Paper and Threads

This week we are taking a beach break, after not being away from our apartment since Jan. 2020.  I'm still surveying Covid-19 science and will resume my "collage/science" blog posts next week.  Here we are taking morning beach walks and trying to re-enter society a little.  My husband and I are both vaccinated and had a delightful dinner with 2 vaccinated friends at their home.  We wear masks in the grocery store and when we have workers indoors with us.  See Below

During the pandemic, I sometimes did pen drawings as I took early morning walks around my NYC neighborhood.    Most of the time I surveyed store windows - and rapidly sketched a few interesting items.  I like to draw on location, and not in my apt or from photos.  These very rapid drawings were done if I saw something interesting or just felt like drawing as I walked.  I always thought that I may paint them, but my daily Covid-19 news letters, podcasts, publications, and FDA and CDC Advisory Board Meetings kept me busy. These are two drawings done last Fall, and this morning I photographed them and added them to my blog - just as a memory of the "our stay at home life."

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The pier-reviewed paper for Israel's Vaccination program just appeared in Lancet and the "real-world" effectiveness >7 days after the second dose was almost identical to the Pfizer Phase 3 study results done for the EUA.  When the vaccine was obtained in Israel their goal was to vaccinate 6.5 million residents age 16 to >65 yrs.  In order to determine effectiveness, assessments were made >7 days after the second dose was given and then vaccinated and unvaccinated individuals were followed with a median follow-up of 7 weeks.  The study period was Jan 29 - Apr 3rd during which they vaccinated 72% of the population of Israel age 16 or older. This surveillance study was done when the UK variant B.1.1.7 was the dominant circulating strain in Israel. See Results Below

There were 109,876 infections in the unvaccinated group and 6,266 cases in the vaccinated group with a calculated effectiveness of 95%.  Asymptomatic, symptomatic, hospitalized, severe or critical hospitalized, and deaths were all assessed and effectiveness in all groups was above 90%.  I was especially interested in the group that was age 65+ (N=1,015,620) and the effectiveness was 94.8% (>65yrs),  95.1% (>75 years), and 94.1% (>85 years).  Immunosenescence, the reduced immune response in elderly patients, is always a concern, but apparently not with this vaccine, or with the UK variant, which makes me very happy.   There are many statistics in the paper, but I thought I would include only the effectiveness of preventing severe disease and deaths:

Severe Disease:  Unvaccinated (3,201)  Vaccinated (206)  Vaccine Effectiveness 98.6%

Deaths:              Unvaccinated (715)     Vaccinated (71)    Vaccine Effectiveness 98.5% 

Please get vaccinated!!!  Two more of our 8 grandchildren got vaccinated yesterday and today as part of the new 12-15 year old group.  One more will be vaccinated now and the other 3 are still too young.  Today's Vaccination for Callum was done under the Whale at the Museum of Natural History - no appointment needed.

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Today I wanted to review what we know about the NYC Variant and other variants found in NYC.  Very little genomic sequencing was done in the US prior to February 2021.  Since then NYC surveys approximately 1100 viruses per week from samples obtained and sequenced in labs here - a very exhaustive process.  I follow the weekly reports to see what variants are circulating, and today outline the variants as of 5.4.21 and review a report from MMWR (the CDC weekly bulletin) on the NYC Variant.  In the first genomic data reported (2.14.21) the NYC variant (B.1.126) accounted for 29% of the variants, the UK variant (B.1.1.7) was 7%, and other variants accounted for 0-1.2%.  Now the NYC variant was 36.7%, the UK variant was 41.5% and only the P.1 Brazilian variant was >1% at 3.6%.  The UK variant definitely increased demonstrating its increased transmissibility.  The NYC variant has increased, but it's trajectory is much slower than the UK variant.

NYC Variant:  There are two subgroups of the NYC Variant, which was originally isolated from an immune deficient patient in Manhattan.  Now the dominating subgroup of the circulating NYC variant is the one which contains the E424K "EEK" mutation - which is present in both the South African and Brazilian variants.  The CDC, after studying patients with either the NYC or UK variant concluded:

1.  The NYC variant does not cause more severe disease.  2.  It is not associated with breakthrough cases after vaccination.  3.  It does not cause more reinfections in patients who had Covid-19.  4.  71% of patients are symptomatic.  Much more testing and analysis is needed, but this is a good start. See  Below

The next Blog Post, Part 2, will review data on variants in other countries:  There is data from Israel on the efficacy of the Pfizer vaccine against the UK and South African variants.  But there are also studies that are reported from Qatar and I will need to look at them before I can pass along the information. 

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You may have already heard that last Friday Pfizer submitted data to amend their EUA to vaccinate 12 to 15 year old children.  My happy dance means that 3 more of our grandchildren may be vaccinated and hopefully before they go to camp.  My 17 and 16 year old grandchildren were vaccinated already without any problems.  Determination of safety, tolerability and immunogenicity of vaccines is usually done systematically like this in younger and younger age groups. This group could take the 2 standard doses of Pfizer vaccine 3 weeks apart, but for younger children reduced doses will also have to be established and tested.  There will be 3 more age groups to be tested and Pfizer will also have to submit data from each randomized placebo-controlled trial.

There were 2,260 adolescents enrolled in this study - with or without a prior history of Covid-19.  Eighteen (18) cases of Covid-19 were seen in the placebo group vs 0 in the vaccinated group.  Neutralizing antibodies were tested and the immune response was even greater than that seen in 16-25 year old volunteers in the previous trial.  The vaccine was well tolerated, with side effects generally consistent with those in the 16-25 year old range. All of the participants in the trial will continue to be followed for a full 24 months, like the original Pfizer phase 3 trial.  The FDA and then the CDC independent scientific advisory board will hopefully approve the amendment quickly.   Then vaccinations can begin.  See Below  

Pfizer also has an ongoing Phase 1/2/3 study in 3 decreasing age groups: Children 5-11 years, 2-5years, and 6 months to 2 years.  The 5-11 year old group began dosing last week and the 2-5 year old group will begin one week after that.  Moderna is also conducting similar trials.  In the last few weeks experts say that herd immunity will not be achieved in the US, and the next wave and clusters of cases will spread quickly in the susceptible groups.  With increased variant transmissibility, one susceptible population may now become children.  That is frightening to me.  This is my 100th collage and Covid-19 discussion since last Spring - and at some point I will have to decide when to return to warm weather outdoor sketching instead.

Posted by Shirley at 6:31 AM | Permalink | Comments (0)

I read two pandemic papers several weeks ago that made me very sad.  While we've all been alarmed at the number of deaths due to Covid-19 these two studies focused on the number of (1)  children who lost a parent and (2) deaths of health care workers.  I don't understand the modeling methods used in the first study, but it is published as a detailed research letter in JAMA Pediatrics, a reputable medical journal. They say that sudden parental death can be particularly traumatizing to children.  Their model demonstrates that from February 2020 to February 2021 there were 37,300 children aged 0-17 who lost at least one parent (9863 less than 9 years old).  Approximately 75% are non-Hispanic whites, the remainder non-Hispanic blacks.  We can only guess the types of trauma this causes in children and the support that will be needed for them.  I remember one family presented on MSNBC by Nicole Wallace in which both parents died, several days apart, leaving multiple young children.  See Below for Study on Health Care Workers

Information about health care workers appeared in the Guardian based on data collected from mid-March 2020 to April 7, 2021.  More than 3600 health care workers died with 50% of them being less than 60 years.  A majority of deceased workers were people of color and more than a third were born out of the US.  A huge number of deaths occurred early in the pandemic, probably in part related to the difficulty getting PPE.  Most of the deaths were nurses and support staff, but also included physicians, pharmacists, first responders and hospital technicians.  Only about 25% of the people who died worked in hospitals.  Other people who died worked in places like residential facilities, outpatient clinics, hospices, and prisons etc.  Covid-19 is a deadly infection and I admire the physicians, nurses, respiratory therapists and other personnel so much. Since then scientists have developed very effective and safe vaccines and this is my plea to everyone reading this to please get vaccinated.  Dr. Michael Osterholm told everyone listening to his podcast from Thursday to get 2 people to agree to getting vaccinated. Please....

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