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  1. #12521
    Join Date
    Mar 2017
    Location
    Sea Island, GA
    This Scientific American article was linked in the NYPost article that kdogg referenced above. It provides a good discussion on the debate about releasing all doses now, and the issue of whether one dose might protect us enough.

    A couple interesting points: 1) they mention the risk that a weaker immune response provided by just one dose might actually allow the virus to mutate, making the vaccine ineffective going forward, and 2) they make the point that obviously both Moderna and Pfizer would have preferred to develop a one-shot vaccine, but that their research and early scientific data led them to focus on a two shot vaccine.

    http://https://www.scientificamerica...the-data-say1/

  2. #12522
    Quote Originally Posted by Tooold View Post
    This Scientific American article was linked in the NYPost article that kdogg referenced above. It provides a good discussion on the debate about releasing all doses now, and the issue of whether one dose might protect us enough.

    A couple interesting points: 1) they mention the risk that a weaker immune response provided by just one dose might actually allow the virus to mutate, making the vaccine ineffective going forward, and 2) they make the point that obviously both Moderna and Pfizer would have preferred to develop a one-shot vaccine, but that their research and early scientific data led them to focus on a two shot vaccine.

    http://https://www.scientificamerica...the-data-say1/
    Here is the money quote from the SciAm article:

    On Twitter, Florian Krammer, a professor of microbiology at Mount Sinai’s Icahn School of Medicine, pointed out another concern with giving only a single dose: the possibility that it might cause a weak immune response, which could make the virus more likely to mutate and potentially make the vaccine ineffective. That is a possibility but may not be a huge concern, Crotty says.

    I don't know how increasing immunity to a virus causes it to be more "Likely" to mutate (seems odd to enhance a chemical property like that).

    But from a mathematical point of view it makes mutations more obvious if the original viruses start to get wiped out. Then only the mutations that are not affected by the vaccine start to survive (visible on a percentage basis). That would make sense.

    Larry
    DevilHorse

  3. #12523

    vaccine rollout by county (NC)

    I live in a rural eastern NC county, and the local health department reported a waiting list of over 4,000 people to get an appointment. My mom and step dad live in Raleigh and are in the 65+ group. After Cooper's announcement yesterday to open it up to that group, they called a clinic in Raleigh and each have an appointment at 1pm on Monday. First of all, I'm a teacher and was supposed to be getting vaccinated before them (not that I'm jealous)-- I guess I've been skipped over now. Second of all, my step dad tells me yesterday that the larger counties in NC have access the Pfizer and Moderna vaccine, and the rural counties only Moderna. I'm trying to figure out how much of this is true, and is there going to be a large discrepancy in rollout county to county? If so, are North Carolinians allowed to be vaccinated in a county outside of primary residence? I guess my concern is a future scenario in which 20-30 year olds in larger cities are getting vaccinated before teachers and other essential workers in smaller counties due to availability. I don't have much info on the whole process, so if anyone could shed some light I would greatly appreciate it.

  4. #12524
    Join Date
    Mar 2017
    Location
    Sea Island, GA
    Quote Originally Posted by DevilHorse View Post
    Here is the money quote from the SciAm article:


    I don't know how increasing immunity to a virus causes it to be more "Likely" to mutate (seems odd to enhance a chemical property like that).

    But from a mathematical point of view it makes mutations more obvious if the original viruses start to get wiped out. Then only the mutations that are not affected by the vaccine start to survive (visible on a percentage basis). That would make sense.

    Larry
    DevilHorse
    Maybe I misinterpreted your comment or misunderstood the article...but I believe the article suggested that a weaker immune response caused by giving just one shot might allow the virus to mutate. They did not suggest that “increasing immunity” would result in mutated virus, as you stated.

    I am certainly not an authority, but it makes sense to me that a weaker immune response would not totally kill the virus, and therefore could allow it to mutate.

  5. #12525
    Quote Originally Posted by Tooold View Post
    Maybe I misinterpreted your comment or misunderstood the article...but I believe the article suggested that a weaker immune response caused by giving just one shot might allow the virus to mutate. They did not suggest that “increasing immunity” would result in mutated virus, as you stated.

    I am certainly not an authority, but it makes sense to me that a weaker immune response would not totally kill the virus, and therefore could allow it to mutate.
    As I understand it, it's just a mathematical problem. The more times the virus replicates, the greater the chance of it mutating. It doesn't really matter how it replicates, only that it does. IANAIDE (I am not an infectious disease expert)

  6. #12526
    Quote Originally Posted by DevilHorse View Post
    Here is the money quote from the SciAm article:

    On Twitter, Florian Krammer, a professor of microbiology at Mount Sinai’s Icahn School of Medicine, pointed out another concern with giving only a single dose: the possibility that it might cause a weak immune response, which could make the virus more likely to mutate and potentially make the vaccine ineffective. That is a possibility but may not be a huge concern, Crotty says.

    I don't know how increasing immunity to a virus causes it to be more "Likely" to mutate (seems odd to enhance a chemical property like that).

    But from a mathematical point of view it makes mutations more obvious if the original viruses start to get wiped out. Then only the mutations that are not affected by the vaccine start to survive (visible on a percentage basis). That would make sense.

    Larry
    DevilHorse
    This is how they think the UK variant emerged.

    https://www.bbc.com/news/health-55388846

    Where has it come from?

    The variant is unusually highly mutated.

    The most likely explanation is the variant has emerged in a patient with a weakened immune system that was unable to beat the virus.

    Instead their body became a breeding ground for the virus to mutate.
    It seems better to have a strong response (from two doses) than a weaker response (from one dose) and give the virus time to change.

  7. #12527
    Join Date
    Nov 2007
    Location
    Vermont
    We are at the point in the vaccine manufacturing cycle when we should absolutely expect that we will be making more vaccine each month than the preceding month.

    Given that, it would seem completely logical to get doses into arms as fast as possible, since there should be more than enough supply coming along subsequently for second doses.

  8. #12528
    Join Date
    Dec 2016
    Location
    Las Vegas, Nevada (Ohio born and raised)
    So I got the call this morning from my previous employer that they have some doses expiring today. Not sure how it all happened but they said I need to come in around noon if I want it. Looks like I won’t have to take up smoking! I did ask why this happened and if they had already tried to find others that need it more. From what they said, I guess I was the last resort before throwing a dose out so that’s why I decided to go. I’d rather have it in my arm than in the trash.

    I guess the moral of the story is to always leave a job on good terms!

  9. #12529
    Join Date
    Feb 2007
    Location
    Chesapeake, VA.
    Quote Originally Posted by PackMan97 View Post
    As I understand it, it's just a mathematical problem. The more times the virus replicates, the greater the chance of it mutating. It doesn't really matter how it replicates, only that it does. IANAIDE (I am not an infectious disease expert)
    This is very close to being exactly correct.

    When an RNA virus replicates, the polymerase (the enzyme the actually replicates the virus's genome) makes mistakes. RNA polymerases lack an editing function; therefore, these mistakes are not corrected. (Think of having Beavis and Butthead running the local fast-food place; they make mistakes, and they don't care!)

    These mutations truly occur completely at random. None of them is repaired. In this fashion, RNA viruses are producing mutated viruses pretty much all the time. The vast majority of these mutations actually harm the virus, in essence making it weaker than the "wild type" virus, and therefore they are outcompeted by the wild type (wt) virus, and they just die off and cause no problems.

    On the other hand, some of them cause a competitive ADVANTAGE; this is most likely to happen when there is immunologic pressure against the wt virus.

    Let me give you an example that might help clarify the situation. RSV is an RNA virus that was discovered in 1956. Mutations are occurring in this virus just as they are in any RNA virus. But if you compare the genome of the circulating virus from 1956 to the one from last year, they are virtually identical. Why is this? Because infection with RSV is not protective, and reinfections occur all the time, there is no immunologic pressure on the wt virus; therefore, the wt virus continues to outcompete all the mutated strains, and continues to be the dominant circulating virus year after year.

    By way of contrast, infection with influenza virus is fairly protective against re-infection with the same strain. This affords some of the many mutated (we use the word "drifted") viruses to outcompete it. The vaccine adds to the problem by producing immunity in a fairly large percentage of the population. Therefore, drifted viruses circulate with regularity. This is the reason that we need to get a new influenza vaccine every year.

    Now, back to SARS-CoV-2. Infection with wt SARS-CoV-2 appears to provide fairly complete protection against reinfection, at least for 8 or 9 months (maybe longer, but we don't have data to show that just yet). If we reach herd immunity, whether through natural infection or through vaccination, it is likely that at least some mutated strains will gain a competitive advantage.

    For the life of me I don't really understand the thought process behind "weak" or "partial" immunity adding to the problem. It seems to me that this way of thinking is actually just an adoption of the thinking we use on a daily basis with regard to BACTERIAL infections; that is to say, low doses or overly short courses of antibiotic therapy do seem to allow mutated bacteria to survive; one way to help prevent the emergence of resistant bacteria is to kill them completely and thoroughly while you have the chance; in other words, use an appropriate dose of antibiotics for an appropriate length of time. Total annihilation leads to suppression of mutations.

    I'm not sure you can just appropriate that line of reasoning to viral immunobiology. It seems to me that complete resistance to infection in a large segment of the population might be a better way to produce a circulating mutant strain. I guess the difference is that I think of viruses evolving on a whole population basis, whereas bacteria are evolving INSIDE a SINGLE PATIENT while the infection is ongoing. I just don't think that is a large part of RNA viral evolution.

    Disclaimer: I'm not ENTIRELY sure that partial immunity in an individual couldn't lead to mutation within that individual during infection. It's just not the way I conceptualize viral evolution of RNA viruses, and I find it extremely doubtful that that would be the major driver of evolution and the takeover of a new strain.
    "We are not provided with wisdom, we must discover it for ourselves, after a journey through the wilderness which no one else can take for us, an effort which no one can spare us, for our wisdom is the point of view from which we come at last to regard the world." --M. Proust

  10. #12530
    Join Date
    Feb 2007
    Location
    Chesapeake, VA.
    Quote Originally Posted by Kdogg View Post
    This is how they think the UK variant emerged.

    https://www.bbc.com/news/health-55388846



    It seems better to have a strong response (from two doses) than a weaker response (from one dose) and give the virus time to change.
    I wrote a longer post about this, but that is not really the way I view viral evolutionary biology, although I suppose it is not impossible. I think this is borrowing from bacterial evolution. Provided a person's immune system works properly, if you do not succumb to overwhelming viral infection, you will clear the virus, with or without preexisting immunity. The T-cell cytotoxic response is a large part of how most viral infections are cleared, which is largely independent of antibody (which is what is engendered by vaccination, at least by the mRNA vaccines).
    "We are not provided with wisdom, we must discover it for ourselves, after a journey through the wilderness which no one else can take for us, an effort which no one can spare us, for our wisdom is the point of view from which we come at last to regard the world." --M. Proust

  11. #12531
    Join Date
    Feb 2007
    Location
    Washington, D.C.

    Good article on why you should wear a mask after vaccination


  12. #12532
    Join Date
    Feb 2007
    Location
    Columbus, Ohio
    Some breaking, disheartening news.

    When Health and Human Services Secretary Alex Azar announced this week that the federal government would begin releasing coronavirus vaccine doses held in reserve for second shots, no such reserve existed, according to state and federal officials briefed on distribution plans. The Trump administration had already begun shipping out what was available beginning at the end of December, taking second doses directly off the manufacturing line.

    Now, health officials across the country who had anticipated their extremely limited vaccine supply as much as doubling beginning next week are confronting the reality that their allocations will not immediately increase, dashing hopes of dramatically expanding eligibility for millions of elderly people and those with high-risk medical conditions. Health officials in some cities and states were informed in recent days about the reality of the situation, while others are still in the dark.

  13. #12533
    Join Date
    Feb 2007
    Location
    Watching carolina Go To HELL!
    I just got my appointment to get my first shot on February 9th at the Greensboro Coliseum! It "only" took 30 minutes of trying to get in on the Cone Health web site, by 2 of us working independently, to get the appointment.

    And to answer a question asked above, in NC you can register in any county to get an appointment, regardless of which county you live in.

    Here I copy the info sent by my PCP (primary care provider):
    Good luck!
    Ozzie, your paradigm of optimism!

    Go To Hell carolina, Go To Hell!
    9F 9F 9F
    http://www.EGLEW.com


  14. #12534
    Join Date
    Mar 2017
    Location
    Sea Island, GA
    Quote Originally Posted by rsvman View Post
    This is very close to being exactly correct.

    When an RNA virus replicates, the polymerase (the enzyme the actually replicates the virus's genome) makes mistakes. RNA polymerases lack an editing function; therefore, these mistakes are not corrected. (Think of having Beavis and Butthead running the local fast-food place; they make mistakes, and they don't care!)

    These mutations truly occur completely at random. None of them is repaired. In this fashion, RNA viruses are producing mutated viruses pretty much all the time. The vast majority of these mutations actually harm the virus, in essence making it weaker than the "wild type" virus, and therefore they are outcompeted by the wild type (wt) virus, and they just die off and cause no problems.

    On the other hand, some of them cause a competitive ADVANTAGE; this is most likely to happen when there is immunologic pressure against the wt virus.

    Let me give you an example that might help clarify the situation. RSV is an RNA virus that was discovered in 1956. Mutations are occurring in this virus just as they are in any RNA virus. But if you compare the genome of the circulating virus from 1956 to the one from last year, they are virtually identical. Why is this? Because infection with RSV is not protective, and reinfections occur all the time, there is no immunologic pressure on the wt virus; therefore, the wt virus continues to outcompete all the mutated strains, and continues to be the dominant circulating virus year after year.

    By way of contrast, infection with influenza virus is fairly protective against re-infection with the same strain. This affords some of the many mutated (we use the word "drifted") viruses to outcompete it. The vaccine adds to the problem by producing immunity in a fairly large percentage of the population. Therefore, drifted viruses circulate with regularity. This is the reason that we need to get a new influenza vaccine every year.

    Now, back to SARS-CoV-2. Infection with wt SARS-CoV-2 appears to provide fairly complete protection against reinfection, at least for 8 or 9 months (maybe longer, but we don't have data to show that just yet). If we reach herd immunity, whether through natural infection or through vaccination, it is likely that at least some mutated strains will gain a competitive advantage.

    For the life of me I don't really understand the thought process behind "weak" or "partial" immunity adding to the problem. It seems to me that this way of thinking is actually just an adoption of the thinking we use on a daily basis with regard to BACTERIAL infections; that is to say, low doses or overly short courses of antibiotic therapy do seem to allow mutated bacteria to survive; one way to help prevent the emergence of resistant bacteria is to kill them completely and thoroughly while you have the chance; in other words, use an appropriate dose of antibiotics for an appropriate length of time. Total annihilation leads to suppression of mutations.

    I'm not sure you can just appropriate that line of reasoning to viral immunobiology. It seems to me that complete resistance to infection in a large segment of the population might be a better way to produce a circulating mutant strain. I guess the difference is that I think of viruses evolving on a whole population basis, whereas bacteria are evolving INSIDE a SINGLE PATIENT while the infection is ongoing. I just don't think that is a large part of RNA viral evolution.

    Disclaimer: I'm not ENTIRELY sure that partial immunity in an individual couldn't lead to mutation within that individual during infection. It's just not the way I conceptualize viral evolution of RNA viruses, and I find it extremely doubtful that that would be the major driver of evolution and the takeover of a new strain.
    This is very helpful! Always appreciate your explanations.

  15. #12535
    Join Date
    Feb 2008
    Location
    Washington, D.C.
    Quote Originally Posted by Mike Corey View Post
    Some breaking, disheartening news.
    I have read that several states announced this week that the age for vaccines was being dropped to 65. I understand that North Carolina did so and Fairfax County, Virginia, which is immediately outside of D.C., issued a notice yesterday that residents 65 and over may register on Monday (January 18) for vaccines.

    I assume these jurisdictions based their decisions, at least in part, on the theory that their supply of vaccines would increase substantially in the short term. Now, I am wondering whether they will withdraw the notices from earlier this week to avoid an overload on their delivery systems, as well as a large number of complaints from disgruntled citizens.

  16. #12536
    Some info for NC residents. I am 69 and was resigned to waiting another month or so for vaccine. Then yesterday NC lowered age requirements to 65+. So I opened Duke mychart but didn’t see any covid option. Then tried the WRAL-listed phone # for Durham Co, put on hold for 1.5 hrs and finally gave up. But then friend emailed me that covid vacc option was now on mychart, so I went back and indeed found it. First 30’ish tries to book a date were futile. No dates available or would give me a time, get my hopes up, but when I confirmed it kept getting “oops” error msg. I was about to give up and then suddenly big bunches of open time slots magically appeared, about 30 new ones for this Sunday alone. I jumped on it and am scheduled to get Pfizer in Raleigh day after tomorrow!

    I don’t know about the fairness of this opening up to 65+ now but I wanted to share my experiences for any of you in my boat that live in NC. Also wanted to say I was impressed that Duke mychart was able to book appts for 65+ within hours of it being announced by the Governor!

  17. #12537
    Join Date
    Nov 2007
    Location
    Vermont
    Good news for us, our state is organized; bad news for us, our state can't get any vaccine. Opening up to 75+ on Jan 25, there will be one web site to get an appt, phone lines for those who dare.

  18. #12538
    Join Date
    Dec 2014
    Location
    I'd tell ya, but then I'd have to kill ya
    Just passed 400,000 deaths on worldometers. Will refrain from further comment or ranting, just SMH.

  19. #12539
    Join Date
    Feb 2007
    Location
    Columbus, Ohio
    More news from the Wall Street Journal on vaccination plans that were slow out of the federal government:

    Operation Warp Speed leaders waited more than two months to approve a plan to distribute and administer Covid-19 vaccines proposed by U.S. health officials, administration officials said, leaving states with little time to implement a mass-vaccination campaign amid a coronavirus surge.

    State and local officials had been clamoring for months for help preparing for the largest vaccination program in U.S. history when the Centers for Disease Control and Prevention published a playbook in September to guide them.

    The CDC had wanted to start helping states plan in June how to get people vaccinated. But officials at Operation Warp Speed rebuffed the agency’s plan for distributing vaccines. They adopted a similar plan in August only after exploring other options—and then held the release of the CDC’s playbook for states for two weeks for additional clearance and to put it out with another document, the officials said.

  20. #12540
    Join Date
    Dec 2016
    Location
    Las Vegas, Nevada (Ohio born and raised)
    So just got my shot. It was the Pfizer one. All is well so far. Had to wait the mandatory 15 minutes so I had some time to talk with some of my old coworkers.

    Something weird DID happen though. They scheduled my next shot for 19 days from today. It was an automatic scheduling from the EMR. When I questioned it, they said there is a 4 day grace period so anywhere from 17-21 days is fine. I’ve never heard this before but actually did find some information on the CDC website about it.

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