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🦘Cacatman's Personal Coronavirus COVID-19 Update Thread

cacatman

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Asymptomatic/Presymptomatic Transmission

Half the Transmission of COVID-19 Comes from Asymptomatic People

Models predicts that 59% of all transmission would come from asymptomatic transmission – 35% from presymptomatic individuals and 24% from never-symptomatic individuals.

The authors acknowledge that the study applies a simplistic model to a complex and evolving phenomenon, and that the exact proportions of presymptomatic and never-symptomatic transmission and the incubation periods are not known. They also note symptoms and transmissions appear to vary across different population groups, with older individuals more likely than younger persons to experience symptoms, according to previous studies.

Asymptomatic cases more like 17-30%

Viral shedding kinetics for asymptomatic COVID-19 is not well understood. Early in infection, individuals have similar viral loads regardless of eventual symptom severity, but asymptomatic cases have lower titers at peak replication, faster viral clearance, and thus a shorter infectious period.

They are 42% less likely to transmit the virus and there are lower secondary attack rates. But this is controversial.

65% of transmission occurs prior to symptom onset!!
 

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cacatman

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Report on Origins of COVID-19
Nevertheless, the WHO report discounts both Redfield’s opinion and Blinken’s misgivings. The report is largely based on a WHO investigator visit to Wuhan from mid-January to mid-February this year. The investigators detailed 4 scenarios by which SARS-CoV-2 could have emerged, listed in order of most likelihood to least:

  • Bats through another animal (very likely)
  • Direct spread from bats to humans (likely)
  • Cold-chain food products (possible but not likely)
  • Laboratory leak (extremely unlikely)
As the report draft explains, the evolutionary distance between bat-based coronaviruses and SARS-CoV-2 is estimated to be several decades, “suggesting a missing link.”

Intermediate hasn't been found.
 

cacatman

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Pfizer, Moderna COVID-19 vaccines highly effective after first shot in real-world use

The risk of infection fell 90% by two weeks after the second shot, the study of nearly 4,000 U.S. healthcare personnel and first responders found.

The results validate earlier studies that had indicated the vaccines begin to work soon after a first dose, and confirm that they also prevent asymptomatic infections.
 

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Rituximab use may be a risk factor for severe COVID-19

As reported in The Lancet Rheumatology, 35% of rituximab-treated patients developed severe COVID-19, resulting in intensive care unit admission or death, compared with 11% of those in the no rituximab group. These findings translated into a significant odds ratio of 3.26 after adjustment for factors including age, sex, comorbidities, and corticosteroid treatment using the inverse probability of treatment weighting propensity score method.
 

cacatman

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Cardiovascular Sequelae

Cardiovascular Function - Abnormal Echocardiograms in COVID-19 Patients

69 countries were examined with 1200 patients. 70% male. 55% had an abnormal echo. Left and right heart dysfunction was surprisingly 39%/33%. Postulated to be due to pulmonary thromboembolism. 3% had MI, 3% had myocarditis, and takotsubo cardiomyopathy 2%. 15% had severe cardiac disease.

Abnormalities were often unheralded/severe. The echo findings changed management in 1/3 of patients.

Therefore dyspnoea/SOA, chest pain etc, needs an echo.


Cardiac Tissue Issues
Cardiomyocytes derived from human induced pluripotent stem cells treated with interleukins and infected with SARS- CoV- 2 in cultures, show increased release of troponin, disorganization of myofibrils, and changes in beating mirroring specific pathologies in some COVID-19 patients.

Elevated levels of troponin noted with COVID-19

Cardiac injury is a common condition among patients hospitalized with COVID-19, and it is associated with higher risk of in-hospital mortality.

Reviewers reported weighted mean incidences (WMIs) of a range of cardiovascular events among participants in these studies; each outcome was reported in a subset of studies, sometimes in single studies. WMIs (range when reported) calculated for multiple studies were as follows: 18.0% (0.2% to 71.0%) for shock/treatment with vasopressors; 11.1% for atrial fibrillation; 8.5% (0.0% to 24.7%) for supraventricular arrhythmias; 7.6% for increase in QT interval; 7.4% (0% to 46.2%) for venous thromboembolism; 6.8% (0.0% to 24.0%) for heart failure; 6.1% for deep vein thrombosis; 6.1% (0.0% to 100%) for mortality (increasing to 32% among cohorts entirely enrolled in the intensive care unit [ICU]); 4.3% for pulmonary embolism; 2.7% (0.0% to 12.4%) for ventricular arrhythmias; 2.6% (0.0% to 12.5%) for myocarditis; 1.7% (0% to 3.6%) for myocardial infarction/acute coronary syndrome; 1.2% (0% to 9.6%) for stroke; and 1.1% (0.0% to 8.1%) for extracorporeal membrane oxygenation use.
 

cacatman

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Risk Factors - Update
Conditions that had previously been categorized as “might be” placing individuals at increased risk – but now are listed as high risk – include type 1 diabetes (in addition to type 2), moderate-to-severe asthma, liver disease, dementia or other neurologic conditions, stroke/cerebrovascular disease, HIV infection, cystic fibrosis, and overweight (in addition to obesity).

Substance use disorders, which hadn’t been previously listed, are now also considered high risk.


The new list groups together certain categories, such as chronic lung diseases (chronic obstructive pulmonary disease, asthma, cystic fibrosis, etc) and heart conditions (heart failure, coronary artery disease, hypertension, etc).

Both diabetes types are now grouped under “diabetes.”
 

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Astrazeneca - "We think that AZ has embellished data"
Controversy over 2 full doses only being 62% effective, study spread across 2 countries and if half dose given first before 2nd, then 90% effectiveness.


symptoms seen in at least 13 patients, all between ages 20 and 50 and previously healthy, in at least five countries are more frequent than would be expected by chance. The patients, at least seven of whom have died, suffer from widespread blood clots, low platelet counts, and internal bleeding—not typical strokes or blood clots. “It’s a very special picture” of symptoms, says Steinar Madsen, medical director of the Norwegian Medicines Agency. “Our leading hematologist said he had never seen anything quite like it.”

Acute infections can trigger clotting and bleeding, sometimes culminating in DIC, Wendtner notes. But abnormal clotting is also a feature of COVID-19. It’s possible, Wendtner says, that the unusual cases had a COVID-19 infection before they got vaccinated; many were health care workers and teachers who may have been exposed at work. Coming on top of the infection, the vaccine might somehow have triggered an overreaction by the immune system, sparking the clotting syndrome. Ganser thinks patients suffering from CVT may be the tip of the iceberg and that more people may suffer similar, but milder, symptoms.

Vaccine cause ruled out for blood clots



Efficacy Revised Down

76% vaccine efficacy against symptomatic COVID-19

100% efficacy against severe or critical disease and hospitalisation

85% efficacy against symptomatic COVID-19 in participants aged 65 years and over


If it is true that all 7 clots were caused by the vaccine, with 1.6 million immunizations, then that works out to a rate of roughly 1 clot per 230,000 jabs or 0.00044%. While the relative risk increase here sounds scary, that means that this equates to an absolute risk increase for people who have been vaccinated of 0.00038%, which is not quite as huge as the headlines are suggesting.

We can also compare this to the risk of COVID-19. Even 20-year-olds are not immune to the disease, and while their risk of death is much lower than the elderly, it comes out to about 1 death per 16,000 infections. So if the vaccine really is causing these blood clots, which can be fatal, then the risk of dying from COVID-19 for a 20-year-old is about 15 times higher than the risk of having a clot. Again, because both of the risks are very small, the absolute difference is also tiny, at about 0.004%.

UK regulator found total of 30 cases of blood clot events after AstraZeneca vaccine use

British regulators on Thursday said they have identified 30 cases of rare blood clot events after the use of the AstraZeneca COVID-19 vaccine, 25 more than the agency previously reported.

The million (or billion) dollar question now is whether the risks and benefits of the AstraZeneca/Oxford vaccine calculation has changed. That hinges on how risky covid-19 is for any given person, how likely the vaccine is to cause VITT, and how likely that is to cause a genuine problem for the few who develop it. This in turn, hinges on the age of the person considering the question. As we know, age is the single greatest factor in determining a person's risk of developing severe or critical covid-19 after infection with SARS-CoV-2. While the statistics numbers are likely to change with improved surveillance (and vigilance), the University of Cambridge has produced a reasonably credible readout on the risks and benefits of receiving the AstraZeneca/Oxford vaccine, given what we already have learned about VITT rates. The risk of VITT is so low that in areas were coronavirus is moderately prevalent (6 cases per 10,000 people per day) or highly prevalent (20 cases per 10,000 people per day), the vaccine remains safer than covid-19 risks by far. Even among people ages 20-29, in moderate-risk zones, the risk of an intensive care unit admission resulting from covid-19 is double that of any serious harms from the vaccine. In high-risk zones covid-19 is six times more dangerous for that age group. The balance tips in the vaccine's favor more and more with each decade, since covid-19 risk goes up with age, whereas vaccine-related risks appear to go down with age. For adults ages 60-69, covid-19 is over 638 times more dangerous than any vaccine-related risk. The only scenario in which the risk-benefit balance currently leans away from the AstraZeneca/Oxford vaccine is for people younger than 30 years old, in low-risk covid-19 zones, according to the University of Cambridge analysis. That means, that for the first time, many experts would specifically recommend that a particular subgroup avoid one vaccine product in favor of another. Until now, despite all the small statistical differences among the available options, experts have largely stuck to one message: get whichever vaccine you are offered first. That message remains true today, with the exception of persons under age 30 in low-risk areas.
 

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cacatman

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Pfizer Vaccination - 23 Deaths in Norway Following Vaccination
Caution advised if administering to elderly

Pfizer vaccination only 52% effective if ONLY one dose is taken.

Pfizer Vaccine - One dose results in 33% Efficacy

Information Sheet

Working on Update Vaccination for Newer Strains

Separately, the vaccine, which has been authorized in the U.S., the U.K., the EU and elsewhere, can be stored and transported at between minus 25 and minus 15 degrees Celsius, or minus 13 and 5 degrees Fahrenheit—similar to a consumer freezer—Pfizer and BioNTech said. Currently, the vaccine’s labels say it must be stored at between minus 80 and minus 60 degrees Celsius, requiring sophisticated equipment.

A single shot of the vaccine is 85% effective in preventing symptomatic disease 15 to 28 days after being administered, according to a peer-reviewed study conducted by the Israeli government-owned Sheba Medical Center and published in the Lancet medical journal. Pfizer and BioNTech recommend that a second dose is administered 21 days after the first.

The latest numbers, which were compiled through Feb. 13 and compare the vaccinated and unvaccinated populations, show that the jab has been nearly 96 percent effective at preventing symptomatic COVID-19 infections two weeks after individuals receive their second dose. When it comes to preventing severe infections, hospitalizations, and deaths from the coronavirus, the figure jumps to an efficacy rate around 99 percent.

Israel’s Ministry of Health says benefits of #PfizerVaccine 14 days after 2jab are: • 95.8% preventing illness cases • 98.0% preventing fever and/or respiratory symptoms • 98.9% preventing hospitalization • 99.2% preventing severe illness • 98.9% preventing death

Six months after getting a second dose of the Pfizer-BioNTech vaccine as part of a 46,000-person clinical trial, volunteers remained more than 90% protected against symptomatic COVID-19 and even better protected against severe disease, a new company study found.

Out of 927 trial participants who fell ill with COVID-19 more than a week after their second dose, only 77 had received the active vaccine, compared with 850 who got a placebo.

Fully effective against the South African Variant.

The Pfizer/BioNTech COVID-19 vaccine is more than 91 percent effective six months after people get their second dose, according to new test data released by the companies.

The findings from more than 46,000 trial participants was released Thursday, CBS Newsreported. There were 927 confirmed symptomatic cases of COVID-19 overall, with 850 cases in the placebo group and 77 cases among those who received the vaccine.

100% vaccine efficacy with its COVID-19 vaccine, BNT162b2, in the prevention of the virus is participants 12-15 years old.

Here, for instance, is what the US Food and Drug Administration says is in Pfizer’s vaccine:
  • Active Ingredient
    • nucleoside-modified messenger RNA (modRNA) encoding the viral spike glycoprotein (S) of SARS-CoV-2
  • Lipids
    • (4-hydroxybutyl)azanediyl)bis(hexane-6,1-diyl)bis (ALC-3015)
    • (2- hexyldecanoate),2-[(polyethylene glycol)-2000]-N,N-ditetradecylacetamide (ALC-0159)
    • 1,2-distearoyl-snglycero-3-phosphocholine (DPSC)
    • cholesterol
  • Salts
    • potassium chloride
    • monobasic potassium phosphate
    • sodium chloride
    • basic sodium phosphate dihydrate
  • Other
    • sucrose
 

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