COVID-19: Vaccine and testing procedures Megathread Part 2 [Mod Warning - Post #1]

speckle

speckle wrote: »

Words translated, so from the horses mouth...

Quote


Published: 14.01.2021

All reports of deaths after vaccination are carefully considered.

- The reports may indicate that common side effects from mRNA vaccines, such as fever and nausea, may have led to deaths in some frail patients, says Sigurd Hortemo, chief physician at the Norwegian Medicines Agency.

Read more: Use of mRNA vaccines in the elderly

The Norwegian Medicines Agency and the National Institute of Public Health jointly assess all reports of side effects. As a result, the Norwegian Institute of Public Health has changed the coronary vaccination guide with new advice on vaccinating the frail elderly.

As of 14 January, 23 reports of deaths have been reported to the adverse reaction register. The figures in the report itself include the thirteen reports that have been assessed by the Norwegian Medicines Agency and the National Institute of Public Health. The other messages are being processed.

All deaths following medical treatment or medication are reportable. You cannot rule any out of consideration even if the treatment did not cause the issue. In the timeframe since the vaccine programme started, these cause of deaths will not as yet have been resolved

greenheep

greenheep wrote: »

Worrying reports coming from Manaus in Brazil where they had hoped herd immunity might have been reached but a new strain appears to be spreading rapidly. Also some reports of people that were infected in the spring being re-infected again.

Trying to stay positive about the vaccine but if just one strain is resistant we are not going to be ending the restrictions this year. I know they have said the vaccines can be tweaked in about 6 weeks but I assume they would still need to be tested and crucially rolled out to everyone again, even those who already received the first vaccine.

Manaus never had herd immunity. That study was rubbish. There have been one or two reports of reinfections but nothing out of the ordinary and nothing to suggest they are any less rare. The vaccine isn't going to fail. Don't believe every scare story you read on twitter.

greenheep

Hardyn wrote: »

Manaus never had herd immunity. That study was rubbish. There have been one or two reports of reinfections but nothing out of the ordinary and nothing to suggest they are any less rare. The vaccine isn't going to fail. Don't believe every scare story you read on twitter.

Yeah you are probably right, I need to take a break from the news I think

seamus

greenheep wrote: »

Worrying reports coming from Manaus in Brazil where they had hoped herd immunity might have been reached but a new strain appears to be spreading rapidly. Also some reports of people that were infected in the spring being re-infected again.

Trying to stay positive about the vaccine but if just one strain is resistant we are not going to be ending the restrictions this year. I know they have said the vaccines can be tweaked in about 6 weeks but I assume they would still need to be tested and crucially rolled out to everyone again, even those who already received the first vaccine.

The odds of a resistant strain coming out are very, very low. At the moment the media are jumping all over reports of variants because they've found a new type of bad news to generate clicks.

There's a good chance that even if a resistant strain did emerge, that the existing vaccines would continue to confer a level of protection against it, which would lessen the impact of any new strain.

The 6 weeks to tweak the vaccine wouldn't require the same months and months of trials. A huge part of the trials can be skipped, and the approval process is considerably faster.

For Manuas in particular, the hopes of herd immunity were ill-founded from the start, and were partially a political gambit to downplay how much the government fvcked up.

For a highly infectious disease like Covid, you need 75% for herd immunity. The more infectious, the higher the threshold for herd immunity. Manuas believed they had achieved 50-66% immunity. Which was based on statistical data, not actual data.

Herd immunity in Manuas was a desperate hope, something to soothe the locals.

speckle

This seems to be what the Norwegians have decided at the moment while awaiting further data....
"For the vast majority of people who are elderly and live with frailty, any side effects of the vaccine will more than be offset by a reduced risk of becoming seriously ill from covid-19. However, for those with the most severe frailty, even relatively mild vaccine side effects can have serious consequences. For those who have a very short remaining life, the benefit of the vaccine may be marginal or irrelevant. Therefore, for very frail patients (eg equivalent to Clinical Frailty Scale 8 or higher) and terminally ill patients, a careful weighing of benefit versus disadvantage of vaccination is recommended.

https://geozr4zgiy5e6jztggnl4nzv3e-adwhj77lcyoafdy-legemiddelverket-no.translate.goog/nyheter/bruk-av-mrna-vaksiner-hos-eldre

Polar101

seamus wrote: »

Herd immunity in Manuas was a desperate hope, something to soothe the locals.

It's pretty shocking. Manaus would have been one of the easiest cities in the world to try zero covid in - they don't even have road connections to most of the country. Instead, they had insanely high infection numbers - and even that went wrong, because they didn't reach herd immunity.

Once the pandemic is over, the city will be an interesting case study on the spread of the disease.

Anyway, this might be the wrong thread for this, so apologies for continuing slightly off-topic.

adam240610

I remember reading that out of the 18-54 age group that 18-24 year olds will get priority due to being more social, if that's the case does anyone know how many people fall into 18-24 vs 25-54 roughly?

seamus

speckle wrote: »

This seems to be what the Norwegians have decided at the moment while awaiting further data....
"For the vast majority of people who are elderly and live with frailty, any side effects of the vaccine will more than be offset by a reduced risk of becoming seriously ill from covid-19. However, for those with the most severe frailty, even relatively mild vaccine side effects can have serious consequences. For those who have a very short remaining life, the benefit of the vaccine may be marginal or irrelevant. Therefore, for very frail patients (eg equivalent to Clinical Frailty Scale 8 or higher) and terminally ill patients, a careful weighing of benefit versus disadvantage of vaccination is recommended.

https://geozr4zgiy5e6jztggnl4nzv3e-adwhj77lcyoafdy-legemiddelverket-no.translate.goog/nyheter/bruk-av-mrna-vaksiner-hos-eldre

For anyone like me who had never heard of the clinical frailty scale;

https://www.dal.ca/sites/gmr/our-tools/clinical-frailty-scale.html

Someone scoring 8 or 9 is profoundly frail or otherwise effectively at death's door. So withholding vaccination seems like a reasonable action; the potential benefit is ultimately minimal.

is_that_so

adam240610 wrote: »

I remember reading that out of the 18-54 age group that 18-24 year olds will get priority due to being more social, if that's the case does anyone know how many people fall into 18-24 vs 25-54 roughly?

18-34s and they might move up the queue ahead of the rest of the 18-54s or even higher, it's still undecided.

Sconsey

adam240610 wrote: »

I remember reading that out of the 18-54 age group that 18-24 year olds will get priority due to being more social, if that's the case does anyone know how many people fall into 18-24 vs 25-54 roughly?

Data here https://www.cso.ie/en/releasesandpublications/ep/p-cp3oy/cp3/assr/

0-14: 1,006,552
15-24: 576,452
25-44: 1,406,291
45-64: 1.135.003
65+: 637,567

hmmm

I think this may have been posted here already, but an interesting recent paper in Nature argues that the future for this virus is that it will become endemic, i.e. keep circulating, acting as a "top up" to immunity generated either through vaccinations or previous infection. It will become a new version of the common cold for most people.

https://www.nature.com/articles/s41577-020-00493-9

"the maintenance of population immunity will not depend on continued vaccinations but on the endemic presence of SARS-CoV-2."
"SARS-CoV-2 is likely to become the fifth endemic common cold virus, causing largely asymptomatic infections."

marno21

Emer Cooke presentation to IIEA this morning (these are usually posted on YouTube after)

Hopeful of AstraZeneca being approved on Jan 29th
Hopeful that Janssen will submit for approval in February (rolling review ongoing)
Confirmed that already approved vaccines will not have to go through new approval processes should they be required to be reconfigured for new variants

https://www.rte.ie/news/coronavirus/2021/0115/1189922-ema-astrazeneca/

seamus

seamus wrote: »

For anyone like me who had never heard of the clinical frailty scale;

https://www.dal.ca/sites/gmr/our-tools/clinical-frailty-scale.html

Someone scoring 8 or 9 is profoundly frail or otherwise effectively at death's door. So withholding vaccination seems like a reasonable action; the potential benefit is ultimately minimal.

For context an evacuation of a nursing home (eg. during a fire) typically comes with a 1-2% death rate. On the higher end of that scale even the stress of movement can be fatal.

lucernarian

iamwhoiam wrote: »

Would not vaccinating those who had a positive covid test not be a logistical nightmare .One person had it in March or April and another in December .So where is the cut off point or who gets it and who doesnt ?

I thoroughly agree, what's happened in Ireland is Leo Varadkar basically mentioning that people should consider a delay if they've been sick from covid-19. I can't see a way to properly or fairly document who's likely to be immune unless we roll out en-masse antibody tests and then act from there. I don't think this is a feasible idea.

Micky 32

hmmm wrote: »

I think this may have been posted here already, but an interesting recent paper in Nature argues that the future for this virus is that it will become endemic, i.e. keep circulating, acting as a "top up" to immunity generated either through vaccinations or previous infection. It will become a new version of the common cold for most people.

https://www.nature.com/articles/s41577-020-00493-9

"the maintenance of population immunity will not depend on continued vaccinations but on the endemic presence of SARS-CoV-2."
"SARS-CoV-2 is likely to become the fifth endemic common cold virus, causing largely asymptomatic infections."

I have read ( unless i picked it up wrong and i’m open to correction) that viruses that increase transmission ( ie the UK variant alledgedly ) that they usually begin to weaken disease. Apparently viruses have done so in the past.

hmmm

marno21 wrote: »

Emer Cooke presentation to IIEA this morning (these are usually posted on YouTube after)

Hopeful of AstraZeneca being approved on Jan 29th
Hopeful that Janssen will submit for approval in February (rolling review ongoing)
Confirmed that already approved vaccines will not have to go through new approval processes should they be required to be reconfigured for new variants

That's really good news, will be interested to hear more.

Regulators have a difficult job at the moment. If they approve a medical treatment and it ends up injuring 20 people, they get blamed. If they hold off and wait for more data, and a hundred thousand people die of Covid in the meantime, they don't get blamed. It'd be the easiest thing in the world for a regulator to hold out for 100% assurance when they are at 99.99%, but that's what they are having to do.

speckle

seamus wrote: »

For anyone like me who had never heard of the clinical frailty scale;

https://www.dal.ca/sites/gmr/our-tools/clinical-frailty-scale.html

Someone scoring 8 or 9 is profoundly frail or otherwise effectively at death's door. So withholding vaccination seems like a reasonable action; the potential benefit is ultimately minimal.

I agree as long as it is fully explained pros and cons to the patient/resident and family and their choices taken seriously into consideration.

For those who want to read more info on the Irish system of assement... which seems to come from NICE Uk...(national institute for clinicial Excelllance... if my memory serves me well.. ) which in turn is based on other literature etc.

Ireland

https://hse.drsteevenslibrary.ie/c.php?g=679077&p=4867432

Link on the above page for free online course

https://rise.articulate.com/share/deb4rT02lvONbq4AfcMNRUudcd6QMts3#/

UK

https://www.criticalcarenice.org.uk/frailty

https://www.england.nhs.uk/ourwork/clinical-policy/older-people/frailty/frailty-risk-identification/

Note fraility assement seems to have another layer to it when complicated by sars coV...regarding to treat or not and how much....does this overlap with potential vaccination or not regarding an otherwise fraility assement... I cannot find at the moment... so I defer to the already posted Norwegian information unless anyone can find further HSE documentation. Was it in the vaccination roll out plans?

ACitizenErased

Norway reporting Pfizer delivery delays. Not sure if that’s due to a Swedish delay or a European delay.

cjyid

ACitizenErased wrote: »

Norway reporting Pfizer delivery delays. Not sure if that’s due to a Swedish delay or a European delay.

https://www.msn.com/en-au/lifestyle/wellbeing/pfizer-to-reduce-vaccine-deliveries-to-europe-says-norway/ar-BB1cMrRI

Russman

I don't know enough to know if this is a good thing or not.....extending the interval between doses.

https://www.irishtimes.com/news/health/covid-19-vaccine-hse-extends-interval-between-first-and-second-jabs-in-move-that-will-speed-up-rollout-to-more-people-1.4459258

iamwhoiam

Russman wrote: »

I don't know enough to know if this is a good thing or not.....extending the interval between doses.

https://www.irishtimes.com/news/health/covid-19-vaccine-hse-extends-interval-between-first-and-second-jabs-in-move-that-will-speed-up-rollout-to-more-people-1.4459258

Prof Karina Butler was asked about extending the interval
Her reply , as far as I remember , was the testing was done on intervals up to 28 days and was deemed to be within optimal range

Marhay70

cjyid wrote: »

https://www.msn.com/en-au/lifestyle/wellbeing/pfizer-to-reduce-vaccine-deliveries-to-europe-says-norway/ar-BB1cMrRI

Well that's a c. 16% reduction, not good news at this stage,.No idea of how long production will be disrupted but it's the type of situation that can lead to unforseen snags.

is_that_so

iamwhoiam wrote: »

Prof Karina Butler was asked about extending the interval
Her reply , as far as I remember , was the testing was done on intervals up to 28 days and was deemed to be within optimal range

Yeah, more people vaccinated initially is a good trade off.

Newuser2

Russman wrote: »

I don't know enough to know if this is a good thing or not.....extending the interval between doses.

https://www.irishtimes.com/news/health/covid-19-vaccine-hse-extends-interval-between-first-and-second-jabs-in-move-that-will-speed-up-rollout-to-more-people-1.4459258

Stick to manufacturers instructions

Anything else is asking for trouble

speckle

It has been over a year now since I first heard of this virus...so I am off again... in a middle of a break from it all..so posting less... while I decide on future plans ...3 times blessed ...one of our adult special need relatives tested negative in the last couple of days after covid surfaced in their care home...All the 80+ ers in the family have made their choices and plans sorted as best we can at the moment. Thanks to great local gps and pointers here from you all.. Keep up the great work...

is_that_so

Newuser2 wrote: »

Stick to manufacturers instructions

Anything else is asking for trouble

From that article.

The guidelines show that the vaccine course consists of two doses between 21 and 28 days apart.

iamwhoiam

Newuser2 wrote: »

Stick to manufacturers instructions

Anything else is asking for trouble

Prof Karina Butler said that 28 days was tested and within the optimal range recommended by the manufacturer . She said 21-28 days was the range recommended as far as I remember

odyssey06

iamwhoiam wrote: »

Prof Karina Butler said that 28 days was tested and within the optimal range recommended by the manufacturer . She said 21-28 days was the range recommended as far as I remember

The problem is that if you are only calling people at 28 days rather than 21 days you've lost your recovery window for missed appointments etc who are now going to be pushed outside the optimal 28 day window. So there's a tradeoff there.
It's a certainty you're going to have people who can't make their appointment.

seamus

odyssey06 wrote: »

The problem is that if you are only calling people at 28 days rather than 21 days you've lost your recovery window for missed appointments etc who are now going to be pushed outside the optimal 28 day window. So there's a tradeoff there.
It's a certainty you're going to have people who can't make their appointment.

This is true. I expect the maximum window goes beyond 28 days though. There is a point at which if someone misses their second dose, they have to start the whole process again. 28 days is the optimal, but it's not the maximum.

So it's a case that this gap between the optimal second dose and the point of no return has been narrowed. It's all about playing the statistics and weighing up the benefits.

Vicxas

Pfizer are dialing back their vaccine delivery while they start to ramp up production.

Not sure how trying to increase production slows down delivery but what do i know