Monthly Archives: March 2021

Re: BUHealth: I am vaccinated!

Two serious ones, now one on humor.

This Frozen musical take-off on getting a vaccine is well done if you like over-the- top musical singers.

You may not enjoy this one if you are not likely to get a vaccine soon. 9/10

 

https://youtu.be/U74wUO54Sdg  5:49 minutes

 

This medley by the same singer from last spring by the same performer. Has a lot of Disney favorites on COVID-19. 8/10

 

https://www.youtube.com/watch?v=eI47Q_pfqsQ      4:22 minutes
Done for the day. Have a great weekend. Weather is looking  up here in Boston.

 

Randy

BUHealth: Consider donating blood

If you are curious about whether you have already had COVID-19 and would like to find out whether you already have antibodies, it is worth knowing that if you give blood, then the American Red Cross automatically tests donor blood and will tell you if you have COVID-19 antibodies.

20% of American donating blood test positive for COVID-19 antibodies.

CDC estimates that 25% of adults test positive in a random sample.

https://www.cnn.com/2021/03/15/health/red-cross-blood-donations-covid-antibodies/index.html

Covid-19 antibodies present in about 1 in 5 blood donations from unvaccinated people, according to data from the American Red Cross

By John Bonifield and Deidre McPhillips, CNN

Updated 12:01 AM ET, Tue March 16, 2021

https://www.cnn.com/2021/03/15/health/red-cross-blood-donations-covid-antibodies/index.html

 

Do something good for others while you find out information about yourself.

 

I searched the American Red Cross website for any mention about COVID-19 and found none. The following is from the Washington Post article two days ago.

 

https://www.washingtonpost.com/lifestyle/2021/03/17/covid-vaccine-blood-donation/

“If I’ve had covid-19 or taken a coronavirus vaccine, can I still donate blood?

“Of course — but with stipulations.”

“Although certain blood donation centers may have their own rules, at the Red Cross, donors who have been diagnosed with covid-19, the disease the virus causes; tested positive for the virus; or experienced any recent symptoms can still donate blood, but they must wait at least 14 days. Because some centers require longer deferrals, check with local blood banks.”

 

BUHealth: Vaccine effectiveness strong against variants and allergic reactions are trivial.

These two accessible, free JAMA Network articles have excellent answers to some common questions. Below are a few selected quotes with key parts in RED.

My notes are in italics, red italics if important. 2 minutes if you just read the red.

Figuring Out Whether COVID-19 Vaccines Protect Against Variants

“How well do the COVID-19 vaccines developed so far protect against these novel coronavirus spinoffs?”

“In Scotland, researchers estimated that Pfizer-BioNTech’s vaccine was up to 85% effective and Oxford-AstraZeneca’s vaccine up to 94% effective in preventing COVID-19–related hospitalizations 28 to 34 days after a single dose—the UK policy is to provide the second dose 12 weeks later.”

“The study, posted February 22 but not peer reviewed, found a 70% reduction in both types of infection [UK and SA] 21 days after participants received their first dose and an 85% reduction a week after receiving their second dose. “Overall, we’re seeing a really strong effect to reducing any infection—asymptomatic and symptomatic,” coauthor Susan Hopkins, MD, PHE strategic response director, said at a press conference. In March, Pfizer and BioNTech announced that non–peer-reviewed data from Israel showed their vaccine was 94% effective against asymptomatic SARS-CoV-2 infection.”

“Fortunately, as the article notes, nearly all vaccines used in humans prevent asymptomatic infection and spread.”

This means that it is most likely that we will not need to keep wearing masks once vaccinated, once the data are in.

“In general, vaccines that are effective in reducing infections do have major impacts on reducing transmission,” said Goodman, director of Georgetown University’s Center on Medical Product Access, Safety and Stewardship. “It is probable that these vaccines will reduce transmission.”

Mounting evidence supports that notion. In a study of UK health care workers immunized with the Pfizer-BioNTech vaccine, participants underwent biweekly polymerase chain reaction testing and twice weekly rapid antigen testing to help investigators determine rates of asymptomatic and symptomatic infections.

Source: JAMA Network Medical News & Perspectives

March 17, 2021

COVID-19 Vaccines vs Variants—Determining How Much Immunity Is Enough

Figuring Out Whether COVID-19 Vaccines Protect Against Variants

There is continuing concern by some people about getting an allergic reaction to receiving a vaccine. This JAMA article addresses this for Pfizer and Moderna.

 

JAMA Insights

February 12, 2021

Reports of Anaphylaxis After Receipt of mRNA COVID-19 Vaccines in the US—December 14, 2020-January 18, 2021

Tom T. Shimabukuro, MD, MPH, MBA1; Matthew Cole, MPH2; John R. Su, MD, PhD, MPH1

 

 

Here is the key result from their study

 

“During December 14, 2020 through January 18, 2021, a total of 9 943 247 doses of the Pfizer-BioNTech vaccine and 7 581 429 doses of the Moderna vaccine were reported administered in the US”

 

No deaths from anaphylaxis after vaccination with either product were reported.

 

“…mRNA COVID-19 vaccines in the US has confirmed that anaphylaxis [allergic reactions]  following vaccination is a rare event, with rates of 4.7 cases/million Pfizer-BioNTech vaccine doses administered and 2.5 cases/million Moderna vaccine doses administered, based on information through January 18, 2021.

 

Of those with an allergic reaction, 77% of those using Pfizer and 84% of those taking Moderna had a prior reported history of allergies or allergic reactions.

 

When considered in the context of morbidity and mortality from COVID-19,9 the benefits of vaccination far outweigh the risk of anaphylaxis, which is treatable. Because of the acute, life-threatening nature of anaphylaxis, immediate epinephrine administration is indicated for all cases. CDC guidance on use of mRNA COVID-19 vaccines8 and management of anaphylaxis is available.10 All facilities administering COVID-19 vaccines should have the necessary supplies and trained medical personnel available to manage anaphylaxis.

 

To put this in perspective the annual chance of getting hit by lighting is about 4  per million in Montana and 0.25 per million in California, and averages 1 per million per year nationwide.

 

About 1 in ten people if hit by lightning die, versus so far 0 in ten million from getting vaccines.

 

Get a vaccine if it is offered to you.

BUHealth humor: final entries in the masked dog photo caption contest

Final entries in the masked dog photo caption contest

Masked Sadie 20210314Waiting for the dog vaccine rollout.”

“Wearing a mask is so easy even my dog can do it!”

“Sadie says: Even I wear a mask when not eating!”

“I hate it when I can’t lick and my hair gets all frizzy!”

“How do you like my matching blue accessories?”

“It takes a smart dog to wear a mask!  How smart does that make you?”

”Don’t worry. I’m all bark and no cough.”

“I miss Uncle Phil!!!!“

“I’ve had enough of being walked by the neighbors during lockdowns … now I deserve this seat!”

“If I should meet thee
After long quarantine
How should I greet thee?
With silence,
With mask.“

“Stop barking about your rights being violated! It’s a mask, not a muzzle!”

“Stinks in here…”

“I really wasn’t barking all that much.  I wish I lived in Texas!”

“I hate it when I can’t lick my butt!”

Thanks for all your great entries! Excellent new entries could be added to this posting.

BUHealth: Being less racist makes some of us less comfortable

The New York Times had a very interesting article on March 5 which documented differences in rates of vaccination by race across the 50 US states. Whereas some states (Florida, Iowa, Wisconsin and Connecticut (?!?) have vaccination rates for blacks that are less than half of the state average, in Massachusetts the rate for blacks is about 85% of the state average, reflecting the states recommitment to serving needier minorities in the state.

box

 

 

Screenshot 2021-03-08 105954

 

 

 

 

 

 

 

 

 

 

 

 

This weekend when I was vaccinated, it was not at my convenient Vanguard primary care provider’s office or at Boston University, which would have mostly served people of privilege, but it was instead provided by a neighborhood community health group in the preschool of a housing project in Brighton MA. Less convenient for me, but much better for the nearby residents.

I am proud of MA for its better-than-average performance on racial equity of COVID-19 vaccinations, even though I know it underlies the enormous dissatisfaction of some of my neighbors and friends of privilege who feel they should have been placed at a higher priority. Being less racist makes some of us uncomfortable, and hopefully also puts more pressure on our government to be sure that everyone who wishes to can get a vaccination. All too often, market systems start by satisfying the needs of the wealthy and privileged (think education, health insurance, zoning, public streets over public transport, etc) and then decide it is not worth doing more for the poor and less privileged. In this case, by vaccinating more minorities, we may also be reducing the overall rates of infection, since infection rates have been much higher in minority groups.

Being less racist makes some of us less comfortable, but in the long run, it may make all of us better off.

BUHealth: I am vaccinated!

A wise friend who read my previous BUHealth post comparing different vaccines warned me that it could be interpreted as saying “Wait to get a vaccine until you get the one you like the most.” I do not recommend that. I care too much about my friends. Instead, you should get a vaccine the first time it is offered to you, whatever one it is.  For me, the first offer was yesterday, when a friend alerted me about a small surplus at one community health center. It was Moderna. I had found it hard to sign up via the weblinks. (I am over age 65, which has blanket permission to get a “jab” in the US now.) Look at how happy it made me.

IAmVaccinated!3

 

 

 

 

 

 

 

 

 

 

 

You too could look like this when you get vaccinated.

I did have a little pain in the arm and a low-grade temperature 99.2o F compared to my norm of 97.7 for the first 24 hours. But it ended. And now I can party continue wearing a mask carefully out of solidarity and because of the nasty new strains that are still popping up.

 

BUHealth: latest research in JAMA on COVID-19 vaccine effectiveness

One JAMA Network article this week and an accompanying editorial about COVID-19 are the first I have seen to carefully present the research about recent SARS-CoV-2 strains/variants, different types of vaccines, effects of one versus two doses, advice for people who were previously infected by SARS-CoV-2, what we know so far about their effectiveness against different strains, and what seems likely in the future. I put links in at the bottom after my summary.

The editorial by Drs. Mascola, Graham, and Fauci provides an accessible overview to brush up on your high-school level biology. It starts with a discussion of the distinction between lineage, variants, and strains: new genetic virus variants are organized into lineages when one variant builds upon another, and when the variants become sufficiently different in behavior from the original SARS-2 virus strain – such as by being more resistant to antibodies, or to vaccines, or more infective or fatal – then they are called a strain. There are dozens of new variants of SARS-2 virus, suggesting it is mutating rapidly.  The UK, South Africa (SA) and Brazil strains are getting a lot of media attention, as they should. There is also a new variant found in southern California which they are trying to figure out its lineage, but it now represents 44 percent of the cases sequenced. Merely by its rapid appearance as the dominant strain in CA, we know it is a virulent strain.

 The article by John Moore (PhD) of Dartmouth was the most relevant to me.

Here are a few quotes from Moore with interpretation in italics.

“Two categories of variants have different implications for vaccine efficacy. …The first category involves variants “…[that]… “spread more rapidly in a population.”

“The second category involves variants that are more concerning, represented by the B.1.351 and P.1 lineages that emerged in South Africa and Brazil, respectively….[that help the viruses resist antibodies created by vaccines or previous infections].

“The combination of a high virus replication rate within an individual (a high viral load) and a suboptimal level of neutralizing antibodies is the exact environment in which resistant viruses are considered likely to emerge and spread.3,4

In other words, people who have had only one dose of a vaccine are more likely to promote new variants since they do not have enough neutralizing antibodies. This motivates the emphasis in the US for two vaccine doses, close together.

“At present, most scientists active in this area are reasonably optimistic that the efficacy of the mRNA vaccines [Moderna and Pfizer] will not be substantially compromised by the B.1.351 and P.1 [SA and Brazil] variants, …”

This is great news if true, but there is little clinical evidence so far..

In order to reduce the creation of new variants, Moore recommends Pfizer, Moderna, and (when approved) Novavax 2 dose vaccines if available, since they give strong antibody protection.

“The Johnson & Johnson 1-dose adenovirus vector vaccine … is less effective than the Moderna, Pfizer, and Novavax 2-dose designs.”

Moore recommends use of Johnson and Johnson one-dose on younger people (aged <40 years) who tend to have naturally lower “viral replication rates” and hence will not give the SARS-COV-2 as much chance to mutate then they get infected.

“All leading vaccine companies are now redesigning their S-protein components to counter new variants, particularly B.1.351 [SA].”

“Another issue with significant implications involves what happens when a mRNA vaccine [Pfizer or Moderna] is given to a person who has recovered from COVID-19. Small-scale studies have shown that a single mRNA vaccine dose rapidly boosts neutralizing antibody titers to very high levels, perhaps rendering the second dose redundant in this special circumstance.10 … A related issue is that the mRNA vaccines appear to trigger strong (although short-lived) adverse effects (such as headaches and mild fever) in people who have previously been infected with COVID-19.”

In light of this, I am planning to get the Pfizer and Moderna rather than J&J, and await further research for the second dose.

Novovax is a huge potential entrant into this vaccine race with its recombinant protein nanoparticle COVID-19 vaccine. It is not yet approved for use in the US, but is hoping for May. It is gearing  up for production at the rate of 2 billion doses per year to be produced in India and Japan. Early clinical results from tests I SA and Brazil are encouraging.

I foresee a long future for vaccines in the world.  

JAMA Viewpoint

March 4, 2021

Approaches for Optimal Use of Different COVID-19 Vaccines: Issues of Viral Variants and Vaccine Efficacy

John PMoore, PhD

Abstract Full Text

free access is active quiz has multimedia online first

JAMA. 2021; doi: 10.1001/jama.2021.3465

This Viewpoint proposes ways to maximize vaccine efficacy and allocation given the rise of coronavirus variants and authorization of a Johnson & Johnson vaccine, including reserving the latter for younger healthier populations, boosting it with a single-dose messenger RNA (mRNA) vaccination, and single mRNA immunization of people with prior documented SARS-CoV-2 infection.

Editorial

February 11, 2021

SARS-CoV-2 Viral Variants—Tackling a Moving Target

John R. Mascola, MD1; Barney S. Graham, MD, PhD1; Anthony S. Fauci, MD2

Author Affiliations Article Information

JAMA. Published online February 11, 2021. doi:10.1001/jama.2021.2088

 

Novavax press release Jan 28, 2021 at 4:05 PM EST

Company web site.

Novavax COVID-19 Vaccine Demonstrates 89.3% Efficacy in UK Phase 3 Trial

 

Yes, even rich white people in the US get bad health care

Despite the abundant evidence2 showing that health care outcomes in the US are much worse than in every other OECD country, I still hear arguments that this is because uninsured, Medicaid, minorities, or low-income people in the US bring down our health outcomes. This myth is repeated35, and believed by a majority of Americans. 6 This JAMA study shows that this is not true. Even high-income white people get worse health outcomes than the average result in OECD countries. Time to change to a better health care system!

 

Key Points

Question  Are the health outcomes of White US citizens living in the 1% and 5% richest counties better than the health outcomes of average residents in other developed countries?

Findings  In this comparative effectiveness study of 6 health outcomes, White US citizens in the 1% and 5% highest-income counties obtained better health outcomes than average US citizens but had worse outcomes for infant and maternal mortality, colon cancer, childhood acute lymphocytic leukemia, and acute myocardial infarction compared with average citizens of other developed countries.

Meaning  For 6 health outcomes, the health outcomes of White US citizens living in the 1% and 5% richest counties are better than those of average US citizens but are not consistently better than those of average residents in many other developed countries, suggesting that in the US, even if everyone achieved the health outcomes of White US citizens living in the 1% and 5% richest counties, health indicators would still lag behind those in many other countries.

JAMA Intern Med. 2021;181(3):339-344. doi:10.1001/jamainternmed.2020.7484

Comparing Health Outcomes of Privileged US Citizens With Those of Average Residents of Other Developed Countries

Ezekiel J. Emanuel, MD, PhD; Emily Gudbranson, BA; Jessica Van Parys, PhD; et al.

December 28, 2020

BUHealth: UK/South African COVID strains are at BU; BU testing looks great; BU plans in-person commencement!

I greatly enjoyed reading about how BU is using its extensive research laboratory resources to test for the presence of the UK and South African variants at BU. This report includes the 70 cases of COVID-19 detected in members of the BU faculty, staff and students during the week of Feb 17-23. Below are a few selected quotes.

Boston University Weekly COVID-19 Report: February 17 to 23

BU has begun sequencing COVID samples for variants; two variants that first emerged in South Africa, UK already detected at BU

Of the positive tests sent to the NEIDL for sequencing since January 25, more than 130 samples have contained enough viral material to allow them to be sequenced.

… thus far, we have detected eight samples containing a COVID variant of concern. Specifically, we have detected two variants of concern: one case of the B.1.351, first detected in South Africa, and seven cases of the B.1.1.7, first detected in the UK. We were not surprised by these results—they confirm what we already suspected, that those two variants have reached our community. “

 

It was informative to me to learn that BU is not able or allowed to tell people which variant they have if infected.

“For regulatory reasons, BU is not permitted to tell individuals if they have a variant form of COVID-19. The scientists who are doing this study are not even aware of which person the samples they are sequencing came from; they just know the virus sample was collected from someone at BU. “

even if we could tell individuals that they had been infected with a COVID-19 variant, that knowledge wouldn’t change our clinical management of that person’s illness.”

 I am fortunate to be part of BU’s comprehensive testing. It is available daily on the COVID-19 dashboard, with testing results as of two days ago.

I only wish that more people had such excellent testing available. I have not seen any recent estimates of the cost to BU of doing these COVID tests, but an early guess was $12 per test. I think a lot of people would be willing to pay $12 (weekly) or $25 (biweekly) for careful testing, which is the cost per faculty member or undergraduate of BU’s testing program. BU is continuing its hybrid teaching, with students in many classes allowed to choose between in-class and remote zooming.

 Based on these low current testing and vaccination efforts at BU, BU announced this week that it will be holding in-person graduation ceremonies on May 16 (graduates only) as long as the city and state allow it. Link is here and below. Go BU!

In-Person Commencement for BU Class of 2021 Planned for May 16, unless City Requires Virtual Ceremony

Class of 2020 will gather October 2 for virus-delayed ceremony: both will be for graduates only