" does not mean "avirulent", an epidemiologist in charge of infection control at a major hospital felt driven to say this:

Some perspective for those who still don't get it:
If I were forced to be infected by either HIV or COVID, I would choose HIV without hesitation.

He goes on to explain himself thus :
COVID can cause many chronic diseases, data suggests that telomere damage ages the body by about 5 years, and it causes damage to the immune system.
HIV mostly just damages the immune system and is easily treated.
Finally, we don't know what else COVID might cause over time.

Now it's fair to say that this is an extreme view, but I can see the point he's trying to make as someone whose daily life involves managing the risks from infectious disease. HIV is really bad, but at least we know its limits, but we still don't know what we don't know about Covid, and we don't have any treatments for long Covid. That's two things to scare the bejeesus out of someone in risk management.

I must admit as someone with mild long Covid, it's really not been much fun lately - I dread to think what it would be like to get it "properly".

[servodude]

And just to hammer home the point that "less virulent than delta" does not mean "avirulent", an epidemiologist in charge of infection control at a major hospital felt driven to say this:

Some perspective for those who still don't get it:
If I were forced to be infected by either HIV or COVID, I would choose HIV without hesitation.

He goes on to explain himself thus :
COVID can cause many chronic diseases, data suggests that telomere damage ages the body by about 5 years, and it causes damage to the immune system.
HIV mostly just damages the immune system and is easily treated.
Finally, we don't know what else COVID might cause over time.

While i understand the point being made
THAT does seem like a very sensationalist and unusual view
which might be tending towards the "this will put me off listening to this guy" part of the spectrum
not least because communicability of covid ceases pretty quickly

-sd

[Hallucigenia]

not least because communicability of covid ceases pretty quickly

But you don't care if you give someone a disease, he's looking at it from a personal POV as a risk management guy, seeing the possibility of severe delibilating disease that hits across the body, that we don't have good treatment for.

10 million cases with a 1% chance of severe consequences, or 100k cases where it's 50/50 - what's worse?

[servodude]

not least because communicability of covid ceases pretty quickly

But you don't care if you give someone a disease, he's looking at it from a personal POV as a risk management guy, seeing the possibility of severe delibilating disease that hits across the body, that we don't have good treatment for.

10 million cases with a 1% chance of severe consequences, or 100k cases where it's 50/50 - what's worse?

Which is part of what makes it sensationalist and unusual
We've seen all sorts here with their "what's it to me" COVID tropes pretending that the default behaviour of humans is self centered and solipsistic
- and it's bogus as ....
- there are some Shylocks about but they are a piddling if noisy minority

[Julian]

And just to hammer home the point that "less virulent than delta" does not mean "avirulent", an epidemiologist in charge of infection control at a major hospital felt driven to say this:

Some perspective for those who still don't get it:
If I were forced to be infected by either HIV or COVID, I would choose HIV without hesitation.

He goes on to explain himself thus :
COVID can cause many chronic diseases, data suggests that telomere damage ages the body by about 5 years, and it causes damage to the immune system.
HIV mostly just damages the immune system and is easily treated.
Finally, we don't know what else COVID might cause over time.

While i understand the point being made
THAT does seem like a very sensationalist and unusual view
which might be tending towards the "this will put me off listening to this guy" part of the spectrum
not least because communicability of covid ceases pretty quickly

-sd

I have no idea about the “quickly” part but as I understand it, seemingly confirmed by the UNAIDS and presumably other web sites, communicability of HIV does also cease if someone is successfully controlling their condition….

When a person living with HIV is taking effective antiretroviral therapy and has a suppressed viral load they are no longer infectious.

[ Source: https://www.unaids.org/en/frequently-as ... v-and-aids ]

- Julian