Vaccine hesitancy and side effects

[Roadrunner]

I have a broader question for folks who don’t want to vaccinate. How do they see the endgame of this pandemic? I am basing this question on the assumption that all of us (pro and against vaccination) have a shared goal of returning to normal life and want to prevent the repeat of NY and LA outbreaks. 
Are you guys thinking in time everybody is exposed and you expect immunity will build naturally? If so, how do we keep hospitalizations down in order to prevent further government shutdowns?

 

[mathnerd]

13 hours ago, happysmileylady said:

DH's entire hospital bill was covered by his insurance.  Having said that, we had already hit the deductible for the year because he had his hip replaced about 4 months before he got sick.

@happysmileylady, thank you very much for your input. Hope you and your kids are doing well.

[Syllieann]

1 hour ago, happysmileylady said:

One thing I haven't seen in this thread is the vaccine and those who have had it.  I mean I think it has been addressed some, but only kind of brushed on.

 

There are 33 million confirmed cases of it in the US and an uncounted number of unconfirmed cases.  I have no idea if my positive antibody test counts in that 33mil, but I know none of my kids cases count because of when I chose testing and because I chose not to put them through a blood draw. 

 

Regardless of my anecdotal documentation...

 

There are a lot of folks who have had it....and that's true even if we ignore those who think they have had it but didn't. 

 

There's not a lot of data that shows that natural immunity is significantly more beneficial than vaccine immunity.  I mean, I think there's probably enough that choosing vaccine over natural could be more beneficial.  BUT...if you don't have the choice.  If you have already had it through no fault of your own...

 

And it was no big deal...

 

Why would someone with that immunity choose to take a medication that they cannot undo, if they can't be really confident that the vaccine won't make them sicker than the actual disease itself? 

 

Please note, as should be obvious....I am very well aware that it is not the case for everyone that the disease is very mild.  But it's a fact that for many people....it is.  If someone had a case where it was very mild, and then they read about people taking one or two or 3 days off work, with fevers and chills and such....and the disease itself didn't produce that for them..............and the vaccine seems to produce stronger reactions like that in those that had it previously.....

 

What should convince those people that they should still get the vaccine?

My uncle had it and thought it was just allergies.  He only got tested because he had a known exposure.  He's 59 and the picture of health.  He didn't want to vaccinate, but since there isn't an option to prove previous infection, he got moderna so he could go to Hawaii more easily.

Another family member with previous infection is in his late 70s and obese with high blood pressure.  He was pretty sick, but figured if he didn't die before he won't die now.  He and his wife run in far right circles.  They would be willing to vaccinate if it lifted mask requirements for church and "hospitality hour," which I guess is coffee and pastries.

Edited May 2, 2021 by Syllieann

[math teacher]

2 hours ago, Catwoman said:

I agree. It seems to be universally accepted that the lack of side effects doesn’t mean that the vaccine didn’t work. 

@math teacher — Have you looked to see if any studies have been done to show the effectiveness of the vaccines on people with your dh’s condition? Have you spoken with his doctors about it? 

My impression is that just about everyone will receive some benefit from the vaccine, but it can be difficult to determine exactly how effective the vaccine will be for any particular individual, so if you are concerned that your dh may not be well-protected, you might be stuck doing what my family is doing — we are still masking and distancing and not going into stores. We are hopeful that enough people will get vaccinated, so the chances of catching Covid will be greatly diminished, and we are especially hoping that the new Pfizer pill will be approved soon, because that will make us feel so much safer.

His doctor recommended the vaccine, but with new information appearing almost daily, his doctor may not have been aware of the lack of good protection. We will discuss it with him at the next visit. 

I We may have to continue the vigilance. If we have to-then we will. I just wish more people would get vaccinated. We live on the border of two counties-one is 17% vaxxed and the other is 6%. 

[Not_a_Number]

42 minutes ago, Syllieann said:

He didn't want to vaccinate, but since there isn't an option to prove previous infection, he got moderna so he could go to Hawaii more easily.

I hope they do add the option to prove previous infection, since it looks like it does provide robust immunity. 

[Bootsie]

The university where I teach has not made any announcement regarding requiring a vaccine for the fall.  They have been doing a lot of encouraging of vaccines.  One of the ways students are encouraged is being told that the university is abiding by the CDC's guidelines that if you have been vaccinated within the past three months and are exposed to COVID (but have no symptoms) you are not required to quarantine.  So, the students are counting months and saying "Personally, I am not too concerned about COVID and am not in a rush to be vaccinated.  The semester is almost over.  It would be better if I wait until August to be vaccinated--so that I am within the three month window when I return to campus in the fall"  Of course, the guidance may change by then.  But, these students are seeing a disadvantage if they get vaccinated now and then return in the fall and are exposed--then they will have to quarantine if the guidance hasn't changed.  

[Matryoshka]

38 minutes ago, Not_a_Number said:

I hope they do add the option to prove previous infection, since it looks like it does provide robust immunity. 

I thought that especially with new variants that wasn't the case at all. I could swear I remember someone linking a study saying previous infection provided pretty much 0% immunity to the South African variant, but the vaccine they were testing as a comparison did. 

[Pen]

@Plum

Rtelating to post you did not want quoted and as you are trying to decide what to do, plus I will try to send you a PM

adding the bold below: 

 

Citation Export

Abstract

Relative risk reduction and absolute risk reduction measures in the evaluation of clinical trial data are poorly understood by health professionals and the public. The absence of reported absolute risk reduction in COVID-19 vaccine clinical trials can lead to outcome reporting bias that affects the interpretation of vaccine efficacy. The present article uses clinical epidemiologic tools to critically appraise reports of efficacy in Pfzier/BioNTech and Moderna COVID-19 mRNA vaccine clinical trials. Based on data reported by the manufacturer for Pfzier/BioNTech vaccine BNT162b2, this critical appraisal shows: relative risk reduction, 95.1%; 95% CI, 90.0% to 97.6%; p = 0.016; absolute risk reduction, 0.7%; 95% CI, 0.59% to 0.83%; p < 0.000. For the Moderna vaccine mRNA-1273, the appraisal shows: relative risk reduction, 94.1%; 95% CI, 89.1% to 96.8%; p = 0.004; absolute risk reduction, 1.1%; 95% CI, 0.97% to 1.32%; p < 0.000. Unreported absolute risk reduction measures of 0.7% and 1.1% for the Pfzier/BioNTech and Moderna vaccines, respectively, are very much lower than the reported relative risk reduction measures. Reporting absolute risk reduction measures is essential to prevent outcome reporting bias in evaluation of COVID-19 vaccine efficacy.

 

[KathyBC]

On 4/30/2021 at 9:28 AM, wathe said:

Yes and no. 

We didn't have a New York-like first wave here, so Canadian data will change.

I think younger people actually are worse off because of the sheer volumes of them.  We are overwhelmed with younger people, and going to have to triage/ration care among younger people.  Young and otherwise healthy people who would have previously have been chosen for the bed in a triage situation will now be competing with similarly "young and healthy" others.

The variants are certainly more contagious, and hence at the very least they indirectly more deadly - they've pushed us into an overwhelm situation. 

Have age demographics changed that much? I thought Canada was still heavier on the older end of the population scale.

[Halftime Hope]

5 hours ago, KSera said:

Regeneron is the only early therapy that so far shows promising potential, but it has proven difficult to implement for a number of reasons, because it has to be given by infusion in a medical setting.

There are a number of early therapies that "show promising potential".  

Fluvoxamine, budesonide, ivermectin, bromhexine, HCQ, and so on. 

AIIMS just published an updated guideline for treating adult COVID patients, and it included some of the above: they may be used off label, even though they were labeled "low level of certainty".  

Lancet Respiratory just published a study using budesonide. https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(21)00160-0/fulltex NNT = 8  I suspect there will be additional studies coming, because the epidemiological data confirms the prophylactic benefit of inhaled glucocorticoids. 

 

 

Edited May 2, 2021 by Halftime Hope

[Frances]

12 hours ago, Pen said:

 
The link is what I meant.   
 

It looks like the official protocol in your area is about the same as here. In a nutshell what seems like:  
 

Do nothing unless severe enough for admission to hospital. 
 

At which point it may be too late for some potential therapies like Regeneron to work. 
 

It seems like a bad approach to my way of thinking. 
 

Bamlanivimab is being regularly used in your state for positive cases at risk of hospitalization, although I don’t know about your specific location.

[KSera]

1 hour ago, Bootsie said:

It would be better if I wait until August to be vaccinated--so that I am within the three month window when I return to campus in the fall"  Of course, the guidance may change by then.  But, these students are seeing a disadvantage if they get vaccinated now and then return in the fall and are exposed--then they will have to quarantine if the guidance hasn't changed.  

That’s unfortunate. Hopefully the university will update that to 6 months, with more recent trial data showing that immunity is still holding strong at 6 months. 

25 minutes ago, Halftime Hope said:

There are a number of early therapies that "show promising potential".  

Fluvoxamine, budesonide, ivermectin, bromhexine, HCQ, and so on. 

AIIMS just published an updated guideline for treating adult COVID patients, and it included some of the above: they may be used off label, even though they were labeled "low level of certainty".  

Lancet Respiratory just published a study using budesonide. https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(21)00160-0/fulltex NNT = 8  I suspect there will be additional studies coming, because the epidemiological data confirms the prophylactic benefit of inhaled glucocorticoids. 

 

 

I should have used different words than “promising potential”. I meant something stronger. I didn’t know of any others with evidence as strong as Regeneron. The budesonide study was interesting. Hopefully they will repeat on larger populations and get similar results. An interesting statistic near the end of the study that seems relevant to this discussion of risk: “our population reflects the general global population, in whom we found a one in seven risk of harm from COVID-19” 

[Corraleno]

Excellent NYT article that includes a discussion of why it's so important to get the second shot. Excerpt below:

“The second dose of mRNA vaccines induces a level of virus neutralizing antibodies about 10-fold greater than the first dose,” said Dr. Paul Offit, a professor at the University of Pennsylvania and a member of the Food and Drug Administration’s vaccine advisory panel. “Also, the second dose induces cellular immunity, which predicts not only longer protection, but better protection against variant strains.”

It’s also not clear how long first-dose protection lasts without the boost from a second dose, Dr. Fauci said during a White House press briefing in April.

.....

Although breakthrough infections after vaccination are rare, they do happen. A recent study of 250 people in Israel who were infected after they were partially vaccinated with the Pfizer vaccine — between two weeks after the first dose and one week after the second dose — showed that they were disproportionally infected by B.1.1.7, the variant first identified in Britain. The same study found that in a group of 149 people infected after the second dose of vaccine, eight infections with B.1.351 (the variant first identified in South Africa) occurred between days seven and 13 following the second dose. No breakthrough infections with the South Africa variant were seen 14 days after the second dose. Although it was a small sample, the finding suggested that full vaccination offers more protection against the variants, said Adi Stern, the study’s senior author, a professor at the Shmunis School of Biomedicine and Cancer Research, Tel Aviv University.

Another study showing the benefits of full vaccination looked at a group of 91,134 patients who had previously been seen by doctors in the Houston Methodist Hospital system and followed them between December and April. Most were not vaccinated, but 4.5 percent were partially immunized and 25.4 percent were fully immunized. There were 225 deaths from Covid-19 in the group, and 219 (97 percent) were among the unvaccinated. But five deaths (2.2 percent) occurred among the partially immunized. Only one person (0.004 percent) died in the fully immunized group. In that study, full vaccination was 96 percent protective against hospitalization and 98.7 percent protective against dying from Covid-19. But the partially vaccinated were only 77 percent protected from hospitalization and 64 percent protected from fatal Covid-19.

 

 

[wathe]

10 hours ago, KathyBC said:

Have age demographics changed that much? I thought Canada was still heavier on the older end of the population scale.

Not a change in raw population numbers, rather a change in who is getting sick with covid and in what numbers.  Sheer volumes of young people who are sick, and sick enough to need hospitalization, sick enough to need ICU care.  40 year-olds haven't had to compete with other 40-year olds for ICU and beds before.  We are still making room for everyone at this point, but true overwhelm requiring ICU bed triage is a real possibility in the near future if numbers requiring ICU beds keep climbing.

And "making room" right now means improvised ICU's and transfering patients all over the province, sometimes by mass casualty ambulance bus.  That in of itself is going to nudge mortality upward - chaos in the system adds risk, which will translate to increased mortality.

Edited May 2, 2021 by wathe

[Dmmetler]

14 hours ago, Corraleno said:

And virtually no one has any idea what their Vit D levels are. It's interesting that the three characteristics that seem to significantly increase the risk of severe disease with covid — being old, obese, or African-American — are all strongly correlated with low levels of Vit D. Obviously the studies on Vit D and covid are only correlational at this point, but so far there is a pretty strong correlation between Vit D insufficiency and severe outcomes. It may turn out that the reason some young, seemingly "perfectly healthy" people end up dying or being hospitalized is that those were the ones with extremely low D levels.

DS and I both have a genetic mutation that makes us not make or process Vit D properly. Without supplementation our levels were in the 10-12 range — with anything less than 30 considered insufficient and below 20 is a serious deficiency. And we had those levels while living in New Mexico and spending huge amounts of time in the sun year round! Without supplementation (and in particular supplementation with D3 + K2), we would still be at those levels — despite seeming "perfectly healthy" and assuming we had zero risk factors for severe covid. 

I wonder how many people who assume their covid risk is very low because they're "young and healthy," or whatever, may actually have unknown issues that make them much higher risk than they realize.

My endo is running vit D levels at each appointment for her patients and supplementing as needed to get into optimal range, because that's one risk factor (in a practice where pretty much everyone is at higher risk due to diabetes, obesity, age or a combination of the above) that can be controlled.  It makes sense to me. My immunologist told me to go on surge protocol to control allergies because allergic reactions make a really great environment for respiratory transmitted infections to lodge, and to increase dosages of things that tend to support immune health. 

 

Both were clear that this would not prevent COVID, nor would it remove the need to do as much environmental mitigation (masks, distancing, etc), and I should still get vaccinated ASAP (in my case, I was able to do so due to employment before I qualified as high risk), but it was something we could do. 

10 hours ago, Bootsie said:

The university where I teach has not made any announcement regarding requiring a vaccine for the fall.  They have been doing a lot of encouraging of vaccines.  One of the ways students are encouraged is being told that the university is abiding by the CDC's guidelines that if you have been vaccinated within the past three months and are exposed to COVID (but have no symptoms) you are not required to quarantine.  So, the students are counting months and saying "Personally, I am not too concerned about COVID and am not in a rush to be vaccinated.  The semester is almost over.  It would be better if I wait until August to be vaccinated--so that I am within the three month window when I return to campus in the fall"  Of course, the guidance may change by then.  But, these students are seeing a disadvantage if they get vaccinated now and then return in the fall and are exposed--then they will have to quarantine if the guidance hasn't changed.  

I really hope they revise that. I had my high school senior get vaccinated ASAP so that hopefully it will be possible to do other vaccinations required for on campus living before fall-and if another covid vaccine is needed, that might make it hard to get all of the above.

[Pen]

12 hours ago, Pen said:

adding the bold below: 

...”

Citation Export

Relative risk reduction and absolute risk reduction measures in the evaluation of clinical trial data are poorly understood by health professionals and the public. The absence of reported absolute risk reduction in COVID-19 vaccine clinical trials can lead to outcome reporting bias that affects the interpretation of vaccine efficacy. ... Unreported absolute risk reduction measures of 0.7% and 1.1% for the Pfzier/BioNTech and Moderna vaccines, respectively, are very much lower than the reported relative risk reduction measures. Reporting absolute risk reduction measures is essential to prevent outcome reporting bias in evaluation of COVID-19 vaccine efficacy.

 

I discovered that the citation does not work  - here’s a link that will work to get to full paper I hope: 

https://www.mdpi.com/1648-9144/57/3/199/htm

 

@KSera you put a confused emoticon? Maybe the link and whole paper will help. 
 

 

Edited May 2, 2021 by Pen

[Bootsie]

1 hour ago, Dmmetler said:

 

I really hope they revise that. I had my high school senior get vaccinated ASAP so that hopefully it will be possible to do other vaccinations required for on campus living before fall-and if another covid vaccine is needed, that might make it hard to get all of the above.

Many of the young people that I talk to are just simply tired of the ever-changing information.  I know that we all are, but I am experiencing an attitude of "I am not at great risk, so there isn't a rush to get vaccinated.  Everything keeps changing--don't wear masks, do wear masks, be six feet away, no that distance isn't important, the lockdown is for a few weeks, ooops-let us see if you should really get a J&J vaccine if you are a young female, you may need a booster,  Why should I listen when the information is going to be different tomorrow?  I'll just wait a few months and then think about it." 

Many of them are not trusting the information they hear.  I have had a number tell me that they would have had much more respect for statements of "We really don't know that much about a new virus.  We think...  It might be helpful to..."  Instead, their perception is that statements have been made as fact when they were not, which they view as dishonest.  They have lost respect for those making the statements and just tune it out and go about their business.  

And they are beyond the age where mom and dad can have them vaccinated.  They have to make the choice.  

[Pen]

PS @KSera (or anyone) if something like inability to get to base article happens again on a post of mine, it would probably be helpful to send me a PM or at least tag me. I don’t usually look at the “likes” or “confused” emoticons.