2022-02-09 General

Vaccines

You know how the mRNA vaccines are f amazing? I want to take a moment to say that I think the next generation of vaccines are going to be even more effective. There have been a rash of papers recently which indicate that we humans still have tricks up our sleeves:

• Multiple targets: All the approved vaccines I know of present the spike protein to the immune system and nothing else. There was a paper I reported on just yesterday where they compared presenting parts of the spike, nucleocapsid and another protein, vs. only the spike, and the former did way better than the latter.
• Nasal inoculation: There have been multiple papers where a nasal spray worked better than an intramuscular injection. There was another paper which found that doing a low dose intramuscular injection followed a respectful interval later by a nasal inoculation worked really well.
• Different stabilization: When it isn’t anchored to a big ball, the spike protein tends to flop around, which isn’t so good for training an immune system to recognize an unfloppy spike. The mRNA vaxes use a modification to the spike called 2-proline stabilization to keep it from flopping around; there’s a more recent stabilization called 6-proline stabilization (which the NDV-HXP-S family of vaccines is going to use) and another called VFLIP which is apparently even better.
• Multivalent vaccines: All the currently approved vaccines are tailored to the COVID Classic variant. You would think that an Omicron-specific booster would be a good idea, but you’d be wrong: for some reason, the Omicron-specific boosters only seem to be about as good as the COVID Classic boosters against Omicron, and much much worse against any of the non-Omicron strains. However, if you mix up a batch of half-Omicron and half-COVID Classic, that works much better. I can imagine that a dose that’s one-sixth COVID Classic, one-sixth Alpha, one-sixth Beta, one-sixth Gamma, one-sixth Delta, and one-sixth Omicron would be really hot.

There have also been studies recently having success with freeze-drying vaccine and with an oral formulation. This won’t give an individual any more protection, but should help a lot with vaccine distribution — which will help community protection.

Most of these techniques are still in the pre-clinical stage (i.e. they are doing tests on lab animals), so we won’t see them for a few years, but they are coming!

---

This preprint from Italy looked at myocarditis and pericarditis in people who got either Moderna or Pfizer vax. The increased risk (over not getting a vaccine) was:

	after first Pfizer	after second Pfizer	after first Moderna	after second Moderna
in first week after dose	1.27x	3.39x	6.55x	7.59x
in first week after dose, males 12-39 y/o	1.53x	3.45x	6.55x	11.91x
in first week after dose, females 12-39 y/o	0.88x	3.88x	0.69x	2.08x
in 12-17 y/os	1.06x	5.74x	N/A	N/A
in 18-29 y/os	1.76x	4.02x	7.58x	9.58x
in 30-39 y/os	0.86x	0.97x	6.57x	3.22x

NB: These numbers look scary-high, but remember that the unvaccinated risk of myocarditis is extremely low, and the risk of getting myocarditis from COVID-19 is much higher.

---

This preprint from Qatar says that both Pfizer and Moderna are crap against Omicron infection six-ten months after vaccination. Boosters help, but those wane as well.

Pfizer still does well against severe disease — ~80% after two doses and ~90% after three. (They didn’t have severe disease data for Moderna.)

Long COVID

This preprint from Estonia reports that people are at an elevated risk of dying long after their COVID-19 infection: more than 3x in the first year, and almost 14x in the first five weeks. For those over 60, the risks were:

• 2.1x for cardiovascular issues
• 1.5x for cancer
• 1.9x for respiratory diseases
• 1.8x for other causes

Variants

This Letter to the Editor from Qatar says that a prior infection has different protection against different second infections:

• 90.2% against Alpha;
• 85.7% against Beta;
• 92.0% against Delta;
• 56.0% against Omicron.

(No, they didn’t look at what variant the prior infection was. That would have been interesting too!)

Mitigation Measures

A few days ago, my post included a graphic which showed the effectiveness of different kinds of masks. This thread points out that the control group was not well-chosen, so the results are questionable. Alas.

Pathology

This paper found that pregnant people with a moderate to severe case of COVID-19 were twice as likely to have major complications with their pregnancy as non-COVID-19 people, and 17% more likely to have a cesarean birth. Good news, though: mild cases were not significantly more likely to have severe outcomes or C-sections.

Testing

This paper reports that they figured out a way to tell – with over 80% accuracy – from blood if someone was unvaccinated, unvaxxed with a prior infection, vaxxed with no infection, or vaxxed with infection. They could even tell if you’d been vaccinated first or infected first.