PlagueWatch 2020-23 - Coronavirus

[budwom]

I would imagine that certain locations may offer the JnJ that do not offer the Moderna/Pfizer because of the far easier storage needs for the JnJ vaccine, so you may know when signing up that you are going to a location that only offers JnJ. I would also imagine that you would be told when arriving for an appointment that a location only had one or another and could then decide if you wanted to skip your appointment and wait for another opportunity.

I know they have not done any studies about doubling up and taking both Moderna/Pfizer and JnJ vaccines so I doubt you could get JnJ now and then get Moderna/Pfizer when it became available in a few months.

At this point, people (and the state) are begging for any vaccine they can get...I think it will be some time before we are offered much of a choice...I expect my turn to come in March, hopefully I can get an mRNA vaccine because I definitely won't turn down a J&J if that's my only option at the time.

[sagegrouse]

To me the question is: if you can get the JnJ vaccine (that appears great at keeping you out of the hospital and from dying, but just decent at keeping you from catching a moderate case of Covid) right away (February/March) versus getting the Moderna/Pfizer vaccine in 4 months, which are you taking? I'm kinda torn, but if there is some degree of protection from all Covid and a lot lot lot of protection from serious/deadly Covid, I think I want to my "get out of jail" card right away versus waiting until summer.



Ohhhh, I would love to see that data. That would seal the deal for me on getting JnJ now versus waiting. If I get it now and am fully protected in a month, that's a huge win versus waiting until summer.

J&J, being tested later, may have been going up against a different mix of COVID types, especially in South America. At least that was one opinion on TV this AM.

[Rich]

Soon after the Exchange's opening bell should be interesting for J&J

As I suspected, the Street is NOT happy

[YmoBeThere]

Ohhhh, I would love to see that data. That would seal the deal for me on getting JnJ now versus waiting. If I get it now and am fully protected in a month, that's a huge win versus waiting until summer.

I think it was misstated as they have revised the article I looked at (CNBC) and restated as "Effectiveness against severe disease increased over time with no cases in vaccinated participants reported after day 49, according to the company."

[PackMan97]

At this point, people (and the state) are begging for any vaccine they can get...I think it will be some time before we are offered much of a choice...I expect my turn to come in March, hopefully I can get an mRNA vaccine because I definitely won't turn down a J&J if that's my only option at the time.

I agree, I'll definitely get the J&J if it means getting it sooner.

[JasonEvans]

As I suspected, the Street is NOT happy

Ehhh... JnJ stock is down about 2.5%, which is not ideal but not exactly disastrous. JnJ is such a huge company -- $80+ bil in annual revenues -- that it would have taken a truly shocking vaccine result for it to move the stock very much.

[-jk]

As I suspected, the Street is NOT happy

What about Reddit?

-jk

[YmoBeThere]

I think it was misstated as they have revised the article I looked at (CNBC) and restated as "Effectiveness against severe disease increased over time with no cases in vaccinated participants reported after day 49, according to the company."

Essentially, if severe cases are what you are trying to avoid, I 'm debating the difference timing wise between Moderna/Pfizer initial dose, +3-4weeks, second dose +1-2 weeks for full effectiveness and J&J 6-7 weeks for full effectiveness. There doesn't seem to be too much of a difference, 4-6 weeks versus 6-7 Am I thinking about that correctly?

[budwom]

Essentially, if severe cases are what you are trying to avoid, I 'm debating the difference timing wise between Moderna/Pfizer initial dose, +3-4weeks, second dose +1-2 weeks for full effectiveness and J&J 6-7 weeks for full effectiveness. There doesn't seem to be too much of a difference, 4-6 weeks versus 6-7 Am I thinking about that correctly?

Pretty significant in the ultimate effectiveness vs severe disease though, right? 72% vs ninety-something...but yes, timing wise it's about the same...

[TruBlu]

Just curious about something regarding the wearing of masks after getting both doses of the Covid vaccine. I know the CDC says to keep wearing the masks, and I definitely will. Did the volunteers who received the vaccination during the trials wear masks afterwards? I would assume that most would. If so, the 95% effectiveness may not hold true for folks who decide to not wear masks after the shots. Maybe the effectiveness drops (SWAG Alert) to 80 - 90% for them.

Did the companies keep track of efficacy during the trials for post vaccine mask wearers vs non-mask wearers? Those statistics could sway some people to continue wearing masks if there is a significant difference.

[CDu]

Pretty significant in the ultimate effectiveness vs severe disease though, right? 72% vs ninety-something...but yes, timing wise it's about the same...

Important to check definitions. I think the 72% was against “moderate to severe disease.” They were 85% against severe disease, defined as making you really sick at home or possibly going to hospital. But they say near 100% effective against hospitalization and 100% effective against death.

[mph]

There's been a lot of recent media coverage discussing the benefits of layering 2 masks. Dr. Fauci recommended wearing 2 masks, calling it "common sense." I'm a big believer in masks and I don't enter any public indoor space without one, but I'm having a hard time understanding the science behind double masking.

I usually wear an n95 mask, but I have a beard so I know I'm not getting a good seal around my face. I figure that's still no worse than wearing a multi-layer cloth mask which also allows air gaps. In either case, how would adding a second mask help when my biggest risk remains the air gaps around the mask? Conversely, if I was wearing a properly sealed N95 mask, would adding a second cloth mask really add much more protection?

In short, intuitively, it seems that adding 8 layers of loose fitting filtration isn't any better than 4 layers of loose fitting filtration. I could even imaging a scenario where it's net-worse if it increases the airflow around the edges of the mask. But, I'm not a scientist or doctor and I realize I'm probably missing something. Would love to hear the thoughts of people who have a better understanding of the science than I do (which means pretty much all of you ).

[MChambers]

There's been a lot of recent media coverage discussing the benefits of layering 2 masks. Dr. Fauci recommended wearing 2 masks, calling it "common sense." I'm a big believer in masks and I don't enter any public indoor space without one, but I'm having a hard time understanding the science behind double masking.

I usually wear an n95 mask, but I have a beard so I know I'm not getting a good seal around my face. I figure that's still no worse than wearing a multi-layer cloth mask which also allows air gaps. In either case, how would adding a second mask help when my biggest risk remains the air gaps around the mask? Conversely, if I was wearing a properly sealed N95 mask, would adding a second cloth mask really add much more protection?

In short, intuitively, it seems that adding 8 layers of loose fitting filtration isn't any better than 4 layers of loose fitting filtration. I could even imaging a scenario where it's net-worse if it increases the airflow around the edges of the mask. But, I'm not a scientist or doctor and I realize I'm probably missing something. Would love to hear the thoughts of people who have a better understanding of the science than I do (which means pretty much all of you ).

My understanding is that the idea behind double masking ties to get a very tight fit. Here’s an article on the topic: https://www.vox.com/the-goods/222513...best-cloth-n95

[budwom]

Important to check definitions. I think the 72% was against “moderate to severe disease.” They were 85% against severe disease, defined as making you really sick at home or possibly going to hospital. But they say near 100% effective against hospitalization and 100% effective against death.

yeah, I know, it's complicated, but it also seems (at first look) to be less effective vs the new mutations...if that's what's available when it's my turn, I'll gladly take it...

[duke79]

yeah, I know, it's complicated, but it also seems (at first look) to be less effective vs the new mutations...if that's what's available when it's my turn, I'll gladly take it...

Yea, this brings up a dilemma that some people may face - If the J and J vaccine is available fairly soon but you have to wait longer for the Moderna or Pfizer vaccine (say a month or two or longer), do you wait for what may be the more effective vaccine or take the J and J now? I'm not sure what I would do.

[PackMan97]

Yea, this brings up a dilemma that some people may face - If the J and J vaccine is available fairly soon but you have to wait longer for the Moderna or Pfizer vaccine (say a month or two or longer), do you wait for what may be the more effective vaccine or take the J and J now? I'm not sure what I would do.

A question for the board physicians...can you take more than one vaccine?

[CDu]

yeah, I know, it's complicated, but it also seems (at first look) to be less effective vs the new mutations...if that's what's available when it's my turn, I'll gladly take it...

I suspect they all are less effective vs the new mutations. The other vaccines just either didn't test on them or didn't report by strain because they weren't relevant yet.

Regardless, a near 100% protection against hospitalization? Seems pretty good for a one-shot vaccine.

[CDu]

Up to 27.9 million doses administered as of this morning, a 1.7 million increase from yesterday. A tad over 25 million doses given since the morning of Dec 30. 22.8 million have gotten at least 1 dose. Definitely making progress. But still a LONG way to go obviously (~7% of the population with at least 1 dose).

[House P]

Important to check definitions. I think the 72% was against “moderate to severe disease.” They were 85% against severe disease, defined as making you really sick at home or possibly going to hospital. But they say near 100% effective against hospitalization and 100% effective against death.

While I appreciate J&J releasing a summary of the results ASAP, this "science by press release" approach leaves some important questions for me.

Does anyone know how they defined "moderate disease" and "severe disease"? Based on the numbers, I assume that anyone hospitalized was classified as having "severe disease", but not everyone with "severe disease" was hospitalized. If I recall correctly, both Moderna and Pfizer only reported "symptomatic disease" along with hospitalization and death.

Also, if they had categories for "moderate disease" and "severe disease", did they have a category for "mild disease"? If so, can we presume that the vaccine was less than 66% effective in reducing "mild disease". Otherwise, I assume that this would have made the press release.

Also, I suppose expert will want to know how many hospitalizations and deaths occurred in the unvaccinated group before concluding how well the vaccine prevents these conditions.

[CDu]

While I appreciate J&J releasing a summary of the results ASAP, this "science by press release" approach leaves some important questions for me.

Does anyone know how they defined "moderate disease" and "severe disease"? Based on the numbers, I assume that anyone hospitalized was classified as having "severe disease", but not everyone with "severe disease" was hospitalized. If I recall correctly, both Moderna and Pfizer only reported "symptomatic disease" along with hospitalization and death.

This is all readily available information, because they have to specify it in the trial design. Per clinicaltrials.gov, JnJ defined moderate and "severe" according to the FDA guidance (found here: https://www.fda.gov/media/137926/download)

Moderate: Symptoms of moderate illness with COVID-19, which could include any symptom of mild illness (fever, cough, sore throat, malaise, headache, muscle pain, gastrointestinal symptoms) or shortness of breath with exertion. Clinical signs suggestive of moderate illness with COVID-19, such as respiratory rate ≥ 20 breaths per minute, saturation of oxygen (SpO2) > 93% on room air at sea level, heart rate ≥ 90 beats per minute; No criteria for severe or critical severity

Severe: Symptoms suggestive of severe systemic illness with COVID-19, which could include any symptom of moderate illness or shortness of breath at rest, or respiratory distress; Clinical signs indicative of severe systemic illness with COVID-19, such as respiratory rate ≥ 30 per minute, heart rate ≥ 125 per minute, SpO2 ≤ 93% on room air at sea level or PaO2/FiO2 < 300; No criteria for critical severity

Basically, moderate is a pretty low bar. Definitely well shy of hospitalization. Severe is a higher bar, but below critical. So, possibly but not necessarily hospitalized, and definitely not life-altering/threatening).

Also, if they had categories for "moderate disease" and "severe disease", did they have a category for "mild disease"? If so, can we presume that the vaccine was less than 66% effective in reducing "mild disease". Otherwise, I assume that this would have made the press release.

They did not have a category for "mild" disease in the trial protocol.

Also, I suppose expert will want to know how many hospitalizations and deaths occurred in the unvaccinated group before concluding how well the vaccine prevents these conditions.

They said near 100% protection against hospitalizations and 100% protection against deaths. So we can infer that there were 0 deaths on the vaccine arm (as you state, no clue how many total deaths), and very few hospitalizations in the vaccine arm compared with the placebo arm (no clue on the scale, but it's COVID so likely a decent number in a trial with 30,000 participants.

I would take these results as follows:
- Definitely less effective than the 2-dose regimens, which were ~95% effective in preventing symptomatic disease and 100% effective in preventing disease back in summer/fall 2020; but...
- Still very effective in preventing truly severe disease (highly beneficial in reducing hospitalization, 100% death prevention)