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Stay up to date on Covid

My latest thoughts on Covid19. The the current state, how we have grown, and what we can do for the future to stay protected.

Scope of the Problem

Low vaccination rates

Since Covid began apparently only 20% (383,706) in Sacramento County have been infected. This also seems low to think that only 1 out of 5 of fellow Sacramento residents of over 1.6 million people have been infected.  It seems everyone that I know has been infected at least once.

 Statistics from the United States

  • Total number of cases:  96 million

  • Total number of deaths:  1 million

 

Average number of cases/ day in Sacramento 

  • January 2022:  4,000

  • November 2022:  115

 

Average number of those in hospital

  • January 2022:  711

  • November 2022:  132

 

*As of November 8, 2022, The cases/ day rate is 'reported'   This is presumably much lower than the real number as many people do home testing and don't report to the county. 

 

Additional information can be found: https://ourworldindata.org/covid-vaccinations

Covid Vaccines

This is unbelievably confusing....and overly political.   I'm going to just try and stick to a few facts.

 

What is somebody supposed to do? 

When are they felt to be "up to date?"

 

Officially someone is up to date when they have received the primary vaccine series (two shots of Moderna or Pfizer vaccines) AND the most recent booster shot. 

 

I presume those who have not had the primary series will not plan to get the booster vaccine.   However, for those of you considering getting a booster shot, read on…

 

The two major players are Pfizer and Moderna. 

 

When they came out in late 2020 the reports of their effectiveness based upon their phase 3 clinical trials was exceptional

  • Pfizer, reported a 95% reduction in contracting Covid   

  • Moderna, was similar at 94%

  • J&J, the one-shot vaccine and was only 67%

 

The question would become, how would they perform in 'the real world'?

 

Again, really impressive results. 

In April 2021 the data released from the CDC found that out of 101 million people who were vaccinated, only 700 were hospitalized with Covid and only 132 people died. 

 Numerous studies later were similar

 

Cleveland clinic from January to mid-April 2021 showed the following:

Out of 4,300 hospital admissions. 99% of these were NOT fully vaccinated. 

This is similarly amazing.  These vaccines WORKED!  They stopped people, thousands and thousands, from dying. 

And, again, numerous studies were similar. And, it was my anecdotal evidence as well from hearing what was going on in our hospitals in Sacramento. Numerous reports would say that pretty much all those with Covid in the Intensive Care Unit were not vaccinated against Covid.

Why low vaccine acceptance?

So...why was there such poor acceptance? What's different now, at the end of 2022?

 

Numerous new variants that led to infection despite vaccination. Further, a decrease in how deadly (virulent) these new variants were. 

 

In other words—The new variants seemed to be able to infect those vaccinated or not.  And neither group (vaccinated or unvaccinated) suffered very much.  Far fewer ended up in the hospital.  See the numbers from Sacramento above. 4,000 people contracting Covid daily in January 2022 and only a few hundred in the hospital.

What can be done now?

So, the question is, what should be done for a vaccine now?  The CDC felt it necessary to include TWO different strains--the original one with the great data noted above and another one with activity against the BA.4 and BA.5 variants. 

 

What are the BA.4 and BA.5 variants.  After the original Covid, it kept mutating and they kept renaming these strains.  First they went through the Greek alphabet—Alpha, Beta, Gamma, Delta, Eta, Iota, Kappa, Lambda  then Omicron.  Then, it seems they stopped ‘naming’ them.  The original Omicron was BA.1.  Now, the most prevalent strains are BA.4 and BA.5.  Newer strains for this fall or even more complicated to remember BQ.1.1 and BA.2.75.2 

 

Like the flu vaccine, the CDC has tried to guess what strains will be coming in the fall and immunize specifically for those strains.  I must admit, when the ‘original’ strain has pretty much been completely eradicated, I’m not sure why this is being included in the vaccine. 

Benefits

The new booster shots are Bivalent.  The initial Covid vaccine was monovalent.   The difference. 

 

The monovalent protected against the original Covid 19 strain

 

The bivalent vaccines protect against the original AND the newer BA.4 and BA.5 strains.  Note, they are not protecting against the BA.1 variant (the original Omicron variant)

 

They are trying to do what Flu vaccine manufacturers have tried to do. Guess what will be the upcoming strain in the next few months and vaccinate against that.

  

The problem.  We really have no idea what Covid strains are going to be prevalent this Winter.  Further, and this is a bit shocking I know, but these Bivalent vaccines were not studied for efficacy in humans.  Only mice.  So, we don’t really know how effective they will be at protecting against the BA.4 and BA.5 variants.  We likely will get preliminary human data sometime in December. 

 

What we do have is history regarding the previous monovalent vaccine and its role in diminishing hospitalizations and death.  Which, as mentioned before, was truly amazing.

 

But, in fairness, we must balance the benefits of these new vaccines with their risks.  And, I think the reason why this is becoming more a question in the minds of most is that the virulence of these later strains is much less.   Simply put, far few people are going to the hospital and dying from these current strains than the original unmutated Covid-19 virus. 

Risks

A large study of over 433,000 Veterans over a 38-week period were given the two different vaccines.  The question was which had more long term adverse effects.   This article appeared in the June 14, 2021 issue of JAMA.  (to find search comparative safety of mRNA vaccines)

 

Initially, in the first few weeks they were quite similar. But, I was struck by the differences, particularly with regards to heart outcomes between the two at the end of the 38 week period.  There were higher rates with ischemic stroke, hemorrhagic stroke, myocarditis, myocardial infarction, thrombotic episodes, and arrhythmias with the Pfizer vaccine as compared to the Moderna.  They theorize, these differences are possibly due to the fact that the Moderna vaccine is more effective and that these adverse events are Covid related (meaning more people in Pfizer cohort would catch Covid).  Please note, these numbers are SMALL, out of 400,000 persons we are only talking about a difference of 80 vs. 48 for myocarditis for example. But, there was a consistency.

 

Another article from the journal Vaccine from August 2022 (Serious adverse events of special interest following mRNA Covid vaccination in randomized trials in adults).  This concluded that the Pfizer vaccine had a 36% higher rate of serious adverse events than placebo.  Whereas, the Moderna vaccine was only 6% higher.

 

Does this make sense?  I think yes because a large Veterans study showed that the Moderna vaccine was more effective than the Pfizer vaccine.  881 vs. 1,135 infections over a 6 month period between January and July 2021.   Again, note that there were over 200,000 in each group showing just how effective these vaccines were overall.  (this was from a January 13, 2022 article in the New England Journal of Medicine)

 

Again, it’s not clear why there is such a difference in side effect between these two vaccines.

Final Thoughts

My conclusion is that the vaccines are generally safe. And to be honest, these concerning side effects are still not very common. These scary side effects I think are more related to actually getting Covid, not the vaccine itself.   Meaning, those who get the vaccine can still get Covid.  And, thus if the Pfizer vaccine cohort get more Covid, they would then get more of these Covid related cardiac issues.  (If you didn’t know, Covid causes a lot of thrombotic / cardiac events).  So, if you don’t protect as well against Covid, you are more likely to then get these events.

 

It’s up to you whether or not to get the booster vaccine.  My goal is to provide some context for my advice.

 

Are the vaccines effective in preventing disease?   Yes.  But…not so much with the more recent variants.

 

Are the vaccines effective in preventing hospitalization and serious illness?  Yes, dramatically so initially, and less so currently.

 

Should you get the new vaccine?  This is not as clear cut.

 

The typical side effects remain the same (soreness and redness at the site of injection, fatigue, fever and headache).

 

I would argue the following.  If you are young and healthy then it’s likely the side effects from the vaccine would be somewhat on par with the effects of the virus itself (as it has become less virulent).  Thus, this cohort would find less benefit in preventing severe disease.

Those who are older or with health problems such as obesity, diabetes, cardiac disease, immunosuppressed, they have far more to gain as they are much more likely to end up in the hospital despite the less virulent Covid strains circulating currently.

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