Viral dynamics of SARS-CoV-2 variants in vaccinated and unvaccinated individuals(medrxiv.org)
medrxiv.org
Viral dynamics of SARS-CoV-2 variants in vaccinated and unvaccinated individuals
https://www.medrxiv.org/content/10.1101/2021.02.16.21251535v3
40 comments
> authors made no distinction between unvaccinated and immunologically naive. This is a distinction that every sensible scientific discussion needs to acknowledge.
Ideally, everyone would be tested for antibodies before receiving a vaccine, then we would have data to differentiate naive+vaccine from survivor+vaccine. This would be helpful for both science and public policy.
CDC needs to stop labelling people who are 13 days after their 2nd vaccine dose as "unvaccinated". A more accurate label would be "partly vaccinated".
Ideally, everyone would be tested for antibodies before receiving a vaccine, then we would have data to differentiate naive+vaccine from survivor+vaccine. This would be helpful for both science and public policy.
CDC needs to stop labelling people who are 13 days after their 2nd vaccine dose as "unvaccinated". A more accurate label would be "partly vaccinated".
> Ideally, everyone would be tested for antibodies before receiving a vaccine
I agree that would help make optimal decisions with regards to distributing a limited supply of vaccine doses.
However it's worth noting that even when antibodies drop below levels detectable by standard tests, individuals are likely to retain robust immune responses that provide sufficient protection from severe outcomes [1][2].
[1] SARS-CoV-2 infection induces long-lived bone marrow plasma cells in humans https://www.nature.com/articles/s41586-021-03647-4.pdf
[2] Prior COVID-19 protects against reinfection, even in the absence of detectable antibodies https://www.journalofinfection.com/article/S0163-4453(21)002...
I agree that would help make optimal decisions with regards to distributing a limited supply of vaccine doses.
However it's worth noting that even when antibodies drop below levels detectable by standard tests, individuals are likely to retain robust immune responses that provide sufficient protection from severe outcomes [1][2].
[1] SARS-CoV-2 infection induces long-lived bone marrow plasma cells in humans https://www.nature.com/articles/s41586-021-03647-4.pdf
[2] Prior COVID-19 protects against reinfection, even in the absence of detectable antibodies https://www.journalofinfection.com/article/S0163-4453(21)002...
Does this mean there's a narrow testing window for people to be able to "prove" their natural immunity?
The window for SARS-CoV-2 antibody tests would be at least 8 months to a year for many individuals.
More expensive tests can detect immunity based on T cells for example, which would provide an even longer window.
And of course really expensive and invasive bone marrow aspirate tests could provide a window approaching a lifetime - but the tradeoffs involved there would likely be unfavorable for practical “proof”. Who knows what technology we’ll come up with in the future though.
More expensive tests can detect immunity based on T cells for example, which would provide an even longer window.
And of course really expensive and invasive bone marrow aspirate tests could provide a window approaching a lifetime - but the tradeoffs involved there would likely be unfavorable for practical “proof”. Who knows what technology we’ll come up with in the future though.
It might be that you alluded to the term “natural immunity” which now comes with extra baggage.
There seems to be a recent talking point for “natural immunity”, and two of my [uk based!] friends who seem to end up on the wrong side of every issue are parroting this. They are somehow both tuned in to US YouTube talking heads, Tucker etc despite being in the UK.
The message that is being pushed as I understand it is “let the virus rip” since if(!) you come through unscathed you will end up with better immunity? Maybe I misunderstand it but they both in a “anti covid vaxx” stance so I think that’s their reasoning - it is somehow better to take your chances with the virus than get the vaccine.
Note that they are both engineers.
There seems to be a recent talking point for “natural immunity”, and two of my [uk based!] friends who seem to end up on the wrong side of every issue are parroting this. They are somehow both tuned in to US YouTube talking heads, Tucker etc despite being in the UK.
The message that is being pushed as I understand it is “let the virus rip” since if(!) you come through unscathed you will end up with better immunity? Maybe I misunderstand it but they both in a “anti covid vaxx” stance so I think that’s their reasoning - it is somehow better to take your chances with the virus than get the vaccine.
Note that they are both engineers.
You could try the 'scared straight' approach and direct them to this thread on the /r/nursing subreddit about what other ICU nurses are seeing right now regarding unvaccinated Covid patients in the ICUs:
https://www.reddit.com/r/nursing/comments/pbvcdu/uhh_are_any...
Some interesting quotes that stood out to me:
"They’re dropping like flies in our ICU. 20- and 30-year-olds on vent and 99% of them unvaccinated."
"There are really only 2 options we are seeing for patients here. -you die -you become permanently disabled. And they are sent to Rehab or Long Term Care"
"Dialysis here. All my new patients in the past six months have had their kidneys damaged due to covid. All of them."
https://www.reddit.com/r/nursing/comments/pbvcdu/uhh_are_any...
Some interesting quotes that stood out to me:
"They’re dropping like flies in our ICU. 20- and 30-year-olds on vent and 99% of them unvaccinated."
"There are really only 2 options we are seeing for patients here. -you die -you become permanently disabled. And they are sent to Rehab or Long Term Care"
"Dialysis here. All my new patients in the past six months have had their kidneys damaged due to covid. All of them."
> it is somehow better to take your chances with the virus than get the vaccine.
As i understand it that statement is more true when the age (and presence of comorbidities) of the subject goes down.
<10y: why on earth would we vaccinate these people?
>70y: why on earth not?
Many of us are in the middle, and that means things are not that clear cut. I believe everyone should choose for themselves, as herd-immunity is off the table and outbreaks amoung the young do not cause much strain on the health care system.
As i understand it that statement is more true when the age (and presence of comorbidities) of the subject goes down.
<10y: why on earth would we vaccinate these people?
>70y: why on earth not?
Many of us are in the middle, and that means things are not that clear cut. I believe everyone should choose for themselves, as herd-immunity is off the table and outbreaks amoung the young do not cause much strain on the health care system.
I think it’s true age is a big factor, but I’m not sure if we can rule out young people from straining the healthcare system (depending on your definition of young or course).
In Scotland this week we had 14 people under 10 admitted to hospital and 78 who were 70+. A big difference but not as big as you’d think. The distribution is also not concentrated around older age groups at the moment, it’s got significant numbers in all age groups:
https://www.travellingtabby.com/scotland-coronavirus-tracker...
Check “Hospital Admissions by Age Group”
In Scotland this week we had 14 people under 10 admitted to hospital and 78 who were 70+. A big difference but not as big as you’d think. The distribution is also not concentrated around older age groups at the moment, it’s got significant numbers in all age groups:
https://www.travellingtabby.com/scotland-coronavirus-tracker...
Check “Hospital Admissions by Age Group”
Hospital admission is not a good metric to go by, because they may be discharged/not occupy it for long. If you check death by age you see no one young died, suggesting the disease is more easy on them ajd they won't need to be 2 weeks in ICU.
What would you suggest as a better metric?
Hospital bed usage per cause would be a better one
> Acute infections in vaccinated and unvaccinated people feature similar proliferation and peak Ct...
If this is the case, what is the "long COVID" risk to people who experience breakthrough infections?
If this is the case, what is the "long COVID" risk to people who experience breakthrough infections?
Lesser. They do say that vaccinated individuals clear the infection more quickly, and indeed cellular immunity takes some time to kick in. From that a good guess is that long covid risk is lower.
Also, remember that selection bias still exists. There are going to be individuals with replication but lower viral loads that never get tested because they have no symptoms, and there will likely be a higher proportion of those in the vaccinated group.
Also, remember that selection bias still exists. There are going to be individuals with replication but lower viral loads that never get tested because they have no symptoms, and there will likely be a higher proportion of those in the vaccinated group.
I suspect that long COVID risk is lower in vaccinated individuals (and hope so as an expat who traveled halfway around the world to get vaccinated) but the risk should be quantified.
There are a growing number of reports of people with breakthrough infections who are experiencing symptoms that aren't "mild", and some reports of people with "long COVID" like symptoms. It's not reason enough to panic, but it's concerning, especially in light of the fact that until very recently, health experts and the media kept telling us that breakthrough infections were "rare" even as it was becoming evident they weren't.
There are a growing number of reports of people with breakthrough infections who are experiencing symptoms that aren't "mild", and some reports of people with "long COVID" like symptoms. It's not reason enough to panic, but it's concerning, especially in light of the fact that until very recently, health experts and the media kept telling us that breakthrough infections were "rare" even as it was becoming evident they weren't.
Yeah it's probably not so rare. The errors in this case never fall on the side of false positive, and it's impossible they caught every breakthrough case. It follows that there are more breakthrough cases than what's reported. The point of contention is by what margin the CDC is off.
If you really want to embiggen the problem, ask yourself how many people got covid but never got tested. The rate of mild infection is probably a lot higher than reported because only people with anxiety and/or serious covid bothered to get tested or hospitalized. Everyone else called in sick or didn't know/care.
Disclaimer: I'm drunk.
If you really want to embiggen the problem, ask yourself how many people got covid but never got tested. The rate of mild infection is probably a lot higher than reported because only people with anxiety and/or serious covid bothered to get tested or hospitalized. Everyone else called in sick or didn't know/care.
Disclaimer: I'm drunk.
I think so. All evidence points to systemic infection being rarer in vaccinated people.
Probably once the initial rush of antibodies dissipates, the virus can get a foothold in the sinuses easy enough. But most the time the immune system will squash it without much trouble.
My feeling so far seems if you think of infection as a continuum then vaccines probably reduce detectable by PCR infection by 2/3rds. Symptomatic illness by 8 to 1. And serious illness by 30 to 1.
But the risk from community spread can be high enough to overwhelm those odds. Where I live case rates are 25 higher than they were 8 weeks ago.
Probably once the initial rush of antibodies dissipates, the virus can get a foothold in the sinuses easy enough. But most the time the immune system will squash it without much trouble.
My feeling so far seems if you think of infection as a continuum then vaccines probably reduce detectable by PCR infection by 2/3rds. Symptomatic illness by 8 to 1. And serious illness by 30 to 1.
But the risk from community spread can be high enough to overwhelm those odds. Where I live case rates are 25 higher than they were 8 weeks ago.
Hmm, this conflicts with other information out there that says Delta is 1000x peak load. Any insight into why that might be?
I think that piece of information (1000x) was superseded many weeks ago, and was replaced with a more "linear" 3x.
That correction surely happened, but I have no idea if there were further updates, refinements, divergent estimates etc.
That correction surely happened, but I have no idea if there were further updates, refinements, divergent estimates etc.
...And in fact, it is now reported that the viral load for that variant is 300x, according to a study from South Korea.
walterbell(2)
Not accounting for this fact is a significant confounding factor in the study, and I'm disappointed the authors made no distinction between unvaccinated and immunologically naive. This is a distinction that every sensible scientific discussion needs to acknowledge.
EDIT: please leave a comment down voters, I’m starting to think there’s some sort of targeted campaign against this type of information
> Vaccine breakthrough infections exhibited similar proliferation dynamics as infections in unvaccinated individuals (mean peak Ct: 20.5, 95% credible interval [19.0, 21.0] vs. 20.7 [19.8, 20.2], and mean proliferation time 3.2 days[2.5, 4.0] vs. 3.5 days [3.0, 4.0]); however, vaccinated individuals exhibited faster clearance (mean clearance time: 5.5 days [4.6, 6.6] vs. 7.5 days [6.8, 8.2]).
> If the Ct values in vaccinated and unvaccinated infected individuals reflect the same amounts of infectious virus, then this implies that individuals with breakthrough infections may be as infectious as unvaccinated individuals in the early stage of the infection, but remain infectious for a shorter time, reducing the total degree of onward transmission. These findings are in keeping with the hypothesis that vaccination protects against the severe manifestations of disease but offers less protection against infection in the upper airway. Precautions are therefore necessary to prevent onward transmission even from vaccinated individuals.
[1] Longitudinal analysis shows durable and broad immune memory after SARS-CoV-2 infection with persisting antibody responses and memory B and T cells https://www.cell.com/cell-reports-medicine/fulltext/S2666-37...
[2] SARS-CoV-2 infection rates of antibody-positive compared with antibody-negative health-care workers in England: a large, multicentre, prospective cohort study (SIREN) https://pubmed.ncbi.nlm.nih.gov/33844963/
[3] Association of SARS-CoV-2 Seropositive Antibody Test With Risk of Future Infection https://jamanetwork.com/journals/jamainternalmedicine/fullar...
[4] Naturally enhanced neutralizing breadth against SARS-CoV-2 one year after infection https://www.nature.com/articles/s41586-021-03696-9
[5] Initial report of decreased SARS-CoV-2 viral load after inoculation with the BNT162b2 vaccine https://www.nature.com/articles/s41591-021-01316-7