4 ms·

You are quite right, but the media, the government, and many public health agencies have been ignoring this, focusing solely on antibody levels, and trying to k

by Vrondi 5y ago

You are quite right, but the media, the government, and many public health agencies have been ignoring this, focusing solely on antibody levels, and trying to keep them constantly high through ever more panicky calls for more and more boosters. For everyone, regardless of prior infection.

f6v 5y ago
Because some times you have to make a call. Some studies are now revealing that booster shots might be less effective in those who recovered (watched a guy present his unpublished data the other day). But it’s not that obvious.
kurthr 5y ago
This is for two reasons: One, measuring antibodies is MUCH easier than measuring T or B cell response. This is especially true early on in the pandemic, if you want to measure representative numbers of people, and you don't know when/whether they will be exposed or catch COVID (due to masking/lockdowns etc). Two, when your problem is that the hospitals are filling up and you're facing a labor shortage for some essential workers for a a few months... then boosting antibodies for 4-6 months to reduce retransmission rates and minimizing symptomatic cases makes a lot of sense.
- eecc 5y ago
  So it's another case of KPI overfitting? Goodhart's law?
- headsoup 5y ago
  Not really, when you look at where things ended up anyway, aside the issues with pumping up antibodies continuously. Another case of going for short term efficiency wins over doing things properly, but not so easily.
- nradov 5y ago
  That was never a valid reason. They were just making things up without following evidence-based medicine practices. https://peterattiamd.com/covid-19-current-state-omicron/ https://peterattiamd.com/covid-19-current-state-omicron/
  - kurthr 5y ago
    I don't understand who your "they" is. In my opinion there were valid reasons for both decisions on antibodies and boosters. Since I know one of the people in your linked podcast, I will not comment on it.
    - nradov 5y ago
      No that's simply wrong. Antibodies are relatively unimportant and levels decline quickly. What actually matters far more is cellular immunity. Fortunately the vaccines and recovery from infection have both been shown to produce a significant level of durable cellular immunity in the vast majority of patients. Who do you personally know in the linked podcast? What are your medical qualifications? https://peterattiamd.com/covid-part2/ https://peterattiamd.com/covid-part2/
      - EdwardDiego 5y ago
        Feel like that's a bit of a rude question to ask.
- lamontcg 5y ago
  A booster has a solid immunological basis. The process of hypermutation and affinity maturation takes months to finish. The initial immune response to a pathogen is poor and takes ng/ml of antibodies to neutralize the threat. The immune system essentially has a "budget" for antibodies and the early antibodies are poor and take up too much of that. Affinity maturation produces higher affinity antibodies that are effective at pg/ml but it takes months. But you can now "fit" many more kinds of antibodies into the bloodstream. Hitting the mature immune response with a booster releases those high potency antibodies from germinal centers. This is why nearly every single vaccine we give kids comes in a series of 2 or 3 shots spaced out over 6+ months. https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolesc... https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html Very few of those are one-and-done shots. The initial mRNA shots were way too close together and were done that way out of expediency since the second shot gave a lot better protection very quickly. It also allowed the trials to complete faster and probably saved 100,000s of lives. It was basically a "wartime" decision to slam shots into arms way too fast. The increased affinity against Omicron after a booster is also something that shouldn't have been a surprise. The utility of 4th shot boosters in non-elderly non-immunocompromised and chasing after the idea of reducing spread through infection is on a lot less firm footing. Even the booster-obsessed Israelis are finding in studies that it doesn't do much good. This coronavirus also is currently mutating too rapidly and infection too many people in each wave to be able to logistically update the vaccines for new variants, so it doesn't look very useful to be thinking of it analogously to the yearly influenza shots.
  - kurthr 5y ago
    I agree with most all of that, and that it was largely unsurprising. When the mRNA shots were developed there was a tradeoff to be made (and BNT/Mod chose slightly different paths) on both amount of RNA and dosing schedule to minimize side effects while rapidly providing strong immunity (we're also lucky JJ and they all chose a stabilized prefusion Spike unlike ChAdOx etc). Boosters for T and B response in particular are common, but orders of magnitude higher antibodies are quite likely to help minimize Omicron effects (especially for first responders who received early Pfizer doses) and do appear to cause significant reductions in infection/symptomatic cases.[1] I would not have slowed down the testing or EUA, although manufacture was an issue early on. We didn't know when/if a significantly immune evading variant would arrive, and I feel fairly lucky with when Omicron arrived (after many of the most susceptible could be vaccinated). If it had arrived 8 months earlier, it would have been catastrophic. I also feel that the WHO choices have not been very good. From down playing human transmission early in the pandemic to demanding that there not be boosters in order to speed up the multi-year process of vaccinating 4billion people by 40million doses, when Omicron was already spreading quickly. Honestly, prioritization in the developing world is more important. They seem more political than other sources. [1] https://jamanetwork.com/journals/jama/fullarticle/2788105 https://jamanetwork.com/journals/jama/fullarticle/2788105
YZF 5y ago
Israel was one of the first place to boost (the first?) and I think the rationale there was not just about antibody levels. There were multiple factors. The emergence of Delta which to some extent bypassed the previous two vaccine doses. The decline in protection against severe disease over time (and specifically against delta). And yes, even temporary control of the community spread (which is maybe the more questionable aspect) to allow the country to remain more or less open while keeping hospital load and deaths under control. In Israel I also believe there is different policy for people that have been infected. This varies from place to place. Determining whether someone was or wasn't previous infected isn't that simple. You can do it if you have good contract tracing, testing, and more centralized health services like Israel does. Also many places didn't have a large enough portion of the population get infected in the first place so maybe not worth worrying too much about.
- throwaway48375 5y ago
  I don't see how it is so hard. Every positive PCR gets reported to the local health department which reports it to the state DPH. If the state can use this data to send me a letter asking me to donate convalescent plasma surely they could add this information to their digital covid passport.
  - YZF 5y ago
    I think if the data is available it is perfectly reasonable, and even expected, to consider it. Like they do in Israel. I can't really comment on the US in this regard but I'd agree with you that if they can they should... Right now where I am (Canada) they don't even bother testing you unless you're at risk, so nobody knows...

by Vrondi 5y ago

f6v 5y ago

Because some times you have to make a call. Some studies are now revealing that booster shots might be less effective in those who recovered (watched a guy present his unpublished data the other day). But it’s not that obvious.

kurthr 5y ago

This is for two reasons: One, measuring antibodies is MUCH easier than measuring T or B cell response. This is especially true early on in the pandemic, if you want to measure representative numbers of people, and you don't know when/whether they will be exposed or catch COVID (due to masking/lockdowns etc). Two, when your problem is that the hospitals are filling up and you're facing a labor shortage for some essential workers for a a few months... then boosting antibodies for 4-6 months to reduce retransmission rates and minimizing symptomatic cases makes a lot of sense.

eecc 5y ago
So it's another case of KPI overfitting? Goodhart's law?
headsoup 5y ago
Not really, when you look at where things ended up anyway, aside the issues with pumping up antibodies continuously. Another case of going for short term efficiency wins over doing things properly, but not so easily.
nradov 5y ago
That was never a valid reason. They were just making things up without following evidence-based medicine practices. https://peterattiamd.com/covid-19-current-state-omicron/ https://peterattiamd.com/covid-19-current-state-omicron/
- kurthr 5y ago
  I don't understand who your "they" is. In my opinion there were valid reasons for both decisions on antibodies and boosters. Since I know one of the people in your linked podcast, I will not comment on it.
  - nradov 5y ago
    No that's simply wrong. Antibodies are relatively unimportant and levels decline quickly. What actually matters far more is cellular immunity. Fortunately the vaccines and recovery from infection have both been shown to produce a significant level of durable cellular immunity in the vast majority of patients. Who do you personally know in the linked podcast? What are your medical qualifications? https://peterattiamd.com/covid-part2/ https://peterattiamd.com/covid-part2/
    - EdwardDiego 5y ago
      Feel like that's a bit of a rude question to ask.
lamontcg 5y ago
A booster has a solid immunological basis. The process of hypermutation and affinity maturation takes months to finish. The initial immune response to a pathogen is poor and takes ng/ml of antibodies to neutralize the threat. The immune system essentially has a "budget" for antibodies and the early antibodies are poor and take up too much of that. Affinity maturation produces higher affinity antibodies that are effective at pg/ml but it takes months. But you can now "fit" many more kinds of antibodies into the bloodstream. Hitting the mature immune response with a booster releases those high potency antibodies from germinal centers. This is why nearly every single vaccine we give kids comes in a series of 2 or 3 shots spaced out over 6+ months. https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolesc... https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html Very few of those are one-and-done shots. The initial mRNA shots were way too close together and were done that way out of expediency since the second shot gave a lot better protection very quickly. It also allowed the trials to complete faster and probably saved 100,000s of lives. It was basically a "wartime" decision to slam shots into arms way too fast. The increased affinity against Omicron after a booster is also something that shouldn't have been a surprise. The utility of 4th shot boosters in non-elderly non-immunocompromised and chasing after the idea of reducing spread through infection is on a lot less firm footing. Even the booster-obsessed Israelis are finding in studies that it doesn't do much good. This coronavirus also is currently mutating too rapidly and infection too many people in each wave to be able to logistically update the vaccines for new variants, so it doesn't look very useful to be thinking of it analogously to the yearly influenza shots.
- kurthr 5y ago
  I agree with most all of that, and that it was largely unsurprising. When the mRNA shots were developed there was a tradeoff to be made (and BNT/Mod chose slightly different paths) on both amount of RNA and dosing schedule to minimize side effects while rapidly providing strong immunity (we're also lucky JJ and they all chose a stabilized prefusion Spike unlike ChAdOx etc). Boosters for T and B response in particular are common, but orders of magnitude higher antibodies are quite likely to help minimize Omicron effects (especially for first responders who received early Pfizer doses) and do appear to cause significant reductions in infection/symptomatic cases.[1] I would not have slowed down the testing or EUA, although manufacture was an issue early on. We didn't know when/if a significantly immune evading variant would arrive, and I feel fairly lucky with when Omicron arrived (after many of the most susceptible could be vaccinated). If it had arrived 8 months earlier, it would have been catastrophic. I also feel that the WHO choices have not been very good. From down playing human transmission early in the pandemic to demanding that there not be boosters in order to speed up the multi-year process of vaccinating 4billion people by 40million doses, when Omicron was already spreading quickly. Honestly, prioritization in the developing world is more important. They seem more political than other sources. [1] https://jamanetwork.com/journals/jama/fullarticle/2788105 https://jamanetwork.com/journals/jama/fullarticle/2788105

YZF 5y ago

Israel was one of the first place to boost (the first?) and I think the rationale there was not just about antibody levels. There were multiple factors. The emergence of Delta which to some extent bypassed the previous two vaccine doses. The decline in protection against severe disease over time (and specifically against delta). And yes, even temporary control of the community spread (which is maybe the more questionable aspect) to allow the country to remain more or less open while keeping hospital load and deaths under control. In Israel I also believe there is different policy for people that have been infected. This varies from place to place. Determining whether someone was or wasn't previous infected isn't that simple. You can do it if you have good contract tracing, testing, and more centralized health services like Israel does. Also many places didn't have a large enough portion of the population get infected in the first place so maybe not worth worrying too much about.

throwaway48375 5y ago
I don't see how it is so hard. Every positive PCR gets reported to the local health department which reports it to the state DPH. If the state can use this data to send me a letter asking me to donate convalescent plasma surely they could add this information to their digital covid passport.
- YZF 5y ago
  I think if the data is available it is perfectly reasonable, and even expected, to consider it. Like they do in Israel. I can't really comment on the US in this regard but I'd agree with you that if they can they should... Right now where I am (Canada) they don't even bother testing you unless you're at risk, so nobody knows...