Sunday, September 5, 2021

Re Covid, what you knew a few months ago is different now. Thank Delta variant and vaccines.


The pandemic is changing. What we knew a year ago is different now.

Here’s some of the latest.

This disease is now driven by the unvaccinated population. The unvaccinated are a minority of the population, but they dominate both all illness and severe illness requiring hospitalization.

An August 2021 study by the Centers for Disease Control of health care facilities in Los Angeles found that if you were unvaccinated, you were 5 times more likely to get the disease and 29 times more likely to require hospitalization for COVID.  

Young people seemed somewhat protected from the early strains of the virus, but that is changing.

“Rates of COVID-19–associated hospitalization among children and adolescents increased rapidly from late June to mid-August 2021, coinciding with predominance of the Delta variant,” the CDC reported.

(Children aged 12 to 17 are eligible for vaccination. Children 11 and younger are not currently eligible.)

Children are getting sick at higher rates than they were early in the epidemic, and unvaccinated kids are getting far sicker. Unvaccinated teenagers are 10 times more likely than those vaccinated to require hospitalization.

Among kids aged 0 to 17, “Emergency department visits and hospital admissions in a 2-week period in August 2021 were higher in states with lower population vaccination coverage and lower in states with higher vaccination coverage,” the CDC said

The changing dominant variant has changed the behavior of the pandemic. Where children were not particularly likely to get the Alpha variant, they seem more likely to get the Delta variant.

“Weekly rates of COVID-19-associated hospitalizations per 100,000 children and adolescents younger than 18 years old increased nearly five-fold, from 0.3 during the week ending June 26, 2021, to 1.4 during the week ending August 14, 2021,” the CDC said.

The data shows that among children, the youngest children are at increased risk.

“The sharpest increase during this period occurred among children aged 0-4 years, for whom the rate per 100,000 children during the week ending August 14, 2021 (1.9) was nearly 10 times that during the week ending June 26, 2021,” said the CDC.

© Jan TenBruggencate 2021

Friday, September 3, 2021

Vaccination against the Delta variant: the newest COVID-19 research

The Delta variant has upended the decline in COVID-19 numbers, but the most recent scientific reports indicate vaccination continues to be dramatically effective against it.

The disease is changing with new variants, and the science is changing as more and more researchers report data reflecting the new dominance of the Delta variant. We reviewed the latest scientific studies, which reflect the presence of Delta. The general conclusions are:

Delta is more capable of overcoming vaccination than Alpha or other variants.  That said, vaccination still provides remarkable protection—far more than half of vaccinated individuals will never experience illness with symptoms that make them feel sick.

❷ Vaccination will make you three times less likely to be infected than not being vaccinated. The COVID vaccines provide strong protection—better than the flu shot does against flu.

❸ Underlying medical conditions still increase the threat of severe infection requiring hospitalization, whether you are vaccinated or not, but vaccination improves your odds of experiencing few or no symptoms.

Here are some of the points in research published within the past three months. I have included hyperlinks so you can look at the original source material.

An Israel study showed that vaccination protection from the Pfizer vaccine dropped from 94 to 64 percent when measured against the Delta variant, the protection for the need for hospitalization only dropped from 97 to 93 percent. Meaning there was an increased chance you might get sick, but you were still extremely unlikely to get very sick. 

An India study similarly showed that while Delta gets through vaccination (which researchers call “breakthrough” infections) a little more effectively than other variants, most vaccinated individuals never get sick. 

An English study done from May to July 2021 found that during the study, earlier variants were completely replaced by Delta. And they found that unvaccinated people were three times more likely to get sick than the vaccinated. 

A Singapore study showed the mRNA vaccines, like Pfizer and Moderna, are extremely effective against the Delta variant. This study found that vaccinated patients who did experience breakthrough infections were much more likely to have no symptoms, while unvaccinated individuals were much more likely to get very sick. 

A Mayo Clinic study in the United States reviewed Moderna and Pfizer vaccines January through July 2021 confirmed that both were generally highly effective, but were less effective against Delta. That said, both are much more effective than the seasonal flu vaccine is against flu. 

A Canadian study found that all available vaccines provide significant protection against all variants. Single-dose vaccination provided some protection but full vaccination (2 doses properly timed) was far better. 

A BMJ (formerly British Medical Journal) article notes that vaccination provides good protection against infection, but that it provides excellent protection (in the 90+ percent range) against being so sick you need hospitalization. 

A Welsh-Scottish-Irish study found that vaccines provide similar or better protection than having actually had the disease. And even if you have had the disease, vaccination increases your protection against reinfection. “Effectiveness of two doses remains at least as great as protection afforded by prior natural infection,” the report says.  

The upshots are these:

Some vaccinated people will still get sick. That is the case with all vaccines--they are not 100 percent effective. As as case counts rise, you'll hear about more of these breakthrough infections, but that doesn't mean vaccines are not working.

All the newest evidence shows that vaccination makes you less likely to get infected with COVID-19, and that even if you do get infected, you are dramatically less likely be so sick that you’ll need hospital care.

Put another way, at this point in the pandemic, if you are not vaccinated,  you and your family are at dramatically higher risk of infection and severe illness.

© Jan TenBruggencate 2021

Monday, July 19, 2021

Your odds if not vaccinated are worse than drawing to an inside straight

Did you get the flu vaccine but not the COVID-19  vaccine?

How about that decision?

According to the Mayo Clinic

In the 2019-2020 flu season, 22,000 deaths among 38 million cases. Somewhat less than 1 in 1,000.

In the COVID-19 epidemic in 2020-2021, 580,000 dead among 32 million cases. Somewhat less than 2 in 100.

If you get the disease, you are 30 times more likely to die of COVID-19 than the flu. And these numbers don’t yet reflect the full impact of the new, more virulent Delta Variant.

Among vaccinated individuals, the death rate drops to less than 1 in 100,000, and most of those deaths are among frail, elderly folks in care homes.

Not getting vaccinated is betting on an inside straight. You might get lucky, but the odds are stacked way, way against it. Less than 1 in 10.

Tuesday, December 8, 2020

Nihoa Island: Conservation crucible protects the last of a genus

Swimming in the clear, 60-foot waters in the lee of Nihoa’s western cliffs, I came across a floating leafed branch blown off the island in high winds.

It was, of course, a native plant: `aweoweo, an edible amaranth that is found on all the small islands from Nihoa to Laysan and Lisianski.

Little Nihoa rises abruptly from the sea 160 miles west of Kaua’i and Niihau. It is a fragment of an old, larger volcanic island, with steep basalt cliffs on three sides, a single sandy beach, and small forests of native loulu fan palms.

The `aweoweo is in good company. Nihoa is also home to many other native species, from the Hawaiian monk seals that sometimes litter the white sand beach by the dozens, to the native Nihoa miller birds that perch in the low bushes, to the native clumping grass, Eragrostis variabilis.

And, it turns out, on the blades of the grass, known in Hawaii as kawelu, there is an exceedingly rare tiny snail found only on this little island. The snail has been known to science for a century, but has only now been given a name.

Endodonta christenseni, photo by David Sischo

It is believed to be the last survivor of the 11 species of Endodonta snails of the Hawaiian Islands.

The story of the Nihoa snail was published in the October 15 issue of the Bishop Museum Occasional Papers, under the title, “The last known Endodonta species? Endodonta christenseni sp. nov.”  

The authors are Kenneth Hayes, John Slapcinsky, David Sischo, Jaynee Kim and Norine Yeung.

They write the snail’s story with a passion many might find unusual in scientific literature:

“Here we finally give what we think is the last Endodonta species a name and describe it using an integrative taxonomic approach. 

“In describing this last Endodonta species, our hope is to inspire increased awareness and appreciation that facilitates and motivates conservation for this species and all the other undiscovered and unnamed species threatened with extinction. 

“Unless protection of this species is implemented, it may be extinct within the next decade and we will lose the last of a lineage that existed for millions of years, and the stories it could tell.”

The snail was discovered on an expedition to Nihoa in 1923, and seen again periodically since then, including by land snail expert Carl Christensen, after whom it was named. 

There’s not much to this snail. It is described as pea-sized. Viewed from the side, it is shaped like a flying saucer. The shell has a complex pattern of striped whorls in browns and tans. And when it’s traveling, the little snail’s two antennae stretch out ahead of it.

The authors say it probably spends most of its time in the moist hearts of the grass clumps, and feeds on films of fungus that form on dead leaves. 

In a press release, co-author Yeung said that there remains hope that other rare species exist and can be protected and saved. “We need to act quickly and decisively if we are to beat the extinction clock that ticks louder with each passing day,” she said.

The paper emphasizes how critical the conservation challenge is: "Despite 15 years of sampling across more than 1000 sites throughout the Hawaiian archipelago, none of the 11 previously described species of Endodonta has been observed in our studies and it is likely that all are extinct. Endodonta christenseni sp. nov. is the only known extant member of the genus and quite possibly the last."

One ray of good news is that related land snails have been raised and increased number in captivity, and it is possible that the Nihoa snail could be re-introduced to parts of the island where it has disappeared due to human-caused wildfire during the 1800s.

© Jan TenBruggencate 2020

Sunday, December 6, 2020

Coronavirus vaccines in Hawai`i: where are we, when are they coming, who can get them?

The COVID-19 vaccine is right around the corner, and it won’t be one vaccine, but several…maybe lots.

What do we know about them?

The old school way to get immunity to a disease is to get the disease. When I was a kid and had the mumps, all the neighbors sent their kids to visit, so they could get the mumps, too. Safer to get mumps as a child than as an adult.

Another way to get immunity is to be exposed to a weakened form or inactive actual virus—which promotes the immune system to respond, but doesn’t actually make you sick. Measles and chickenpox vaccines are these. But that’s not what we’re dealing with in most COVID-19 vaccine trials likely to be used in the U.S.

If you need to stop a car from getting to its destination, you have many options: remove the driver, drain the fuel, blow out a tire, blockade the road, poke a hole in the radiator. 

There are also lots of different ways the body fights a virus, and different vaccine approaches tackle the problem in different ways. 

There are dozens of different vaccine trials underway. They go through a range of trials to prove they work and that they’re not dangerous. Some fall by the wayside due to problems of various kinds, including side-effects, not a strong enough immune response, and any of a lot of other issues.

The companies whose vaccines seem nearest approval in the United States are Pfizer, AstraZeneca, Moderna and Johnson&Johnson, not necessarily in that order. Pfizer and Moderna have already asked for emergency FDA approval for release in the United States.

Russia and China have actually released and are using vaccines, but these have not gone through all the safety and effectiveness trials that most Western medical officers recommend. 

Pfizer and its partner BioNTech have actually released a vaccine in England. It is BNT162b2, which is approved for emergency use in the United Kingdom, and which they say is more than 90 percent effective and has few side effects (like fatigue or fever). One bonus is that it has high effectiveness in elderly people, who sometimes don’t respond well to vaccines.

But there are many more vaccines in the pipeline.

So how are vaccines different? (Caveat: This is hyper complicated, so these brief paragraphs are more place markers than useful descriptions.)

There are the nucleic acid vaccines, which use bits of the genetic code of the virus (but not the actual virus) to train your immune system to recognize and fight the virus. The Pfizer and Moderna vaccines use this technology. 

Viral vectored vaccines use a harmless virus to ferry a fragment of the COVID genetic material to the immune system, so it can recognize and fight the virus if you’re exposed.  The AstraZeneca/University of Oxford and Johnson&Johnson vaccines use this technology. 

Protein subunit vaccines introduce isolated COVID-19 proteins from the virus into the body. They can’t introduce the disease, but they can produce an immune response. Novavax has the vaccine with this technology that’s closest to approval.

Chinese and Indian companies are leaders in working on inactivated or weakened virus vaccines, which is a more traditional vaccine technology, but the vaccine can take a long time to manufacture.

Here is a Washington Post piece on the various technologies, with a little more detail. 

Some of the vaccines require two doses for full effectiveness. (Johnson&Johnson’s is a one-dose vaccine.) Some need special care in handling, like super cold temperatures—but while that can require specialized refrigeration units, they can generally be transported in coolers on dry ice to immunization facilities. So you don’t need all that many high-tech freezers.

If you’re following the vaccine issue, you know that one of the big issues is when vaccines will be available in large amounts and who gets a vaccination first. The AARP has a piece reviewing the state of vaccine issues here. 

There is a fairly straightforward approval process. First, the Food and Drug Administration is authorized to issue an Emergency Use Authorization. As mentioned earlier, Pfizer and Moderna have already applied; others aren't far behind.

Emergency Use Authorization by the FDA is permitted in emergencies like a pandemic. The organization itself says it “may allow the use of unapproved medical products, or unapproved uses of approved medical products in an emergency to diagnose, treat, or prevent serious or life-threatening diseases or conditions when certain statutory criteria have been met, including that there are no adequate, approved, and available alternatives.” More data here. 

Once the FDA does its part, the ball is the court of the Centers for Disease Control and its Advisory Committee on Immunization Practices, which not only decides whether to approve, but who should get it. The committee has already voted that the first recipients will be “health care personnel, other essential workers, adults with high-risk medical conditions, and adults aged ≥65 years (including residents of long-term care facilities.)” 

It’s a big deal and there’s lots of pressure, so prognosticators are suggesting approval could happen before Christmas, or at least before the end of the year.

Meanwhile, officials in every state are setting up their vaccine distribution plans. And yes, that includes Hawai`i. You can learn more about our state's vaccination program here

© Jan TenBruggencate 2020