Yes. Alan Dove specifically said an approved vaccine will lower hospitalization and death, but might not lower infections. Go to about 1:07:38.
TWIV has gone out of its way to emphasize there needs to be a minimal viral load to infect, but they’ve also emphasized that asymptomatic people can have high viral loads.
Wouldn’t “sterilizing immunity” versus “protective immunity” be a continuum, rather than a binary state? I.e. it is mostly about how quickly your immune system destroys all of the virus that infects you?
For example, suppose you go to Marin County and an anti-vaxxer’s measles-infected kid coughs in your face. You are now infected with measles, some of which invades your cells to make more virus that you can now exhale at others (and maybe some of the original virus you inhaled goes out in a later breath). But your immune system, primed with measles vaccine, notices and stamps out the infection very quickly, so your exhaled breath includes measles virus for only a very short time.
But then maybe COVID-19 would take longer to stamp out even if you have a strong immune response to it from vaccine (or previous infection), leaving you contagious for a lot longer. But would it take less time to become virus-free in that case compared to a non-immune person getting similarly effective?
I think the answer here is, nobody knows.
We do know, however, that someone who has had covid, and thus has obtained whatever immunity they’ve obtained, can be infected again. TWIV talked about this: there’s someone in the literature who was infected and got sick, got better, and then later tested positive on a screening test. They know the person was re-infected, because they sequenced the first and second viruses and they were different strains. The TWIV folks said this was protective immunity, because the person didn’t get sick the second time. They didn’t talk about whether the person was known to have had enough viral load to be infectious from the second infection, but in their conversation they seemed to think the person would be infectious.
I ran into this article on persistent or latent viral infections, which suggests that COVID is neither. https://www.knowablemagazine.org/article/health-disease/2020/viruses-come-stay?utm_source=STAT+Newsletters&utm
However there is no mention of heart issues, which, according to the article’s conclusions, would not be from persistent infection but from the immune system itself.
Heart issues could be from damage from the immune system, but could also be damage from the heart itself being infected and damaged by covid.
Moderna released their vaccine protocol. It is not what the TWIV guy was saying, exactly.
Participants get the first shot, and then four weeks later. They start “counting” for purposes of getting illness two weeks after the second shot, six weeks after the first shot, because in theory immunity wouldn’t have had a chance to build up before then.
The endpoint is preventing 60% illness from covid. Here’s the definition of illness:
If they meet that definition and they test positive for covid they count as having illness from covid.
They’ll evaluate efficacy when 53 participants (placebo group and treatment group combined, since they won’t know who’s in which) have gotten covid illness. If the study shows efficacy, that’s it, they produce the final report. Otherwise they’ll evaluate at 106 participants, and if that doesn’t show efficacy, at 151 participants. They’ll follow everybody for two years to monitor side effects in any case.
I’m not disputing that Moderna’s protocol is not what Alan Dove said on TWIV, but I didn’t catch any discrepancies. Did you mean regarding sterilizing vs protective immunity?
I listened to TWIV 662 The Joy of Vox, and came away with a better understanding of the different categories of vaccines and how each is made. I also really appreciated getting a sense for how the companies making the vaccines are communicating and collaborating. But I’m still unsure about efficacy. Say you get the vaccine, but it’s not 100% effective and you contract the virus. Wouldn’t you be less infectious than someone who didn’t have the vaccine? If you have antibodies to the spike protein, then your immune system is shutting down viral particles before they invade your cells—before your viral load can rise high enough for transmition.
It worried me what Alan Dove said about vaccinated health care workers still transmitting the virus to their patients. Will try to find out more.
Alan Dove said success would be defined as preventing 80% of serious illness from covid. Moderna defines success as preventing 60% of any illness from covid, even mild illness.
We don’t know. I’m not being cute here. We really don’t know at all. We don’t know if asymptomatic people are less infectious than symptomatic people. We know of plenty of asymptomatic transmission.
I listened to this today. Very interesting. From The Brian Lehrer Show on NYC public radio–he’s a treasure of NYC for sure.
Dr. Dayna McCarthy, rehabilitation medicine physician at Mount Sinai, talks about working with patients suffering from long term coronavirus symptoms at the Mount Sinai Center for Post-COVID Care, and takes calls from listeners who consider themselves “long haulers.”
https://www.wnyc.org/story/fatigue-headaches-brain-fog-some-covid-symptoms-last-beyond-14-days
Does Wearing Glasses Protect You From Coronavirus?
After researchers noticed fewer nearsighted patients in a hospital ward in China, they speculated that wearing glasses might offer some protection against Covid-19.
https://www.nytimes.com/2020/09/16/well/live/does-wearing-glasses-protect-you-from-coronavirus.html
@3SailAway wrote:
@“Cardinal Fang” answered:
I asked an infectious disease doc about this, and I thought the explanation was worth posting. First of all, there are different types of antibodies, and not every type is triggered by every vaccine. Two that are important in this case are IgA and IgG (immunoglobulin A & G).
IgA is present in the mucosal surfaces which line the nose, respiratory tract, digestive tract, ears, eyes and vagina. These are the parts of your body that are inside the body, but exposed to the outside world and constantly besieged by pathogens (bacteria, fungi, viruses). IgA neutralizes these without a large, and unnecessary, systemic (full body) immune response.
IgG is the most common type of antibody found in the blood.
So, if a Covid vaccine causes the vaccinated person to produce IgG, but not IgA, they could have inner immunity but lack surface immunity. If they contracted the virus, it would replicate in their nose and throat, giving them a high viral load and making them infectious. Yet, when the virus penetrated the mucus membrane to the blood, IgG would neutralize it, so that the person did not get sick. Systemic reactions such as cytokine storms and multi-system inflammation would not be triggered.
TLDR: The basic question was, could vaccinated people still be contagious if the vaccine is not 100% effective and they contract Covid? @“Cardinal Fang” 's answer , “We don’t know,” is correct. The purpose of the vaccine is to reduce serious disease, so that is the main endpoint of the current Phase 3 trials. However, asymptomatic spread, and infectiousness despite vaccination will also be studied.
The Pfizer vaccine protocol is out. They’re going for the early kill. Their first interim evaluation is when 32 participants have gotten sick from Covid. If only 6 or fewer of those people were vaccinated, they’re going to stop the study right then and there and ask for approval.
Overall, according to their protocol, if the vaccine prevents 50% of illnesses from covid that otherwise would have occurred, it’ll be a little less likely than 50/50 to be approved. If the vaccine prevents 60% of illnesses from occurring, it’s very likely to be approved.
Will they also be evaluating whether those who do get infected, get less serious illness?
Honestly? This makes me think they want to be first to get the money from it rather than it being a great option for everyone to go for.
I wish the world could work together with experts evaluating all the options to pick the best one or two and money/politics weren’t a factor.
To each their own, of course, but we still won’t be jumping to get anything until there is far more data from what seem to be non-partisan and non-financially affected groups.
What part of fang’s post are you negatively reacting too?
Pfizer/BioNTech’s deal with Barda is $19.50/dose, which seems very reasonable, and a price on which I doubt they are making much, if any, profit. I am comfortable with Pfizer working with BioNTech, a German company, but would not feel comfortable with regulatory, or ‘expert’ input from companies in many other countries.
What non-partisan or non-financially affected groups do you expect to generate vaccine data?
An approved vaccine could be less effective, possibly a lot less effective, for people not wearing masks. They’re instructing volunteers to wear masks, and volunteers, who are responsible people, probably mostly wear masks. It could be that wearing a mask attenuates the viral load in case of exposure, so that the vaccine has a chance to work.
One thing the vaccine makers are not doing at all is surveillance testing to detect asymptomatic infections. (I think. Those protocols are long and complicated.)
I think you’re right. However, since they are vaccinating such huge numbers of people, some of them will get tested for reasons outside of the vaccine trials, such as for work, school, football tickets, or due to contact tracing. In that way, asymptomatic infections will be found in the vaccinated (if they exist). If the vaccinated ever test positive, they report it to the vaccine trials so data can be gathered. If they find asymptomatic infections, maybe they’ll swab noses to test for IgA, and draw blood to look for anti-SARS-CoV-2 T-cells, so they can learn more about how someone gets infected but not sick.
Just 32 people getting Covid using a “luck” factor of who is exposed and who isn’t doesn’t seem reliable at all to me. The volunteers aren’t attending the same events, sitting at the same tables at restaurants, or being challenged by the disease in the lab, and we honestly don’t even know who will be going out more in hot spots vs not.
Is there any other vaccine that has been approved with so little “concrete” data on volunteers?
There are oodles of vaccine possibilities in development right now - worldwide. Once the first one hits the headlines with “It works!!!” even under dubious test results, will the others even have a chance? What if one of them is better? This isn’t a sprint. We want the best option possible, best being defined by proven to have the best odds.
In our country (and a few others) I’m not sure it’s possible to have non partisan interference right now, but in an ideal world I’d like to trust the CDC and or multiple medical college researchers looking at the data (with the medical colleges not profiting off of any of the candidates, of course).
There’s no way in the world I’m going to trust any manufacturer or group purely looking for speed. Masses will get the vaccine, think they are protected, and go about life without precautions. If they’re right, all will be better, but what if they’re wrong?
I’m willing to wait for that data to surface. It’ll be more of a real test.