COVID-19 treatment and vaccine update thread

[Smoove_B]

So we gave up on NPIs because we were vaccinating our way out of it. Now we're giving up on vaccinating our way out of it? We're magical-thinking our way out of it now?

I think the mistake (the one I made too) was that we were trying to get "out" somehow. Instead, The Great Barrington folks got their wish. Just let it wash over everyone repeatedly, mostly uncontrolled and let's see what happens.

[Kraken]

We've reached a stalemate with SARS-CoV-2. Our vaccines can't prevent infection. They reduce disease severity, but additional doses don't produce additional benefit in most people. Since we've abandoned all mitigation measures (which, let's face it, weren't terribly effective short of actual lockdowns), the virus is free to keep simmering until it mutates into a new variant or we develop a new generation of vaccines (which we're not pushing very hard to do). Stalemate.

I still have a pandemic cart in my kitchen that's chock-full of covid tests, masks, hand sanitizer, and liquid hand soap. I won't dismantle it anytime soon, but it feels less and less relevant.

[Zaxxon]

Ars has a write-up on the WHO advisors thing now, and the [upvoted] comments are solid as usual...

Get a booster, dont get a booster, maybe get a booster! The government will pay for it! The government won't pay for it, the government might pay for it!

It's no wonder most non-immunocompromised people who have been pressed back to working at the office have simply shrugged their shoulders and accepted that "it's over"

Risk assessments are great, but what it seems to have come down to is that the WHO says the benefits are marginal, while the FDA says while the benefits to an individual are marginal the reduced burden on healthcare system during infection waves is substantial enough to justify continuing the recommendation. The FDA's guidance also has the benefit of being much simpler and more legible from an end-user standpoint. Just saying "all adults should get boosters" is pretty clear-cut guidance. During the early days of the vaccine there was a lot of chaos around eligibility, prioritization, recommendation, etc. that led a lot of people who were eligible to avoid seeking vaccination and boosters.

[LawBeefaroni]

I still have a pandemic cart in my kitchen that's chock-full of covid tests, masks, hand sanitizer, and liquid hand soap. I won't dismantle it anytime soon, but it feels less and less relevant.

We got rid of ours months ago. It's been replaced with another apocalypse go-bag.

[Sudy]

Ars has a write-up on the WHO advisors thing now, and the [upvoted] comments are solid as usual...

Some of the downvoted ones are also worth reading if you need to bring down your mood.

I didn’t get a flu shot until I retired from teaching public school because there is no way I could ever avoid whatever was the virus of the month. Fortunately, I got over everything, and hardly missed any teaching time. I took off more days for my family and personal sanity than for viruses during my career.

[Zaxxon]

I didn’t get a flu shot until I retired from teaching public school because there is no way I could ever avoid whatever was the virus of the month. Fortunately, I got over everything, and hardly missed any teaching time. I took off more days for my family and personal sanity than for viruses during my career.

Saw that one and had the same thought.

[Smoove_B]

Inching forward:

The US government will soon authorize another round of COVID-19 vaccine booster doses to certain high-risk populations, namely people 65 and older and those with compromised immune systems, according to a Washington Post report that cited anonymous officials familiar with the plan.

The spring booster plan for high-risk individuals in the US would resemble booster offerings already in place in Canada and the United Kingdom, and it would put the country largely in agreement with updated recommendations released last week by the World Health Organization. The agency's advisory group on immunizations determined that, as of now, healthy adults and children do not need additional boosters in the near term, but certain high-risk groups should be offered boosters every six to 12 months.

The US's spring boosters will be offered to high-risk people who have gone at least four months since their last shot and want additional protection, the Post reported. The US last authorized a booster dose in September, meaning that some in the high-risk group may be around seven months past their last dose.

Before the doses are available, the Food and Drug Administration will first announce an authorization, which will reportedly occur in the next few weeks. The Centers for Disease Control and Prevention will then need to sign off, which is expected to occur quickly and will make the doses available immediately. They will likely be free to all those who want them, as the federal government has a glut of boosters.

Of note:

Still, experts have expressed mixed opinions about who should get boosted, when, and with what. While most agree that frequent boosters benefit the immunocompromised, opinions vary on shots for older adults, with suggested age cut-offs ranging from the 50s to 70s and some saying it should largely depend on health status as well as age.

While age and immune status are the high-risk factors identified for spring boosters in the US, the WHO advisers were more inclusive in their definition of high risk, including pregnant people, younger people with significant comorbidities (such as heart disease and diabetes), and frontline health workers, in addition to older adults and the immunocompromised.

...

The formula of future boosters will also likely draw debate, with some experts suggesting a monovalent booster—one that would target only the current omicron strains—would be better than the bivalent formulation.

For now, only 16.5 percent of the US population—and only 42 percent of people age 65 and older—have received a bivalent booster dose.

[Smoove_B]

Happy to report some good news:

The Biden administration is launching a $5 billion-plus program to accelerate development of new coronavirus vaccines and treatments, seeking to better protect against a still-mutating virus, as well as other coronaviruses that might threaten us in the future.

“Project Next Gen” — the long-anticipated follow-up to “Operation Warp Speed,” the Trump-era program that sped coronavirus vaccines to patients in 2020 — would take a similar approach to partnering with private sector companies to expedite development of vaccines and therapies. Scientists, public heath experts and politicians have called for the initiative, warning that existing therapies have steadily lost their effectiveness and new ones are needed.

...

Jha and others said the new effort will focus on three goals: creating long-lasting monoclonal antibodies, after an evolving virus rendered current treatments ineffective; accelerating development of vaccines that produce what is known as mucosal immunity, which is thought to reduce transmission and infection risks; and speeding efforts to develop pan-coronavirus vaccines to guard against new variants of SARS-CoV-2, as well as other coronaviruses, from Middle East respiratory syndrome (MERS) to still-unidentified viruses in that family.

[Zaxxon]

[Smoove_B]

I might be late to the party here (work has been....interesting), but word on the street is that starting next week (+/-) you wont' be able to get the OG monovalent vaccinations any more. From now on, only the bivalent vaccinations will be available (in the United States) - for an initial series or for a "booster".

Start your conspiracy theories now.

[Sudy]

Wow, I'm stunned that some Canadian hospitals have or will eliminate masking except during outbreaks or in patient care/waiting room areas. I thought and hoped masking was here to stay in hospitals and doctor's offices. Like, forever. There can be exceptions for areas with spread-out contact, sure. But hospitals seem like an excellent place to transmit respiratory infections?

We recognize that COVID-19 is here to stay. We have to plan to gradually and safely go back to normal, while we continue to focus on mitigating risk to vulnerable patients.

Why does today's "normal" have to return to yesterday's normal, during a less enlightened time?

[stessier]

I might be late to the party here (work has been....interesting), but word on the street is that starting next week (+/-) you wont' be able to get the OG monovalent vaccinations any more. From now on, only the bivalent vaccinations will be available (in the United States) - for an initial series or for a "booster".

Start your conspiracy theories now.

Outside of the conspiracies, functionally I don't think this is a bad thing, right?

[Smoove_B]

No, I don't think it's bad - given what's currently circulating. If there's a shift in the dominant strain(s), I've seen it argued that the current bivalent vaccination might not be nearly as useful as it is right now. Assuming there is an ability in place (at a regulatory level) to allow for a quick swap or modification of exactly what's offered in the bivalent vaccines (like what we're doing each year for influenza), that's not a bad thing.

[Max Peck]

Given that the bivalent vaccines still target the original strain, the same as the monovalent vaccines, even with a significant shift in the circulating virus they'd still be at least as effective as the monvalent vaccines, wouldn't they?

[LawBeefaroni]

Wow, I'm stunned that some Canadian hospitals have or will eliminate masking except during outbreaks or in patient care/waiting room areas. I thought and hoped masking was here to stay in hospitals and doctor's offices. Like, forever. There can be exceptions for areas with spread-out contact, sure. But hospitals seem like an excellent place to transmit respiratory infections?

We recognize that COVID-19 is here to stay. We have to plan to gradually and safely go back to normal, while we continue to focus on mitigating risk to vulnerable patients.

Why does today's "normal" have to return to yesterday's normal, during a less enlightened time?

Honestly, it's because some people are assholes. The constant battle to get anti-maskers to mask up when it's required is taxing on hospital and office staff, particularly front desk and security.

I was at the mothership yesterday for a meeting and when I was at the concierge asking for directions to the meeting room, a visitor walked up without a mask and the desk worker asked him to put one on. We are still mask required in patient areas and have opted to consider atriums/lobbies as patient areas, for now. The guy got all huffy-puffy and was quoting what he thought state law was but the woman at the desk gave him such a withering glare that he stopped and acquiesced. It was magical but clearly born out of having to do that shit all day, every day.

[TheMix]

We need some "No shirt, no shoes, no mask, no service". Maybe that would get through. I mean, they've "suffered" the first two for ages without complaining. But suddenly the last one...

(HAH! Just kidding! Of course it wouldn't work. Though the logic that would be jumped through would certainly be "entertaining".)

[em2nought]

I'm pretty much the only person I see wearing a mask, my cousin who is squatting at my house says she wears one, because she knows I want her to if she's gonna keep occupying my space, but I seriously doubt it.

Where I'm headed eventually, wearing masks was already a thing before covid.

[Kraken]

I stopped masking at the grocery store a few weeks ago. When I get covid again it will be because Wife brought it home, same as the last two times. Honey badger don't give a shit.

[LordMortis]

They wore them in the hospital sort of. Some staff were obviously ignoring the directive over the PA every hour or so. No one was wearing them in the adjacent ortho office I went to this week. Just me. No one at wore them at the police station. that's the only places I've been for a month. I think masking is over for everyone but me and maybe there might be a few of a noticeable demographic grocery shopping. I'm not sure as I haven't been grocery shopping in a month. It's probably time for me and now is a good time, as I cant drive or actually go anywhere without assistance.

[ImLawBoy]

We did an excursion to a local shopping mall yesterday because everyone needed shoes. A few of the employees there were masking, but I didn't see any other customers besides us masking (and it was surprisingly crowded - I thought malls were dead?). I'm one of a handful of holdouts at the grocery store. Oddly, there still seem to be a decent number of kids at the twins' school who still wear masks.

[Max Peck]

I still mask up when I go to a store, which is something I still do as little as possible. Somebody has to be the last uninfected person in the world, so why not me?

[Smoove_B]

Just waiting for an article to share, but the FDA has authorized a second booster of the bivalent shots for (1) people over 65 and/or (2) with weak immune systems. Needs to be approved by CDC, but in theory it could then be available later this week.

Switching over to the bivalent version being the only one now available was approved at the same time.

EDIT: Washington Post it is then:

Federal health officials will not formally urge that people get a second booster. Instead, the “permissive” policy says they may get a second dose if they want.

Even as some people have been clamoring for a second booster, others appear unconcerned. Only about 42 percent of people 65 and older have received the first bivalent booster, according to the CDC.

Also:

Federal officials have noted they are not advocating a second omicron booster for young people, who in rare cases can experience heart-related side effects after getting the vaccine.

The FDA on Tuesday also retired the original mRNA vaccines by Moderna and Pfizer-BioNTech in favor of the updated shots.

The FDA still plans to move to a once-a-year coronavirus vaccine shot for most Americans — a timetable announced in January that is intended to coincide with annual flu inoculations in the fall. The FDA and its advisers hope the simplified schedule will encourage more people to get coronavirus vaccine doses. Officials will select a reformulated dose in coming months based on which coronavirus strain scientists think is most likely to be circulating in fall and winter.

[LordMortis]

TY, At this point I'm stuck at home but come May when I presumably can drive again and presumably restart my immune nuking infusions I'll look into getting jabbed again.

[RMC]

https://www.news5cleveland.com/news/con ... o-covid-19

Not the health system I work for, but right next door to us, so I am guessing we will be dropping mask requirements soon as well.

[Smoove_B]

NJ just dropped them today for hospitals and doctor's offices so yeah, I'd expect everyone everywhere will soon be "mask optional". Good luck.

[LordMortis]

TY, At this point I'm stuck at home but come May when I presumably can drive again and presumably restart my immune nuking infusions I'll look into getting jabbed again.

My GI doctor and Osteo Doctor seem to be debating starting my remicaid equivalent again. GI says I've been off too long and now getting back on is more complicated. Osteo says at least six weeks from surgery. I'm going with Osteo, which doesn't make GI happy. It doesn't help that the infusion service, and before that Humira have been hammering these precuations into me for over a decade. I need to ask about when to get the 2nd bivalent, I guess.

[Smoove_B]

Gonna put this here as there's nothing political involved:

Are repeat COVID infections dangerous? What the science says

Just how much harm repeat infections will cause is a matter of debate. “There are some almost pathologically polarized opinions out there,” says Danny Altmann, an immunologist at Imperial College London. One side argues that SARS-CoV-2 is a run-of-the-mill respiratory virus, no worse than the common cold, especially for those who have been vaccinated. Others have said that repeatedly getting COVID-19 is a gamble. Each bout comes with a risk of damage — or at least changes — to the immune system, and long-term health repercussions. Both groups are armed with evidence. What do the data say about the risks of reinfection and the potential for COVID-19 to cause lasting consequences?

Please allow me to TLDR; it for you

Spoiler:

[malchior]

That reinfection risk table is...not great.

[Smoove_B]

It's not, but the study that the table was created from used a cohort of older white men, pulled from a pool of military veterans. Trying to extrapolate that out to the general population isn't a good idea, but it certainly does suggest (to me, at least) we need to perhaps consider there are still things we don't understand about this virus in the medium to long-term.

[Sudy]

As a layman I don't understand how anyone could believe or expect otherwise? COVID isn't static. It may be different than the flu, but that seems like a good guideline for caution. But then I mean... no one gets their flu shots so I guess it didn't matter.

But there's no reason a COVID Spanish Flu can't happen, right? Even if the mechanisms and chances may be considerably different. And long COVID is obviously still largely a mystery because we're only a few years out from the first cases.

[Max Peck]

Speaking as an older white male military veteran whose hobby is keeping his number of COVID infections at zero, that study seems highly cromulent.

[Sudy]

Once you pop you can't stop.

[Smoove_B]

As a layman I don't understand how anyone could believe or expect otherwise? COVID isn't static.

I'll tread lightly, but people believe and expect otherwise because it's what they hear from people driving the entire process (government officials, private sector leaders, businesses/employers, etc...). I was with a group a few weeks ago and asked them what the #3 killer was in the United States for 2022. When I indicated it was COVID, minds were blown. I don't think it will leave Top 10 for 2023, but I'm not sure if it will remain #3. My point is there has been an insane amount of effort applied to playing down the virus and getting back to normal.

It may be different than the flu, but that seems like a good guideline for caution. But then I mean... no one gets their flu shots so I guess it didn't matter.

It's different in a significant way. Depending on where you live, influenza cycles seasonally meaning there are times of the year when you needn't worry about influenza. SARS-CoV-2 has not stopped circulating since we identified it and we've given up on trying to do anything in the short or medium term to address that.

But there's no reason a COVID Spanish Flu can't happen, right? Even if the mechanisms and chances may be considerably different. And long COVID is obviously still largely a mystery because we're only a few years out from the first cases.

In terms of it changing into something different that might increase morbidity and mortality? Absolutely. And yes, we're probably a still few more years out from understanding the contributing factors for Long COVID (or PASC as we're being encouraged to call it), much less addressing it medically. I think more realistic is the next hurdle we'll see when they (hopefully) develop the nasal vaccinations that block transmission. The hurdle here being refusal people will have with uptake.

These next ~8 months could be very telling, assuming variables don't change much (new variants) and we've settled into a "new new" normal.

[Kraken]

2 Mass. hospitals report no covid inpatients

For the first time in about three years, major Massachusetts hospitals said Tuesday they have no in-patient COVID-19 cases.

Calling it a “big milestone,” Tufts Medical Center spokesman Jeremy Lechan said, “As of 6:45 a.m. (Tuesday) morning, we have no COVID-19 inpatients for the first time since March 21, 2020.”

...

Dr. Todd Ellerin said the same was true at South Shore Health, where he is director of infectious diseases.

[Unagi]

Wow, he is like the one consistent element to the story, and the no COVID patients. I bet he could go around and make that true anywhere he was hired. How wonderful that the world has him.

[Kraken]

Wow, he is like the one consistent element to the story, and the no COVID patients. I bet he could go around and make that true anywhere he was hired. How wonderful that the world has him.

?

The Tuft dude is speaking for Tufts. The SSH dude is speaking for his hospital. I don't see fake news here.

[Unagi]

Yeah, I totally read that poorly. Like really poorly. It was late, I was about to go to bed.

[Smoove_B]

With the requirements relaxed on COVID-19 testing in hospitals overall back in January (no more testing asymptomatics) and this guidance from last week:

Number of Data Elements. The CDC will reduce the number of data elements that hospitals must report from 62 to 44. Specifically, CDC will make the following data fields optional for federal reporting:

Total hospitalized pediatric suspected or laboratory-confirmed COVID-19 patients
Hospitalized and ventilated COVID-19 patients (patients currently hospitalized in an adult, pediatric or neonatal inpatient bed who have suspected or laboratory-confirmed COVID-19 and are on a mechanical ventilator)
Total ICU adult suspected or laboratory-confirmed COVID-19 patients
Hospital onset (total current inpatients with onset of suspected or laboratory-confirmed COVID-19 14 or more days after admission for a condition other than COVID-19)
Previous day’s adult admissions with suspected COVID-19 and breakdown by age bracket
Previous day’s pediatric admissions with suspected COVID-19
Previous day’s total ED visits
Previous day’s total COVID-19-related ED visits

Hospital information is potentially about to become useless. About the only thing we have left is wastewater surveillance but funding was cut for that with the expiration of the emergency, so I'm honestly not even sure where that stands.

Also, I can't think of a single disease that we've treated like this over the last 26+ years - where we just decided "that's enough".

[Sudy]

So apparently tuberculosis is a thing we could be curing worldwide....

[Daehawk]