Hello!
Lots of info in this update plus local cases. This update has a lot of vaccine information as there has been a lot of data released and studied lately.
Local cases:
Lake County, IL: Things are looking much better. Testing positivity is down to 2%. Residents fully vaccinated: 60%; Residents with at least one dose: 76%; hospital beds used: 6%; ICU beds used: 16%
Kenosha, WI: Testing positivity is stable at 7%. Residents fully vaccinated: 52%; Residents with at least one dose: 56%; hospital beds used: 11%; ICU beds used: 12%
Racine, WI: Testing positivity is up slightly at 8%. Residents fully vaccinated: 53%; Residents with at least one dose: 57%; hospital beds used: 6%; ICU beds used: 9%
Research updates:
Mixing and matching Pfizer vs Moderna:
There has been a lot of speculation about whether it is ok to switch from Pfizer to Moderna for the booster and vice versa. First, I'll clarify only Pfizer is approved for a "booster" whereas Moderna was only approved for a "third dose" for severely immunocompromised (solid organ transplant or equivalent) although it just received EUA today for a “booster”. With that being said, many people have anecdotally gone and gotten a third shot/booster dose/ it's all semantic here for themselves prior to FDA EUA for a booster. These renegades have also been indiscriminate in their vaccine loyalty and basically took any decent shot out there. We now have data that not only is that safe, but it also possibly gives a more robust immune response. Being a science lover myself, I reviewed the study and although the sample size was small (458 cross overs studied), the data showed that switch hitters were both safe and possibly more immunogenic than using the same vaccine for booster. This data will be officially presented later but there is a cool chart that shows the cross over.
News on aspirin: Multiple outpatient protocols have incorporated aspirin or oral anticoagulants as a way to prevent blood clot complications, based on observational studies. The data repeated from a recently completely randomized trial suggests no benefit to taking aspirin or anticoagulants for prevention of covid complications. Another idea bites the dust. Don't stop your aspirin if you take it for other reasons though.
New vaccine darling: Astra Zeneca released their phase 3 study data for their vaccine and said it was 79% effective at preventing symptomatic disease and 100% effective against severe disease and hospitalization. There was also no increased risk of clots in the trial of over 32,000 participants. This is not an mRNA vaccine for those leery of those. Instead, it is an adenovirus vector that can enter the cell but can't replicate inside it. J&J is the other adenovirus vaccine we have available.
Slurpees, tree bark and moths: Novovax reported 92% efficacy against covid overall, 100% against severe disease. Cases of breakthrough were due to variants. The vaccine provided excellent covid alpha protection (the original strain). Data was not collected at a time when there was delta predominance so it is hard to say what the stats would be for delta protection. They do not plan to apply for EUA yet due to quality control issues in third party validation standards. Sounds reassuring!
This vaccine is actually super interesting because it does not use mRNA or adenovirus vector technology. It's another type called subunit protein. The spike protein is generated by infecting moth cells with a virus and the code for the spike protein. The adjuvant is tree bark that potentiates an immune response.
This might be a good vaccine for people that don't like mRNA vaccines for whatever reason (microchip mind control, mutant DNA, whatever) or have an anaphylactic allergy to PEG (mRNA vaccine problem) or believe that moths + bark = more natural. Unfortunately, the tree bark that gives the saponins (an ingredient in slurpees!) is a rate-limiting resource. Fascinating if anyone wants to read more about it:
https://www.reuters.com/business/healthcare-pharmaceuticals/chilean-tree-holds-hope-new-vaccines-if-supplies-last-2021-10-06/?fbclid=IwAR1sCU7rzShGfXauktGdquyCBDECl_nMv4JeYK-MwLzmFHAYJoeB6olQUws Pfizer Full dose vs child dose: The Pfizer vaccine is approved for children ages 12 and above and adults. The dose is 30 ng. The dose that was tested for kids 5-11 which has been recently evaluated for EUA approval will be 1/3 of the adult dose or 10 ng. For comparison, the Moderna vaccine full dose for adults is 100 ng. If you have a child that is on the cut off, it is best to go with their age recommended dose. Do not go by weight as vaccines are not dosed by weight but rather by immune system response. Child have robust immune systems and respond to lower doses than adults. That is why there is a pediatric flu dose for kids under 6 months, a child and adult flu dose and then a high dose flu vaccine for older adults over age 65. Older adults typically need a bigger amount to have a good response. For parents evaluating if the vaccine is safe for their child, we would go by the child's age, not height or weight. Get your child the dose recommended for their age category. Pfizer booster vs Moderna 3rd shot: Technically the booster is only available to people who got pfizer the first 2 series and meet the criteria for booster (over 65 or have a high-risk health condition or job - which is admittedly loosely defined). For people that got moderna, there is no booster approved yet but EUA was just unanimously recommended today. They have a third dose approved for immunocompromised only but this might change in a few days. You must attest that you are either over 65 or high risk somehow. The pfizer booster is the same dose as the first two shots of Pfizer. Whereas the moderna “booster” is half the first two doses (50 ng vs 100ng). Moderna "third dose" is the regular dose of the first two moderna (100 ng). Is anyone following this??? Moderna is supposedly supposed to update their booster data (50ng dose) in the next 1-2 weeks. Also, the data that was released Non- responders: Recent studies have show that up to 36% of people who are naturally infected with covid do not develop any neutralizing antibodies, despite the level of severity of symptoms and disease, and could become infected again as soon as they come in contact with covid again. This means that up to 36% of people have no "natural immunity". Of the non-responders: 18% reported mild disease; 67% moderate disease; 12% severe disease. Basically, the study conclusion was that immunity through disease is not only dangerous (ie you could die or be seriously ill) but may not be statistically possible at all. The efficacy of protection given by the vaccine is much better than the actual disease. This study was very small (72 people) so I personally think it is too early to apply this data broadly. This study's findings also contradict the Israeli data from 32,000 people. However, the Israeli study has been heavily criticized in the scientific community for poor design and thus useless data. In other words, the debate is still raging on. We need someone, somewhere do to a good quality study with high numbers to sufficiently draw conclusions. In the meantime, we know that truly some people mount no response to infection.
Mu Variant:
Delta has out competed Mu and Mu has essentially not been an issue which is awesome since it’s fairly vaccine resistant.
Have a good weekend everyone!
Dr. Green
Medlogic Primary Care
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