Studies have shown that the booster does in fact markedly increase antibody response.
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Do we know that a third shot is more likely to keep these older frailer folks out if the hospital as opposed to making sure they get monoclonal antibodies as soon as they test positive?
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Our area is behind on monoclonal antibodies. The medical establishment seems more focused on vaccines. I am hoping for more attention to treatments!
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Antibody production is one part of the immune response. We have patients who are admitted to the hospital with the highest titer possible of antibody production. What we donât know is the functional capability of other things such as cellular immunity. Exposure to extremely high viral load can play a part as well. We know that antibody response is lower in the elderly and wanes faster in this age group. They also often have significant comorbidities and a higher risk of progression to severe disease, so they would benefit from a booster. And still should get monoclonal antibodies if they test positive. Or monoclonal injection if they have been exposed but do not have a positive test. The latter is a course of four injections and an hour of observation.
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But note that this is not necessarily the same as the âwaning immunityâ that everyone seems to be latching onto. It could very well be that, for at least some people, an additional dose beyond the usual dose(s) (e.g. Pfizer x3 instead of x2, or J&J x2 instead of x1) would provide usefully stronger immunity, because the usual dose(s) may not be protective enough for them, not because their immunity from vaccination wanes quickly.
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Antibody titer does not equal immunity.
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That is why I said it is âone partâ.
Thatâs why I said the the post above that certain populations, such as the elderly (or on medications like CellCept in particular), have an initial lower antibody response. But the booster have shown to be effective in these people.
The CDC could have been studying a lot of this stuff, but has chosen not to. (A national health system has little to do with it. The bosses decide how to spend their budget.)
Listening to the FDA meeting on booster shots â very interesting. Lots of discussion on process. One presenter asked for requirement of 5-10 years of data. One other presenter stated (and I agree) that whatâs needed for pandemics is a process that is faster than the virus.
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People with obesity appear to have decreased T cell immunity to the flu vaccine, despite good antibody response. I havenât seen data on this for the COVID vaccines. Since obesity is such a big risk factor for COVID complications and death (and 40% of US adults have obesity) I think it is important to look at vaccine efficacy over time in this population. They could show that people with obesity are in need of boosters to prevent serious breakthrough infections, even at younger ages.
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5 years of data. Unbelievable.
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The meeting is an âOpen Public Hearingâ. Not sure how participants were selected. Some presentations are purely data based, others are basically conjecture. I am floored by the number of presenters defending Nicki Manaj.
The fact that they have an open public meeting is part of the problem. What a giant waste of time.
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I believe the FDA is congressionally mandated to hold an âopen public hearingâ for at least 60 minutes at every advisory committee meeting. Members of the general public as well as individuals or spokespeople from industry, consumer advocacy groups, and professional societies may ask to speak and submit written comments as well.
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By far the most helpful answers for treating Covid have come from results of the UKâs RECOVERY trials.
Thatâs how we know that dexamethasone works. (This information was available in June 2020!) Thatâs also how we know that hydroxychloroquine, convalescent plasma, lopinavirâritanovir, and azythromycin do not work.
In the first months of the pandemic, my husband started to use dexamethasone for patients with low oxygen during the cytokine storm (second week). For some, it was not enough, so he added tocilizumab (an IL-6 inhibitor). He tried it when patients were headed in the wrong direction because it made sense that it would work, knowing the progression of the disease and immunology. However, DH did not trust his personal observations because he knew that physicians can fool themselves into thinking what they do is helping. The only way to know for sure is a large, randomized, double-blinded, controlled trial. But there were no such trials in the US. It was a huge relief when the results from RECOVERY showed that dexamethasone was definitely working. Unfortunately, without the evidence that tocilizumab worked, hospitals started cancelling doctorsâ orders for the drug. (Unlike dexamethasone, tocilizumab is expensive.) DH fought many times to have his patients receive it.
Finally, in November, the RECOVERY trial reported that tocilizumab significantly reduced the chance of progressing to invasive mechanical ventilation or death from 38% to 33%. The trial also showed that in COVID-19 patients with hypoxia (requiring oxygen) and significant inflammation, treatment with the combination of dexamethasone and tocilizumab reduces mortality by about one third for patients requiring simple oxygen and nearly one half for those requiring invasive mechanical ventilation.
This knowledge is absolutely crucial for convincing hospital administrators, for establishing the standard of care, for teaching care providers. (In fact, there are still many urgent care clinics in NYC giving antibiotics to people with Covid.) Why hasnât the US been able to quickly put together these large, simple, incredibly helpful trials? One point in the UKâs favor was that their trial instantly had access to potential subjects at 176 NHS hospitals.
The Recovery Trial was made possible by the UKâs unified, government-run health care system. The National Health Service runs most hospitals in the country, and their staff, including the research staff, are all government employees. British patientsâ medical records are all shared in one data system.
This made setting up the worldâs biggest clinical trial in the middle of a pandemic straightforward. To hear the doctors involved tell it, it was as simple as the countryâs chief medical officer sending a letter to the head of every hospital, asking them to take part. The grand experiment was soon underway.
âWe were able to get up and going within days. That was because of the NHS,â says Duncan Browne, who is running the Recovery Trial program at a hospital in Cornwall. âWhereas if we had a fragmented approach, I think weâd still be arguing about it.â
That quote is from Vox: The UK Recovery Trial for Covid-19 treatments helped save a million lives with its dexamethasone study - Vox
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Your husband sounds like a very caring, competent physician. 
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The CDC has a research budget in the millions, and they could have asked for millions more when the pandemic hit, or even last year from the new Admin, who proclaimed to want to follow âthe scienceâ. CDC chose not to (or were told not to ask for more $$ by their higher ups?).
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