VACCINES:
1 - The U.S. Food and Drug Administration is expected, as early as tomorrow, to bump up the status of the Pfizer/BioNTech COVID-19 vaccine from “authorized” on an emergency-use basis to “approved” for adults and children 12 years and up, per various reports. “Previous polling by the Kaiser Family Foundation [in June] found that 31% of unvaccinated people would be more likely to get their shots if a vaccine earned full approval,” writes Beth Mole at Ars Technica (8/20/21). A similar approval for Moderna’s COVID-19 vaccine could follow within weeks, Mole’s story states. “Full approval is expected to spur a [additional] wave of vaccination mandates—from hospitals, universities, and other employers,” Mole writes: https://arstechnica.com/science/2021/08/report-pfizers-covid-19-vaccine-may-get-full-fda-approval-monday/.
2 – Pfizer/BioNTech and Moderna COVID-19 boosters (3rd shots) were authorized by the U.S. Food and Drug Administration on 8/12/21 for organ transplant recipients and some other adults with compromised immune systems. And 3rd shots of these mRNA vaccines also could become available next month in the U.S. for all U.S. adults over 18 who received the Pfizer or Moderna vaccine, but can and should you get one if you become eligible? Find answers to your immediate questions in Tanya Lewis's 8/20/21 interview with virologist and vaccine researcher Shane Crotty, of the La Jolla Institute for Immunology, and infectious disease specialist and epidemiologist Celine Gounder, of NYU and Bellevue Hospital. Third shots of the mRNA vaccines make sense for people over 80, Crotty says, but it's not clear that younger people will gain a lot more protection from them. For people who received the Johnson & Johnson single-dose vaccine, "it is time," he says, to get a second dose, because data suggest the J&J vaccine is not as protective against the delta variant of SARS-CoV-2. (There’s not enough data yet to make a decision on J&J boosters, plus this vaccine works differently than the mRNA vaccines do, per this AARP story by Dena Bunis, 8/19/21). As for the ethics of giving booster shots when so many people worldwide remain unvaccinated, Crotty says, "I think it’s a false dichotomy. The vaccines are going to expire; you're not going to move them around. The best-case scenario in the U.S. would be if we got all unvaccinated people vaccinated. It would be far better than dealing with boosters. The math is not even close" (Scientific American): https://www.scientificamerican.com/article/should-you-get-a-booster-shot-heres-what-we-know/.
3 - For a boost of confidence in the protection afforded by COVID-19 vaccines, see this graph of reported SARS-CoV-2 infections, broken down by percent vaccinated and unvaccinated, in most U.S. states. Carolyn Ryan at The York Times tweeted it on 8/12/21 by (thus, I suspect the data and graph come from their site):
4 - Or see this insight about COVID-19 vaccinations, hospitalizations and deaths in the most vaccinated and least vaccinated U.S. states, tweeted 8/9/21 by Brown School of Public Health Dean Dr. Ashish K. Jha. I think the general trends hold today:
SCHOOLS:
5 - Many experts agree that reopening U.S. schools to in-person instruction this fall should “be a priority,” but big variations in vaccination rates among children as well as the spread of the delta variant of SARS-CoV-2 make it crucial that schools take additional COVID-19 safety precautions, reports Emily Anthes at The New York Times. Some of the story’s takeaways: 1) “studies suggest that—last year at least—in-school transmission was generally low when schools took basic precautions,” such as masking, symptom screening, handwashing, improved ventilation, virus testing, maintaining students in smaller groups, and three-foot distancing; 2) vaccines authorized for ages 12 and up in the U.S. “provide strong protection against the delta variant. They reduce the odds of being infected with the virus and guard against the worst outcomes, including hospitalization and death”; 3) the U.S. Centers for Disease Control now recommends that teachers, staff, visitors, and children of all ages wear masks in schools, whether or not they are vaccinated or living in a coronavirus hotspot; 4) “vaccines for some children under 12 could be authorized before the end of the year” (8/2/21, updated 8/10/21): https://www.nytimes.com/2021/08/02/us/covid-schools-delta-variant.html.
DELTA:
6 - Insufficient vaccination is driving the current wave of SARS-CoV-2 infections and hospitalizations in the U.S., not “breakthrough” infections, writes German Lopez at Vox (8/3/21). There is not enough research and data “to draw final conclusions about the role of the delta variant,” and “evidence continues to show the vaccines reduce the virus’s rate of spread, delta or not,” Lopez writes. A surge of infections with the delta variant of SARS-CoV-2 in the UK (where 70 percent of the population is partially vaccinated—the U.S. is at 60% and the world is at 32%, per Our World in Data as of 8/21/21), “has come and gone with only small increases in hospitalizations and deaths,” the story states: https://www.vox.com/22602039/breakthrough-cases-covid-19-delta-variant-masks-vaccines.
7 - Available evidence “strongly suggests that vaccinated people are still much less likely to transmit [SARS-CoV-2], even with Delta,” writes demographer and population health researcher Jennifer Beam Dowd, of the University of Oxford, England, at Dear Pandemic (8/8/21). “This has made our estimates of transmission from vaccinated people change from *rare* to *possible*:” https://dearpandemic.org/delta-contagious-vaccinated-vs-unvaccinated/.
PUBLIC HEALTH:
8 - For various U.S. counties and cities, this web tool estimates the risk that at least 1 person positive for SARS-CoV-2 will be at your gathering, depending on the number of people present. Estimates are based on local case numbers. When I first drafted this item a few weeks ago, NYC had an 8% risk in a gathering of 20 people, per the tool. Today that figure is 13%. The tool is a “project led by Prof. Joshua Weitz and Prof. Clio Andris at the Georgia Institute of Technology” along with other researchers, the site states. Beneath the map, the site includes a button to click for global estimates: https://covid19risk.biosci.gatech.edu.
9 - Here’s a way to think about infections with SARS-CoV-2 among people who are already vaccinated: When 100% of a population is vaccinated against COVID-19, 100% of infections from the virus that causes it (SARS-CoV-2) will occur among the vaccinated. I forget where I read that helpful framing for “breakthrough” infections, but add to this growing portion of vaccinated people in the U.S. the following factors—the contagiousness of the delta variant of SARS-CoV-2, the slowdown in COVID-19 vaccination rates in the U.S., and lifted masking requirements and other restrictions. Thus, it’s not too surprising that U.S. infections in vaccinated people appear to be rising. Preliminary data reveals this trend in 7 U.S. states (California, Colorado, Massachusetts, Oregon, Utah, Vermont, and Virginia), reports Apoorva Mandavilli at The New York Times (8/18/21). "The absolute numbers remain very low, however, and there is little doubt that the vaccines remain powerfully protective," Mandavilli writes. The vast majority of people hospitalized for COVID-19 in the U.S. continues to be people who are unvaccinated. Nearly 75% of vaccinated people who end up in the hospital due to COVID-19 are age 65 or older, the story states. Many of these people are obese, and/or immune-compromised, and/or have diabetes: https://www.nytimes.com/2021/08/17/health/covid-vaccinated-infections.html.
10 - I never stopped wearing a mask in public indoor settings (mostly; I’m hardly perfect). Here’s the latest masking guidance from the U.S. Centers for Disease Control (8/13/21): https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/about-face-coverings.html.
SCIENCE:
11 - There’s been some uncertainty about whether blood levels of antibodies to SARS-CoV-2 reflect the strength of our immunity to the virus. You might wonder, what about the roles of B cells and T cells, which are not as easy to measure but also reflect the strength of the immune response? New findings (8/10/21), not yet reviewed by experts for flaws, suggest that antibodies are indeed a clear indicator of the strength of one’s immune protection against SARS-CoV-2, reports Andrew Joseph at STAT (8/16/21). If valid, the result could enable smaller studies of vaccine effectiveness, with some pre-set antibody threshold as a marker of protection against SARS-CoV-2, the story suggests: https://www.statnews.com/2021/08/16/scientists-clues-how-safe-vaccinated-people-are-from-covid-19/.
12 - The delta variant currently dominates SARS-CoV-2 infections in the U.S., but other variants are on the horizon. An 8/19/21 story by Kai Kupferschmidt at Science reports on forecasts of how the virus might evolve in the future. To date, the virus has evolved to “better avoid human antibodies” and to “become a bit more virulent and a lot more infectious, causing more people to fall ill,” Kupferschmidt writes. The story suggests that SARS-CoV-2 is likely to evolve to become deadlier, though it is unclear whether the current COVID-19 vaccines would work less well against such variants. Describing the perspective of Edward Holmes, a viral evolution researcher at the University of Sydney, Kupferschmidt writes: “A popular notion holds that viruses tend to evolve over time to become less dangerous, allowing the host to live longer and spread the virus more widely. But that idea is too simplistic, Holmes says”: https://www.sciencemag.org/news/2021/08/new-sars-cov-2-variants-have-changed-pandemic-what-will-virus-do-next.
ENTERTAINMENT:
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GENERAL UPDATE: This issue was harder to write than most. Items that I pre-wrote went out of date faster than usual (I might put some of them in the archive). I’m sticking with my usual barometers — scientific evidence, rationality, and a modest degree of skepticism.
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