Covid-19 vaccines and vaccinations

A Boston hospital is opting against providing a heart transplant for a 31 yr old man who refuses to get vaccinated against COVID-19. The hospital policy requires transplant patients to receive a vaccine.

Given the shortage of available organs, they want to ensure that a patient who receives a transplanted organ has the greatest chance of survival.

 

I most likely wouldn't have gotten vaccinated this past summer b/c of a vestibular virus and dizziness. My city made it possible by providing homebound services.

 

But is this evidence-based? Given the immunosuppresant medication, any protection will be due to circulating antibodies or T-cells induced before the transplant - the former of which is known to wane very quickly with regards to Omicron.

Some people on Reddit are making it out to be a more general decision based on compliance and the willingness of patients to comply with medical directions (example - obese patients or smokers advised to make changes before they are eligible).

 

I think maybe some other quotes might help.
(NB I have to admit, the quote you chose did make me uncomfortable. The reason I get no medical care is because there’s a lack of research and known effective care to give me. I dislike that every mention of my illness requires reference to over-emotional women - no matter what they’re saying when they mention it).

Try:
“During times of crisis, loosening one’s ethical standards is especially tempting, but it’s especially important to hold them high, Wynia told me. That’s a frustrating line for health-care workers to hold, however. They will continue to suffer from burnout, moral distress, and harassment—and many will quit. Medical care will be spread even more thinly. Some people who did everything they could to avoid COVID may die from unrelated conditions. None of this is fair. Nor is it solely the responsibility of unvaccinated people.”

or
“COVID remains a collective crisis—and one driven more by political inaction than personal irresponsibility.”

My own thought: He doesn’t say this but all the countries who needed vaccines and were denied access…maybe we should be more upset about that? That’s how we keep breeding more variants: more people in the whole world getting it and bouncing it around.

It is a good article as a reminder that we need to look at all forms of mitigation, not just the vaccines. And social inequities that get in the way of access to medical care (which includes good advice, relationships with medical people you can trust, and vaccines etc).

What it misses is a sentence to remind us that this is a global problem, one that can only be ‘over’ when we act globally.
I think: If we keep breeding this thing, whether it’s in central Africa or North America, it’s going to keep thriving.
It was a nice reminder @mango, thank you, that it’s too easy to blame or our annoying neighbour etc when the problem is on a larger scale.

Step one: retain your ethics. They have been developed in hard times, you’ll be needing them.

I’m glad to be reminded that if the problem fits a socioeconomic profile, maybe it needs a better look at the barriers in the way of help.
I think access is under-considered. It’s not the only factor, some people without socioeconomic issues are simply behaving badly, but sometimes it’s the start.
Rural people on a budget will have access difficulties that those in metro centres cannot imagine.

 

@Snow Leopard

I don't know if it's based on evidence, but Dr. Arthur Caplan (professor, medical ethics) states that its' 'necessary' for this type of procedure. He says that our immune system is 'shut off' after any transplant, kidney, heart whatever and that organs are rare.

The flu/cold could kill us too, so I'm wondering if the hospitals policy also includes patients that refuse the flu-shot? That would be interesting to know.

 

If the immune system is simply "shut off", then prior vaccinations won't work either, by definition. The reality is the immune system responses are suppressed due to the medication, but this is not the same as it being entirely "shut off".

Here is a recent study of a third vaccination of (post)transplant recipients. https://www.medrxiv.org/content/10.1101/2021.12.29.21268529v1

The results show that protection against Omicron was very weak before the third dose and was still weak afterwards.

Another recent study. https://www.medrxiv.org/content/10.1101/2022.01.03.22268649v1

This is not the same as vaccinating people before transplantation - but we know the neutralising response against omicron is weak and wanes very quickly. It remains to be seen if 8-12 weeks of weak protection post-vaccination will actually make a difference.

 

Pfizer has recently started testing Omicron-specific vaccine, so we will see how that goes.

 

It is possible to get the 4th shot here now. I'm kind of thinking about it, as I had my third one back in August. But I read all kinds of conflicting things about it, so I'm not sure if it is really worth getting it. Is it useless against omicron and the possible later variants? Does it still build protection? Would it be wiser to wait for a newer vaccine that targets newer variants? So I'm kind of confused. @Snow Leopard Is it possible to tell if it is worth it based on what we know right now?

 

@Wyva

I'm weary of the 4th shot too.

This came out today:

https://www.nature.com/articles/d41586-022-00200-9

 

So.....my 2 jabs of AZ are seen as largely ineffective against infection by omicron (which makes it extra special that people, who have had just these, are no longer seen as needing to isolate in the UK, when omicron is basically the only game in town), and my booster, received mid October, is about to 'run out', in an area with a 'rate' of nearly 1500 per 100,000.

I have to wonder, am I wasting my time eating salads, which I hate, in order to be a thinner corpse

(Yep, I'm having one of them days )

 

If the virus is circulating in significant numbers, some (weak) protection can be better than nothing. It still provides good protection against Delta too, if it is circulating in your region.

Ideally we'd have supply of vaccines against Omicron within a month (that is the strength of using mRNA technology - it is simple to change the 'formula' - if they made the decision in mid-Nov, we'd have them soon). But realistically they are at least 2 months away in terms of supply and you might have to wait 3 months or more given the demand.

So given that it has been 4-5 months since your booster, if you want additional protection now, and if you don't have any demonstrated health reasons to avoid the booster I'd suggest getting another booster.

 

I disagree with Ed Yong, I live in a rural area of the US, (78.4% voted for the Republican Party, in the last election) we are at 2,940 cases per 100,000. Vaccination cards are not necessary for any event. Only medical offices require masks. Sport events and businesses are open like it is 2018. Only a handful of us wear a mask when in the shops. Physicians are openly mocked.

In my area, vaccines are free, free travel is provided by the local governments. A county nurse gives free vaccination to home bound people. 48% are fully vaccinated. Less than 20% have received a booster. I got my Moderna booster in November. I'm 55 and was the youngest person in the booster queue.

I agree with Ed Yong, unvaccinated people should receive healthcare. However, so many nurses are needed for the unvaccinated it is causing a problem.

A local man was hit by a car while strapping down his bulldozer. There was no bed open at our small hospital. So the ER agreed to send him home. Less than 24 hours later, he had a stroke. He was then flown to the closest city. His left side is now messed up. Secondly, he needs inpatient rehab, but that is full of Covid patients with organ damage. So he is receiving at home rehab.

 

I personally would wait to see what new vaccines come out in the near future. I don't see the point of repeatedly being injected with a vaccine that isn't long lasting and obviously isn't working as well as it was hoped.

 

Apart from new-variant specific vaccines, there isn't going to be much innovation in the near future. I've seen others speculate (such as on Reddit) about "2nd generation vaccines", but I fear those people are going to be disappointed.

Perhaps nasal vaccinations uses as boosters may help (especially if expected people to be vaccinated every 3 months!), but the nasal Influenza vaccine (AstraZeneca's "FluMist"), which is based on a live virus has poor efficacy compared to the intramuscular injected vaccine.

The lack of longevity is a characteristic of a highly transmissible respiratory virus with a relatively short incubation period. Some protection against severe outcomes will be preserved long term because it is reliant on memory T-cells and most T-cell epitopes are preserved between variants. But T-cell responses require cells to be infected in the first place and SARS-CoV-2 has several tricks whereby it suppresses immune responses (particularly Type-1 interferon responses).

Protection against symptomatic infection requires antibodies that immobilise the virus before many cells are infected - which requires blocking the receptor binding domains of the spike protein, with well targeted antibodies that lead to direct blockage of binding, or opsionisation that leads to clearance by the immune system before the virus has a chance to bind to the cell membrane and enter the cell.

It is essentially a race for the virus to enter the cell before it is inhibited.
New variants means that there may no longer be effective antibodies that block the receptor binding domains.

The generation of antibodies on an ongoing basis is dependent on the lifespan of the antibody secreting plasma cells (that I can't really think of any way to enhance by vaccine design, but who knows). It is also dependent on the formation of new plasma cells from the germinal centres, which do survive over time, so long as there is a source of antigens. The availability of antigens is dependent on the flow of antigens into the germinal centres in the lymph and their non-destructive capture by follicular dendritic cells. But the use of these antigens in affinity maturation means the numbers decline exponentially over time. Researchers decades ago have shown that small amounts of antigen are preserved for the lifespan of a rat - but in low numbers. As far as I know, none of the vaccines in development are specifically looking at the kinetics of antigen preservation by follicular dendritic cells and how that could be enhanced (and I don't have any specific ideas either - I'm not sure how much of an effect adjuvants can have in the case of subunit vaccines and the availability of the antigen over time.).

As you may have guessed, since the availability is based on exponential decay, a larger amount of antigen in the first place will lead to better numbers, at least in the short term (<12 months). This is in part why the mRNA vaccines have superior efficacy compared to the viral vector vaccines and inactivated virus vaccines - a greater effective dose of the antigen where it matters in the germinal centres used to train B-cells.

 

Anyone got any thoughts on this article "Covid-19 vaccines are probably creating a ‘nocebo effect’" by Dr Siouxsie Wiles (Microbiologist and science communicator. Her specialist areas are infectious diseases and bioluminescence), Bioluminescent Superbugs Lab, Auckland University, New Zealand

https://www.stuff.co.nz/national/he...accines-are-probably-creating-a-nocebo-effect

Which refers to this systematic review https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(21)00239-8/fulltext

 

Haven't read the whole Lancet review, just done a quick word search to see if they mention levels of background symptoms in the general population. Because when you specifically ask people if they have common symptoms like fatigue or headaches quite a few will answer yes, whether related to the vaccine or just coincidental.

This is the only bit the word search found, my bolding:

So, no extra symptoms over and above the population background level. It may very well be that people misattribute the symptoms they're coincidentally experiencing to the injection (vaccine or placebo) but that's misattribution, not nocebo as I'd define it as for me the term nocebo implies additional symptoms conjured up through the power of expectation.
I don't know how the study's authors define nocebo.

 

It's a similar problem to the "LongCOVID" (in quotes because the authors don't understand what LongCOVID is) studies. They think that measuring whether someone reports having a symptom on a symptom checklist implies the same symptom burden. But it is not, because they are not measuring the severity and impact of those symptoms.

 

Someone we know well has reported having much heavier periods since her covid booster injection. There seems to be talk of it on the web, but thought I'd try and get a more objective indication from our forum here. She is in her early thirties, and has never experienced this before.

 

I think the problem is that almost everyone is having a booster injection.
And a few people from time to time suddenly get heavy periods.
So there are bound to be a few people with both.