Scrutable

Herainestold wrote: Sun Feb 28, 2021 9:10 pm I am just thinking that it is amazing that we have so many vaccines that all seem to work. We haven't had much luck with anti-virals or other treatment drugs, at least not yet, but the vaccines look like they are a huge success.

"Some of us believe that vaccination should be targeted at the ~20% of the population that is truly high risk, and let the rest of the population acquire broader and more lasting protection from natural infection, an approach that may be safer and more cost-effective overall"

Italian researchers have discovered that healthcare workers with obesity produced only about half the amount of antibodies in response to a second dose of the jab compared with healthy people. Although it is too soon to know what this means for the efficacy of the vaccine, it might imply that people with obesity need an additional booster dose to ensure they are adequately protected against coronavirus.

Previous research has suggested that obesity – which is defined as having a body mass index (BMI) over 30 – increases the risk of dying of Covid-19 by nearly 50%, as well as increasing the risk of ending up in hospital by 113%.

shpalman wrote: Mon Mar 01, 2021 10:45 am Pfizer vaccine may be less effective in people with obesity

Italian researchers have discovered that healthcare workers with obesity produced only about half the amount of antibodies in response to a second dose of the jab compared with healthy people. Although it is too soon to know what this means for the efficacy of the vaccine, it might imply that people with obesity need an additional booster dose to ensure they are adequately protected against coronavirus.

Previous research has suggested that obesity – which is defined as having a body mass index (BMI) over 30 – increases the risk of dying of Covid-19 by nearly 50%, as well as increasing the risk of ending up in hospital by 113%.

Non-peer-reviewed preprint at https://www.medrxiv.org/content/10.1101 ... 21251664v1

bob sterman wrote: Mon Mar 01, 2021 9:25 am Even with highly effective vaccines available - the "Great Bullsh*ttington" types won't stop.

A "Retired pediatrician" reckons he's calculated a Number Needed to Treat for the Pfizer-BioNTech based on the data from Israel, doesn't like the look of it, and is advocating...

"Some of us believe that vaccination should be targeted at the ~20% of the population that is truly high risk, and let the rest of the population acquire broader and more lasting protection from natural infection, an approach that may be safer and more cost-effective overall"

https://www.bmj.com/content/372/bmj.n56 ... -responses

The stupid is so strong in his "response" I can't be bothered to check whether the NNT calculation is correct - but even if it is, it's the NNT to get a benefit during a 42 day period! I would imagine most vaccine recipients were hoping to enjoy benefits over a longer period than this.

And this idea that natural infection is a safer approach for acquiring immunity - how about we compare the IFR for natural infections vs vaccines. Perhaps call it the NNK (Number Needed to Kill).

The frustrating thing is the anti-vaxxers will refer to his comment on an editorial as an "article in the BMJ".

Strongly protective immunity develops rapidly following a single vaccination and at least in the short period covered by the timetable of the Phase III trial, there was no additional benefit from a second vaccination. This increases options for use of this vaccine, e.g., for ring fence vaccination, for use in travelers and for mass vaccination rollout. It highlights the need for further research into duration of immunity following a single vaccination and for understanding mechanisms of protection.

shpalman wrote: Mon Mar 01, 2021 10:45 am Pfizer vaccine may be less effective in people with obesity

Non-peer-reviewed preprint at https://www.medrxiv.org/content/10.1101 ... 21251664v1

Millennie Al wrote: Tue Mar 02, 2021 1:20 am

shpalman wrote: Mon Mar 01, 2021 10:45 am Pfizer vaccine may be less effective in people with obesity

Non-peer-reviewed preprint at https://www.medrxiv.org/content/10.1101 ... 21251664v1

Maybe it just means that the existing dose is inadequate (i.e. not that an additional separate dose is required). There are many treatments which are calibrated by body weight.

shpalman wrote: Tue Mar 02, 2021 2:14 pm

Millennie Al wrote: Tue Mar 02, 2021 1:20 am

shpalman wrote: Mon Mar 01, 2021 10:45 am Pfizer vaccine may be less effective in people with obesity

Non-peer-reviewed preprint at https://www.medrxiv.org/content/10.1101 ... 21251664v1

Maybe it just means that the existing dose is inadequate (i.e. not that an additional separate dose is required). There are many treatments which are calibrated by body weight.

Does that also mean they should need a higher viral load in order to get infected?

Since obesity is a major risk factor for morbidity and mortality for patients with COVID-19(Popkin BM, D. S, Green WD, Beck MA, Algaith T, Herbst CH, et al. Individuals with obesity and COVID-19: A global perspective on the epidemiology and biological relationships. Obes Rev. 2020;21(11):e13128), it is mandatory to plan an efficient vaccination program in this subgroup. Evidence suggests that SARS-CoV-2 infections are more severe and linger for about five days longer in people who are obese than in those who are lean(Drucker DJ. Diabetes, obesity, metabolism, and SARS-CoV-2 infection: the end of the beginning. Cell Metab. 2021).

The constant state of low-grade inflammation, present in overweight people, can weaken some immune responses, including those launched by T cells, which can directly kill infected cells(Vandanmagsar B, Youm YH, Ravussin A, Galgani JE, Stadler K, Mynatt RL, et al. The NLRP3 inflammasome instigates obesity-induced inflammation and insulin resistance. Nat Med. 2011;17(2):179–88).

lpm wrote: Wed Mar 03, 2021 8:38 am The vaccine doesn't reproduce but the immune system thingies do.

basementer wrote: Wed Mar 03, 2021 1:42 pm

lpm wrote: Wed Mar 03, 2021 8:38 am The vaccine doesn't reproduce but the immune system thingies do.

My understanding is that the mRNA vaccine does reproduce. It's more like a conventional attenuated vaccine than an inactivated one: first it subverts the body into producing millions of blank newspaper articles labelled "Daily Mail", then over the next two or three weeks the immune system learns to destroy anything carrying that logo. After that, if exposed to real Mail articles, the immune response will be to turn on the shredder.

basementer wrote: Wed Mar 03, 2021 1:42 pm

lpm wrote: Wed Mar 03, 2021 8:38 am The vaccine doesn't reproduce but the immune system thingies do.

My understanding is that the mRNA vaccine does reproduce. It's more like a conventional attenuated vaccine than an inactivated one: first it subverts the body into producing millions of blank newspaper articles labelled "Daily Mail", then over the next two or three weeks the immune system learns to destroy anything carrying that logo. After that, if exposed to real Mail articles, the immune response will be to turn on the shredder.

shpalman wrote: Wed Mar 03, 2021 8:54 am Why should there be a difference? The whole point of this paper is that we know COVID-19 is more severe in obese individuals

Since obesity is a major risk factor for morbidity and mortality for patients with COVID-19(Popkin BM, D. S, Green WD, Beck MA, Algaith T, Herbst CH, et al. Individuals with obesity and COVID-19: A global perspective on the epidemiology and biological relationships. Obes Rev. 2020;21(11):e13128), it is mandatory to plan an efficient vaccination program in this subgroup. Evidence suggests that SARS-CoV-2 infections are more severe and linger for about five days longer in people who are obese than in those who are lean(Drucker DJ. Diabetes, obesity, metabolism, and SARS-CoV-2 infection: the end of the beginning. Cell Metab. 2021).

so it's important to figure out if the vaccine is also less effective in them (which turns out to be the case, at least for the endpoints measured in the paper).

It may not necessarily be because

The constant state of low-grade inflammation, present in overweight people, can weaken some immune responses, including those launched by T cells, which can directly kill infected cells(Vandanmagsar B, Youm YH, Ravussin A, Galgani JE, Stadler K, Mynatt RL, et al. The NLRP3 inflammasome instigates obesity-induced inflammation and insulin resistance. Nat Med. 2011;17(2):179–88).

but it's a better mechanism than "there's more of an obese person so it's harder for their immune system to cover all of it" and there's no need to postulate differences between the infection and the vaccine because they are developing less immune response to both.

Herainestold wrote: Wed Mar 03, 2021 2:34 pm So why is COVID-19 more severe in POC and BAME individuals? Do we know?

Lothar Wieler, the head of the Robert Koch Institute, Germany’s disease control agency, has been quoted by German media as saying the topic was “taboo” for the German government who feared the debate could be seen as racist. He reportedly called it a “huge problem” that had “massive implications” for the government.

...

There has been very little public debate in Germany about the extent to which people from minority ethnic groups might be affected more by the virus, whether owing to not being reached by government communications on the virus, or to a higher risk of exposure through work, or to other reasons such as health issues or living arrangements.

Herainestold wrote: Wed Mar 03, 2021 2:34 pm
So why is COVID-19 more severe in POC and BAME individuals? Do we know?

Herainestold wrote: Wed Mar 03, 2021 2:34 pm

So why is COVID-19 more severe in POC and BAME individuals? Do we know?