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The Dive's Covid Thread

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DISCUSSION​

This study found that the current bivalent vaccines were about 30% effective overall in protecting against infection with SARS-CoV-2, when the Omicron BA.4/BA.5 lineages were the predominant circulating strains. The magnitude of protection afforded by bivalent vaccination was similar to that estimated in a recent study using data from the Increasing Community Access to Testing (ICATT) national SARS-CoV-2 testing program [16].

The strengths of our study include its large sample size, and its conduct in a healthcare system where a very early recognition of the critical importance of maintaining an effective workforce during the pandemic led to devotion of resources to have an accurate accounting of who had COVID-19, when COVID-19 was diagnosed, who received a COVID-19 vaccine, and when. The study methodology, treating bivalent vaccination as a time-dependent covariate, allowed for determining vaccine effectiveness in real time.

The study has several limitations. Individuals with unrecognized prior infection would have been misclassified as previously uninfected. Since prior infection protects against subsequent infection, such misclassification would have resulted in underestimating the protective effect of the vaccine. However, there is little reason to suppose that prior infections would have been missing in the bivalent vaccinated and non-vaccinated states at disproportionate rates. Those who chose to receive the bivalent vaccine might have been more worried about infection and might have been more likely to get tested when they had symptoms, thereby disproportionately detecting more incident infections among those who received the bivalent vaccine. This risk is mitigated by the time-dependent treatment of bivalent vaccination, because with such treatment, risk of disproportionate detection is actually in the opposite direction. If individuals received the bivalent vaccine thinking it would reduce their risk of infection, they would have been less inclined to get tested for the same symptoms after getting the vaccine (bivalent vaccinated state) than before getting the vaccine (non-bivalent vaccinated state), providing greater opportunity to detect infection in the non-boosted than the boosted state, thereby having the effect of overestimating vaccine effectiveness. Those who chose to get the bivalent vaccine were also more likely to have lower risk-taking behavior with respect to COVID-19, having the effect of a higher risk of COVID-19 in the non-boosted state (as those who chose not to get the bivalent vaccine, expectedly with higher risk-taking behavior, remained in the non-boosted state throughout the duration of the study), thereby again potentially overestimating vaccine effectiveness. The widespread availability of home testing kits might have reduced detection of incident infections. This potential effect should be somewhat mitigated in our healthcare cohort because one needs a NAAT to get paid time off, providing a strong incentive to get a NAAT if one tested positive at home. Even if one assumes that some individuals chose not to follow up on a positive home test result with a NAAT, it is very unlikely that individuals would have chosen to pursue NAAT after receiving the bivalent vaccine more so than before receiving the vaccine, at rates disproportionate enough to affect the study’s findings. We were unable to distinguish between symptomatic and asymptomatic infections, and had to limit our analyses to all detected infections. Variables that were not considered might have influenced the findings substantially. There were too few severe illnesses for the study to be able to determine if the vaccine decreased severity of illness. Our study of healthcare personnel included no children and few elderly subjects, and the majority would not have been immunocompromised. Lastly, during most of the study the circulating variants were those represented in the vaccine. It is not known if the vaccine will be equally effective when the strains circulating in the community are not those represented in the vaccine.

A possible explanation for a weaker than expected vaccine effectiveness is that a substantial proportion of the population may have had prior asymptomatic Omicron variant infection. About a third of SARS-CoV-2 infections have been estimated to be asymptomatic in studies that have been done in different places at different times [17–19]. If so, protection from the bivalent vaccine may have been masked because those with prior Omicron variant infection may have already been somewhat protected against COVID-19 by virtue of natural immunity. A seroprevalence study conducted by the CDC found that by February 2022, 64% of the 18-64 age-group population and 75% of children and adolescents had serologic evidence of prior SARS-CoV-2 infection [20], with almost half of the positive serology attributed to infections that occurred between December 2021 and February 2022, which would have predominantly been Omicron BA.1/BA.2 lineage infections. With such a large proportion of the population expected to have already been previously exposed to the Omicron variant of SARS-CoV-2, there could be some concern that a substantial proportion of individuals may be unlikely to derive substantial benefit from a bivalent vaccine.

The evolution of the SARS-CoV-2 virus necessitates a more nuanced approach to assessing the potential impact of vaccination than when the original vaccines were developed. Additional factors beyond vaccine effectiveness need to be considered. The association of increased risk of COVID-19 with higher numbers of prior vaccine doses in our study, was unexpected. A simplistic explanation might be that those who received more doses were more likely to be individuals at higher risk of COVID-19. A small proportion of individuals may have fit this description. However, the majority of subjects in this study were generally young individuals and all were eligible to have received at least 3 doses of vaccine by the study start date, and which they had every opportunity to do. Therefore, those who received fewer than 3 doses (>45% of individuals in the study) were not those ineligible to receive the vaccine, but those who chose not to follow the CDC’s recommendations on remaining updated with COVID-19 vaccination, and one could reasonably expect these individuals to have been more likely to have exhibited higher risk-taking behavior. Despite this, their risk of acquiring COVID-19 was lower than those who received a larger number of prior vaccine doses. This is not the only study to find a possible association with more prior vaccine doses and higher risk of COVID-19. A large study found that those who had an Omicron variant infection after previously receiving three doses of vaccine had a higher risk of reinfection than those who had an Omicron variant infection after previously receiving two doses of vaccine [21]. Another study found that receipt of two or three doses of a mRNA vaccine following prior COVID-19 was associated with a higher risk of reinfection than receipt of a single dose [7]. We still have a lot to learn about protection from COVID-19 vaccination, and in addition to a vaccine’s effectiveness it is important to examine whether multiple vaccine doses given over time may not be having the beneficial effect that is generally assumed.

In conclusion, this study found an overall modest protective effect of the bivalent vaccine booster against COVID-19, among working-aged adults. The effect of multiple COVID-19 vaccine doses on future risk of COVID-19 needs further study.
 
If there is an effect it may be behavioral, someone may be more confident to go out in public and closely interact with others putting themselves at greater risk of coming into contact with people who have covid
 
When you use staff of a clinic as your test group, they are going to encounter the various mutations of covid that while not clearly new strains, will have slightly diferenct envelope proteins since they can be acquired from the host cell. So it might be true that for each exposure the vaccine in 97% effective, multiple exposures to variants may well prove to have only protected 30% of the victims. On the plus side, even if someone is infected, it has been shown that being vaccinated does reduce severity and duration somewhat.

Of course the thing that the trial doesn't attempt to provide is a comparison with another institution of a similar size in which their are likely to be roughly the same number of exposures as and average person would expect to encounter.

My sister is immunocompromised and so while I'm not unduly concerned about my own health, I do everything I can to ensure that she isn't exposed to any infections thus I won't visit her if I've suffered from a contagious infection in the previous few weeks. Likewise I wear a mask so I don't get sick and then can't visit.

Amazing to think that smallpox was recorded at least 3500 years ago but the last recorded case was in 1977. As far as I know only 2 samples exist and their is a question surrounding should we destroy them for fear of someone else having kept samples with ill-intent in mind. Still, that took from 1796 (Dr. Edward Jenner noting that cowpox infection inferred smallpox immunity) until that time to eradicate it.

I am following the CIA accusations with interest. The FBI stated that it was a lab-leak with moderate confidence and the Department of Nuclear Energy to state the same with low confidence. So the CIA flip-flopping between low confidence and 'no comment' is telling.

It doesn't seem like a good plan to build a BSL-4 facility in the middle of a city either. The saving grace of the Sverdlovsk anthrax leak was the remote location of the lab. Imagine THAT in a built up city with an international airport. It's STILL scary that just one person was able to acquire the US weaponized anthrax... and then to mail it to people.
 
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I have also changed my position somewhat. Historically when a new infective agent is alien, the body has no defences at all. Think about the devastation that the Europeans visited on the Americas in the form of new diseases. But the adaptive immune system does what it says on the tin.

T cell response tends to focus on parts of the virus that doesn't change,

I can't physically get out much and isolation has that upside to it. The number of people I interact with is very limited. So I will wear a mask on the bus which most people don't, but that's cultural. In places like Japan it's common for people to wear masks to prevent the spread of influenza.

If surgeons can manage to wear a mask for 8 hours, I can manage to get along with one for 20 minutes.
 
AlsoTapered said:
I have also changed my position somewhat. Historically when a new infective agent is alien, the body has no defences at all. Think about the devastation that the Europeans visited on the Americas in the form of new diseases. But the adaptive immune system does what it says on the tin.

T cell response tends to focus on parts of the virus that doesn't change,

I can't physically get out much and isolation has that upside to it. The number of people I interact with is very limited. So I will wear a mask on the bus which most people don't, but that's cultural. In places like Japan it's common for people to wear masks to prevent the spread of influenza.

If surgeons can manage to wear a mask for 8 hours, I can manage to get along with one for 20 minutes.
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Masks are a mental security blanket, they do basically nothing. I am more than happy to let people wear what they want, but don’t force normal people to wear that shit. It has many health affects, and all of them are negative.
 
mal3volent said:
me neither.

I find it hard to trust the people who said the shots would prevent us from getting it

then quickly changed their story to "you'll get it, but the symptoms won't be as severe"

seems like to me it's more propaganda than anything else at this point
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people are catching it again too - 2 people at my work right now - and it's in little clusters at the facilities that i visit

but im telling ya, and im not just saying this - all the ppl now that are catching it again that im seeing, have all been previously vaxxed - i have yet to see a non-vaxxed person catching it within the last 6 months

and im around it almost everyday, and still nothing - no vaxx no covid
 
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