COVID-19 treatment and vaccine update thread

[Smoove_B]

Missed this from a few days ago, an update on the upcoming Fall 2023 vaccination:

Earlier this year, U.S. regulators settled on a new strategy for COVID-19 vaccines. Like the annual flu shot, the vaccines will be updated each year based on the virus’ evolution, then rolled out in the fall. Accordingly, on 15 June, advisers to the U.S. Food and Drug Administration will weigh which strain or strains of SARS-CoV-2 should make up the next iteration of vaccine, so that the agency can greenlight a version for companies to mass-produce.

Regulators may well jettison the original SARS-CoV-2 strain that emerged in China and is long extinct—but which people are still being vaccinated against today. Many scientists favor eliminating it. The ancestral strain “should go out of the formulation,” says William Messer, an infectious disease specialist and viral immunologist at Oregon Health & Science University. Last week, the World Health Organization (WHO) agreed. But other questions loom, including whether to bundle multiple virus strains into the vaccine or just one.

...

Whether a single-strain XBB.1 vaccine is the best bet or whether multiple Omicron strains should be included is a point of debate. In the past few months, two closely related XBB substrains, XBB.1.5 and XBB.1.16, have crowded out other Omicron variants. “We’re basically trying to guess what the next generation of variants will be, descending from which lineage,” Ho says.

“From what we know now, matching the vaccine to whatever circulating variants you’re trying to protect against probably does best,” says Angela Branche, an infectious disease specialist at the University of Rochester. She co-leads a study called
COVAIL that’s examining immune responses spurred by different boosters. It has found that monovalent vaccines against Omicron perform somewhat better than those that include the ancestral strain.

All that said, I heard some rumblings that the Fall 2023 vaccine might only be available to "high risk" folks; I am hoping that's not the case and it's offered to everyone (like the annual influenza shot).

[Smoove_B]

Also from today, not great:

A new study from the Centers for Disease Control and Prevention suggests that most adults who haven’t received an updated COVID-19 booster shot have “relatively little remaining protection” against hospitalization compared to the unvaccinated.

The study found that the majority of Americans haven’t received the updated booster shot and that their last shot was likely over a year ago.

“Results of this analysis indicate that these adults might have relatively little remaining protection against COVID-19–associated hospitalization compared with unvaccinated persons, although might have more remaining protection against critical illness,” they wrote in the study, which was published Thursday.

...

Protection from the updated shots followed a similar waning trend to the shots that came before it, according to the new study.

The research found that the bivalent shot’s effectiveness against hospitalization among adults was 62% up to three months after it was administered. But six months after the shot, the protection against hospitalization falls to 24% compared to unvaccinated adults.

The study found that the updated shots do offer sustained protection against “critical illness,” which it defined as intensive care unit admission, death or both. Vaccine effectiveness against critical illness was 69% up to three months after vaccination and 50% up to six months.

[Isgrimnur]

So we have a tetanus booster that lasts 10 years, but a COVID vaccine that lasts slightly longer than the biological effects of my trip to the pizza buffet. Nice.

[Smoove_B]

Don't have too much to share here lately, but this seems newsworthy:

The Food and Drug Administration has withdrawn authorization for Johnson & Johnson's COVID-19 vaccine, ending its short-lived but troubled existence amid the pandemic.

In a letter last week, the FDA's top vaccine regulator, Peter Marks, wrote to Janssen Biotech—the Johnson & Johnson-owned, Belgium-based company responsible for the vaccine—saying that the agency was revoking authorization. Marks opened the letter by noting that the withdrawal was at the request of the company.

...

The complete withdrawal this month comes as the FDA prepares to discuss new formulations of COVID-19 vaccines for this fall. The FDA has long held to the idea of updating COVID shots much like annual flu shots—reassessing vaccine formulas in the late spring/early summer in order to prompt manufacturers to have updated formulas ready for rollout in the fall. The agency's vaccine advisory committee will meet on June 15 to discuss the best formula for this fall.

...

The FDA advisors meeting on June 15 will discuss reformulations that will apply to mRNA vaccines made by Pfizer-BioNTech and Moderna. Novavax, which makes a protein-based vaccine available in the US, is also working on an updated COVID-19 shot against XBB strains.

[Daehawk]

Still need to go get my shot. Guess Ill try to run by and get stabbed next Monday.

[Lassr]

I plan on getting the booster sometimes this summer. I got COVID about 3 months ago so I had some anti-body protection that is probably about gone now.

[Smoove_B]

As a reminder:

Food and Drug Administration advisers will meet Thursday to discuss how the next round of Covid boosters should be updated to target strains that may be circulating this fall.

Time is of the essence: The FDA needs to soon pick the strain, or strains, that it thinks will be prevalent later this year, so drugmakers have enough time to manufacture the new shots.

...

This will be only the second time the Covid vaccines have been updated. Last year, the FDA authorized new shots that targeted both the original coronavirus strain as well as the BA.4 and BA.5 omicron subvariants, two strains that are no longer in circulation in the U.S. The first iteration of the vaccines, authorized in December 2020, only targeted the original coronavirus.

...

In the documents, FDA scientists said real-world studies show that although the current updated boosters in use in the U.S. do provide protection against XBB.1.5, the antibodies generated appear to be lower than what’s seen against BA.4 and BA.5.

“These data suggest that an updated strain composition of Covid-19 vaccines to more closely match currently circulating Omicron sublineages is warranted for the 2023–2024 vaccination campaign,” the scientists wrote.

And of course, "Who?"

It’s unclear if the new vaccines will be recommended for everyone this fall. A CDC advisory committee, called Advisory Committee on Immunization Practices, is scheduled to meet next week to talk about updated Covid boosters, among other vaccines.

Dr. Ofer Levy, the director of the Precision Vaccines Program at Boston Children’s Hospital, said that it would make sense for everyone in the U.S. to get a Covid booster every year.

[Zaxxon]

I would like to register my desire to receive an updated booster this fall. Make it happen, Smoove!

[Smoove_B]

I genuinely don't know what to expect anymore - wouldn't surprise me either way to have them approved for everyone or for them to restrict use. The fact that hardly anyone wants to take them might be working against the process - demand for universal access just isn't there. But it would also add to the chaos to have people that have been vaccinated 5+ times vs those that refuse to vaccinate on the other end of the spectrum, so there's that too.

Regardless, everyone knows COVID-19 isn't a big deal anymore. All the cool kids are now worried about pandemic bird flu again, so...

[MHS]

I'm taking part in an AstraZeneca double-blind study for a new monoclonal antibody vaccine for immunocompromised people. I figure it might be the only way I can get additional vaccinations assured over the next 15 months. I'll let you all know if I get any superpowers.

[Zaxxon]

[Smoove_B]

Of note:

The FDA’s Vaccines and Related Biological Products Advisory Committee voted unanimously in support of tweaking the shots to target an XBB strain, as well as dropping the original coronavirus strain from the formulation.

The committee did not, however, make a formal recommendation on which specific XBB lineage the updated boosters should target, nor did it make a recommendation on who should get the shots and when. The latter will likely be left up to the Centers for Disease Control and Prevention, which has its own advisory committee meeting next week.

And:

Uptake of the booster shots has been low to date. Only 17% of the U.S. population has gotten an updated booster, according to the CDC.

[dbt1949]

I was talking to my doctor today and it seems he caught the bad kind of covid last month. He had 4 shots and still caught it.

[Smoove_B]

I was talking to my doctor today and it seems he caught the bad kind of covid last month. He had 4 shots and still caught it.

I'm not sure there's a "good" kind of COVID-19 to catch. Every time it infects you, it's rolling the dice. Sometimes it's mild. Other times...not so mild.

Looking for an article, but this commentary from the FDA does not leave me feeling great:

FDA Marks: no one will disagree we need a better generation of vaccines but we are here right now with whate we have. next gen are at least two years away at the rate we are going.

This is really speaking to the short protection window surrounding vaccination (~3 months). If the virus was seasonal (like influenza) that might not be a big deal, but it's in constant circulation so you're basically picking the 3 months you''d like for the most protection. Not great.

[dbt1949]

I should have worded it a "bad case" and left it at that.

I think I had the "good" kind. It was a very mild case 2-3 years ago.

[Smoove_B]

I think you're likely a super-mutant and COVID-19 caught you.

Stay safe my friend!

[Blackhawk]

I was talking to my doctor today and it seems he caught the bad kind of covid last month. He had 4 shots and still caught it.

The four shots are likely why it isn't his third time through the ringer, and they likely contributed significantly to the fact that he's back at work after a month instead of dealing with potentially permanent side effects.

[Smoove_B]

I'm sure we're going to start seeing similar ads here in the United States any day now.

Every time you catch COVID-19, your risk of other severe issues starts to rise.

Research is starting to show that with reinfection, your chance of serious issues such as diabetes, mental health issues, and chronic fatigue goes up.

Yup...any day now....

[LordMortis]

Co-morbidity is why anytime I'm in a place for anything other move around until you can get out, I am still masking. I realize it's more for them than it is for me but that's all I can do. It's mainly for healthcare sessions and in these healthcare environments, they always inform me that masks are no longer mandatory, as if to single me out. Now that I'm back on remicaid, I think it's time to ask my PCP if I can/should boost my bivalent. Only he's of the conceding we've all lost mind, or so it seemed when last I saw him. The more I've reflected, the more disappointed I am in his opinion. Still, looking around I know how small of a minority I am in.

[Smoove_B]

Co-morbidity is why anytime I'm in a place for anything other move around until you can get out, I am still masking. I realize it's more for them than it is for me but that's all I can do. It's mainly for healthcare sessions and in these healthcare environments, they always inform me that masks are no longer mandatory, as if to single me out. Now that I'm back on remicaid, I think it's time to ask my PCP if I can/should boost my bivalent. Only he's of the conceding we've all lost mind, or so it seemed when last I saw him. The more I've reflected, the more disappointed I am in his opinion. Still, looking around I know how small of a minority I am in.

Probably not a popular opinion, but I think many physicians are in a mental space where they either accept masking all the time as part of protecting themselves and vulnerable patients (and not just from COVID-19) -or- they've convinced themselves COVID-19 isn't really a big deal anymore and they're not at risk for complications associated with re-infection and/or passing it on to patients.

More and more it's reminding me of what Semmelweis went through after suggesting that doctor's dirty hands were making people sick and how long it took the medical establishment to finally accept it.

I am hoping I'm still alive when people look back at the 1990s and time through now (?) and are horrified that we didn't do anything to help treat and protect the indoor air we breathe - in the same way we finally realized drinking water filled with human and animal waste was a bad idea.

[Zaxxon]

I am hoping I'm still alive when people look back at the 1990s and time through now (?) and are horrified that we didn't do anything to help treat and protect the indoor air we breathe - in the same way we finally realized drinking water filled with human and animal waste was a bad idea.

I can say that the HEPA filters we bought last year have been a great purchase. Aside from helping us avoid spread when someone is sick, it's amazing how they kick up when cooking, when the outdoor AQI is high, when contractors are working in the house, etc. Drives home how often we were/are exposed to breathing shitty air even at home.

[Isgrimnur]

https://cowaymega.com/pages/airmega

We have an AP-1512HHS and a 250S. One in each of our main open areas. When the kids have been sick, we also crack a couple windows on each level and keep our distance from the kids, but have only masked up when our daughter actually had COVID.

[LawBeefaroni]

I am hoping I'm still alive when people look back at the 1990s and time through now (?) and are horrified that we didn't do anything to help treat and protect the indoor air we breathe - in the same way we finally realized drinking water filled with human and animal waste was a bad idea.

I can say that the HEPA filters we bought last year have been a great purchase. Aside from helping us avoid spread when someone is sick, it's amazing how they kick up when cooking, when the outdoor AQI is high, when contractors are working in the house, etc. Drives home how often we were/are exposed to breathing shitty air even at home.

We have one that goes to high when someone farts. I'll actually go into the room to let one off just to see it kick on.

[Zaxxon]

We have one that goes to high when someone farts. I'll actually go into the room to let one off just to see it kick on.

[Max Peck]

I have two HEPA air purifiers, a Coway AP-1512HH in the bedroom and a Honeywell HPA300C in the living room. The air quality sensor in the Coway is sensitive enough that it freaks out when I pan sear a steak in the kitchen.

This shows what one year of in-door city air does to a HEPA filter, and that's just the crud that makes it through the prefilter. There is a new filter on the left, and the used one on the right.


I have no idea whether they've been put to the test in terms of controlling viruses. I run them on high for a few hours anytime someone has had to come into the apartment for some reason, such as plumbing repairs, but I have no way of knowing whether or not any of those people were infected with anything.

[Max Peck]

Speaking of physicians who have opinions about COVID, I bring you this gem from the files of Beth Mole:

Doctor who sold bogus COVID vaccination waiver to dog loses medical license

A doctor in Tennessee has lost his medical license after a local news investigation revealed he was selling bogus COVID-19 vaccination waivers to essentially anyone—including patients he had never met, patients in far-flung states, and one black Labrador retriever named Charlie.

In a consent order signed May 16, the Tennessee Board of Medical Examiners determined Robert Coble had violated state statutes on the grounds of "unprofessional, dishonorable, or unethical conduct," and "making false statements or representations, being guilty of fraud or deceit … in the practice of medicine."

Coble voluntarily surrendered his medical license, effective that day, which is equivalent to a revocation. Coble also agreed to refrain from reapplying for a medical license for at least a year and to pay a $1,000 fine and the costs of the board's investigation of his case, up to $2,000.

Once he gets his license back, I'm sure there will be plenty of right-minded patients clambering for his medical services.

[Isgrimnur]

Charlie should need a booster by then.

[Hipolito]

I've got to thank Smoove for keeping us in the know about covid, as without him I'd have been among the the masses who thew caution to the wind long ago and assumed the pandemic was over. I'm still usually the only one around wearing a mask, and I have never had covid (at least not to my knowledge; there's always the possibility that I've had it asymptomatically).

That being said (you knew this was coming), I've been wondering whether I should still be masking. Is it OK to ditch the N95 join the maskless masses now?

I'm under 65 and not severely immunocompromised, but I did get a booster a couple of months ago. Everyone in my household has had covid and recovered from it.

[WYBaugh]

Got the latest COVID booster and Shingrix together on Saturday morning. Was hating myself Saturday night.

[Kraken]

That Shingrix is brutal stuff. Not as brutal as shingles, though.

I gotta remember to get my second pneumonia shot in January.

[Smoove_B]

That being said (you knew this was coming), I've been wondering whether I should still be masking. Is it OK to ditch the N95 join the maskless masses now?

I'm sure you're going to find now that opinions still vary, and I think it comes back to being OK for whom? Are there people that still benefit when those around them are masked? Yes. Will you as someone that doesn't benefit nearly as much want to mask for them in places where they don't have a choice but to be (mass transit, a bank, a supermarket, a doctor's office, a classroom)?

For most vaccinated folks the danger of death is likely the lowest its ever been. Where the equation gets fuzzy is your risk tolerance towards "Long Covid" or PASC (post-acute sequelae of SARS CoV-2 infection). The data is telling us that after infection (regardless of vaccination status) you have about a 1 in 10 chance of PASC. Could last 3 weeks. Could last 3 months - or longer. No one knows. The actual risk is also up for debate - PASC risk might be even higher; we're still learning. There's some data suggesting that repeated infections potentially increase that risk (slightly); we're still learning. In science literature and health communication 1 in 10 is not considered "low" risk by any stretch, so do with that what you will. To be clear, PASC symptoms can range wildly, so someone that just feels "run down" for a month is in the same category (currently) as someone that has cognitive impairment or organ damage.

We're (collectively) in a strange spot because there is no "you do you" solution for a communicable disease - but that's how we're acting; public health has been suppressed and I still don't have any way to process it. The idea that we've been sold this message that somehow public health is actually the collective measure of our individual choices is...something. I couldn't (and wouldn't) fault anyone for completely giving up at this point.

Sorry if all this isn't helpful - I fully acknowledge I'm an outlier, though not amongst my peers.

tl;dr Smoove is still not eating in restaurants or hanging out indoors unmasked with strangers or around groups of people. I'm still more or less a hermit. My job contract was modified and I'll only be doing remote work through December so I don't need to deal with masking while working for another 6 months. I'm not worried about dying; I am concerned about PASC.

[Max Peck]

I'm not worried about dying; I am concerned about PASC.

<insert meme="There are dozens of us!">

I'm old-adjacent, so I'm probably a little more worried about dying in the messy way that severe COVID tends to kill people, but it also makes me more concerned about Long COVID PASC. The prospect of potentially being chronically ill for a decent chunk of the time I have left before old age itself makes me chronically ill seems like a poor trade-off for indulging in things like dining in a crowded restaurant.

[AWS260]

After 3+ years of dodging the bug, COVID finally caught up with me. Mask up, people!

Getting paxlovid was a relative breeze, other than the longish wait at the CVS clinic for a script.

Now to figure out the right balance between working from home and "Sorry guys, COVID, I'll be in bed until next week."

[em2nought]

Most folks here probably wouldn't believe it, but I'm still masking in public. I think the most benefit from the mask is it keeps me from touching my mouth or nose with my, acquired in public, germ riddled hands. So which brand of booster isn't going to drop me dead in my tracks if I'm exerting myself? Excess mortality seems to be a thing right?

My hand cleaning has slipped a bit, but I still have a high MERV filter in my AC

I'm surprised I never got the bug because I used to have to shop in several stores each week for my mother no matter what. That doesn't apply anymore though as being alone in the hospital got her during covid, but not covid itself.

I am concerned about dying, because I'd like to at least enjoy myself a little before I go.

[Hipolito]

Thank you, Smoove, and hope you recover soon, AWS260.

I am worried about PASC. 1 in 10 odds is definitely not low enough. I know a couple of people who have it. They have to plan their entire days around how much energy they have.

[Isgrimnur]

I spent two days of my four-day weekend sleeping extra to deal with fatigue. And a third wasn't much better without the nap.

[Smoove_B]

A clue (perhaps) coming from research in Spain regarding possible connection to (some) of the symptoms of Long COVID (PASC):

Emerging studies now suggest that many of these symptoms may be a consequence of damage to the vagus nerve. As the body’s primary communication superhighway, the vagus nerve extends into every major organ in the body, including the heart, lungs, and gastrointestinal tract. Injury to this nerve, therefore, can disrupt the systems we rely on to breath, digest, and simply function on a daily basis.

...

Compared to individuals that recovered with no lasting symptoms from COVID-19 or were never exposed to the virus, forty percent of those with Long COVID also had observable flattening of the diaphragm, a muscle at the base of the lungs that contracts to control breathing. This was often associated with a measurable reduction in lung pressure, which could explain symptoms like shortness of breath and light-headedness.

...

Given how many organs depend on the vagus nerve for direction, Llados et. al found that damage to this nerve impacted other vital systems as well. Individuals with Long COVID exhibited greater heart rate variability, changes in speech, difficulty swallowing, and reduced mobility in the gastrointestinal tract.

The study is in pre-print, but it is certainly something to watch.

[Blackhawk]

Nerve damage, ouch.

[Kraken]

Yeah, that would be a big deal. I thought the medical establishment had concluded that Covid is a circulatory disease. If it's traveling via the vagus nerve, that's worse.

[Smoove_B]

Yeah, that would be a big deal. I thought the medical establishment had concluded that Covid is a circulatory disease.

It was certainly an early theory and for many people (particularly those that require emergency treatments), there does seem to be a connection to the circulatory system, yes. But if that was the only thing happening to people exposed to the virus, we wouldn't be able to explain all the other things happening to people. For example, if the virus was affecting blood clotting or artery elasticity, that doesn't really help to explain cognitive issues (aka "brain fog") or persistent joint pains.

If it's traveling via the vagus nerve, that's worse.

I'm not sure that it's traveling via nerves (like the rabies virus does) but instead it's somehow damaging the vagus nerve. And depending on where (or to what extent) you get specific symptoms. But maybe we'll find it it is traveling via nerves.

Again, normally I love this stuff. But now? Not so much.