This week, there have been a TON of articles with “What you need to know” in the headline. “What you need to know about the fall vaccines”, “What you need to know about BA.2.86”, “What you need to know about COVID this fall”, “What you need to know about COVID rapid tests heading into the fall”, “What you need to know about the rising COVID cases”, What you need to know about COVID for back-to-school”. It actually made it a bit more difficult to find interesting articles. 🙁
Media
This article from the US says that Meta has disabled keyword searches for anything related to COVID-19. It’s completely unclear why. Something about it being “potentially sensitive content”. ???
Vaccines
On Sept 11, the US FDA approved both Pfizer and Moderna XBB.1.15-based vaccines. It needs to go through a US CDC committee and then get the head of the US CDC to approve it. It is still evaluating the Novavax vaccine probably waiting until Novavax has data on its effectiveness against BA.2.86. (Pfizer and Moderna already had the data, but Novavax is a much, much smaller company and probably doesn’t have the resources to test against every variant.)
Not to be outdone, one day later, Health Canada approved the Moderna XBB.1.5 vaccine. There is no further approval needed, doses just need to get on Canadian shelves, which this article reports will probably happen in early October.
A few hours after that, the US CDC Advisory Committee on Immunization Practices (ACIP) met, where Moderna, Pfizer, Novavax presented their data on their XBB.1.5-based vaccines.
From the Moderna slides:
(Aside: I think it’s interesting that the XBB.1.5-base vaccine is better against XBB.1.16 than it is against XBB.1.5!)
Note that the Moderna XBB.1.5-based vax elicits much better antibodies than the bivalent BA.5 against what’s circulating now (look at the numbers, not the size of the bar):
From the Pfizer slides:
Pfizer compared one dose of the XBB.1.5 vax to multiple doses of earlier vax. That might be disingenuous: there is some evidence that having a vax based on an older strain degrades the effectiveness of later vaccinations with newer strains.
From the Novavax slides:
Again, the Novavax vaccine might be slightly less effective in most humans than the data promises because most humans got vaccinated with COVID Classic and not BA.5. On the other hand, most humans have gotten infected with something more recent than COVID Classic, so ¯\_(ツ)_/¯.
The new vaccines all reportedly do well against what’s currently circulating (e.g. EG.5.1 and XBB.1.16.6). From the Novavax presentation to the FDA on 11 Sep :
From another presentation at the ACIP meeting, they found that essentially nobody suffered any adverse effects from the bivalent boosters. TWO people — both men under 40 — had myocarditis or pericarditis. TWO.
This paper from USA/Novavax provides some evidence for Novavax’s original formulation getting more durable the more shots you have. It’s a little hard to eyeball from the chart, but the correlates of protection dotted lines on the IgG antibody chart (top chart, A) imply that effectiveness drops from ~91% to ~76%(a 17% drop) in 154 days after the second shot, but only from ~95% to ~92% (a 4% drop) in 140 days after the third shot. (Yes, yes, 140 is smaller than 154, but I really don’t think the effectiveness is going to drop that much in two weeks!)
From the neutralization titres chart (bottom chart, B), it’s even more extreme. Eyeballing, the imputed VE drops from ~87% to ~50%? (wild guess, as the dotted lines don’t go that low) (a 43% drop) in 154 days after the second shot, but only from ~93% to ~87% (a 7% drop) in 140 days after the third shot.
And look at how strong three doses of the COVID Classic-based Novavax is against BA.4/5! I have been saying for a long time that my interpretation/extrapolation of what I’d seen was that Novavax gave weaker protection than mRNAs against variants the vaccine was based on, but that it gave broader protection. I’m glad to see data that pretty explicitly supports that.
This paper from Moderna says they made a version of its vax which doesn’t encode the whole spike protein, just two important parts which act as “keys” to “unlock” the target host cell. This new vax is fridge-stable instead of needing ultra-cold Even more importantly, it works as well or better (in mice) than Moderna Classic.
This makes sense to me: when presented with the whole spike protein, the human body could spend a lot of effort making antibodies that glom onto parts of the spike protein that don’t matter. If your immune system only sees the “keys”, it will only make antibodies that gum up the keys. More efficient! (Which maybe also means lower doses, which ought to mean lower side effects.)
This paper says that sub-lingual (non-injected) vaccines given to monkeys did a good job of eliciting IgA antibodies — the ones responsible for protecting mucous membranes.
(The paper made me imagine the poor scientists trying to put pills or liquids under the tongues of monkeys. Yeah, sublingual vaccination might be easier for humans, but I imagine that’s got to be one of the hardest ways to vaccinate monkeys!)
Long COVID
From a slide deck from the 12 Sept 2023 US CDC Advisory Committee on Immunization Practices meeting:
This preprint from South Africa and the UK says that the majority of Long COVID patients treated a with a combination of three different anti-coagulants had their symptoms resolve!
This paper from USA found that children who got two doses of vax were 46% less likely to test positive for COVID-19 if they showed up at the ER or to Urgent Care. The vaccine effectiveness was 30% against ER/Urgent Care visits and 40% against hospitalization.
That sounds pretty low, but the control — unvaccinated children — probably had a lot of COVID-19 infections.
COVID-Related Excess Death and Sickness
This paper from USA (from March 2022) found that people who had COVID-19 infections had higher risks for various things than controls:
- 7.55x risk of respiratory failure;
- 5.66x risk of fatigue;
- 4.43x risk of hypertension
- 2.63x risk of memory difficulties;
- 2.59x risk of kidney injury;
- 2.50x risk of mental health diagnoses;
- 1.47x risk of hypercoagulability;
- 2.19x risk of cardiac rhythm disorders.
Note though, that compared to a historical pre-COVID group which had viral lower respiratory illness, only respiratory failure, dementia, and post-viral fatigue had increased risks! Viruses are just plain nasty, don’t catch them!
This preprint from UK says that people who got vaccinated then got a COVID-19 infection had higher levels of anti-spike antibodies, but lower levels of anti-nucleotide antibodies than unvaccinated people who got infected. They theorize that maybe being vaccinated meant that they didn’t get as sick, so didn’t create as strong a reaction to the nucleotide proteins. (Reminder: the vaccines don’t have nucleotide proteins.)
They also found that higher levels of anti-spike antibodies correlated with shorter duration infections, though the severity of the symptoms seemed to be about the same. However, people with higher anti-spike antibodies were less likely to have six or more symptoms and also had lower Ct values (which correlates with infectiousness, I believe).
Variants
This paper from USA found that COVID-19 was running pretty rampant in white-tailed deer in Ohio. Worse, it has jumped to humans at least 30 times just in Ohio. Even worse, they estimate that it’s mutating three times faster in deer than in humans. 😬
Testing
This review article found a ton of papers which agreed that dogs can be trained to detect COVID-19 very accurately. Dogs can tell the difference between COVID-19 and other respiratory illnesses, aren’t thrown off by variants, and there is also evidence that dogs can recognize Long COVID!
This paper from India found that 12% of COVID-19 patients in their sample had detectable levels of SARS-CoV-2 in their eye fluids, in patients both with and without eye symptoms.
Transmission
Does vaccine-acquired immunity help stop spread more from protecting the uninfected person or reducing the contagiousness of the infected person? This paper from Switzerland which looked at secondary attack rates (from contact tracing) found that partial immunity from vaccination in the infected person didn’t affect the secondary attack rate much, but immunity in their contacts did, as long as it was recent. Infection-acquired immunity in the infected person did reduce the secondary attack rate in earlier strains, but helped less and less as more variants showed up. Infection-acquired immunity in the uninfected contact helped quite a bit, and got more helpful as different variants showed up.
A while back, I reported on one study which said that there was basically no live virus exhaled by COVID-19 when they were just sitting quietly, i.e. not singing, exercising, yelling, etc. This paper found that there was quite a bit of SARS-CoV-2 RNA found in the breath of COVID-19 patients who were sitting quietly.
They also found that the level of virus RNA in the breath didn’t really drop until day 8. (I continue to say that the advice of BC (and US) CDC that you can resume normal life after 5 days is total bullshit.)
Levels of viral RNA in breath increased with increasing COVID-19 symptoms, but was not affected by variant, vaccination status, age, time of day, or sex. (I believe I’ve seen reports that the amount of virus RNA goes up with age, and that men spew more than women, but I can’t find that article right now.)
Pathology
This slide from a US CDC epidemiologist (at the US CDC ACIP meeting) show yet again why we should vaccinate the kids against COVID-19:
This paper from Netherlands found that many people had impaired lung function a year after a COVID-19 infection:
- 11% of people with mild infections;
- 22% of people with moderate infections;
- 48% of people with severe/critical infections.
This paper from China which studied people hospitalized with COVID-19 found that the more severe the illness, the lower their vitamin D levels were and the higher their IL-5 levels were. People who were put in ICU had lower levels of D than people who stayed out of the ICE; people who died had even lower levels.
They also found that the higher the vitamin D levels, the lower the IL-5 levels and the higher the levels of CD8+ T-cells. (Those are both good things.)