COVID-19 vaccines: medical concerns and recommendations

[Joe S]

This was super useful detail that cuts through the complexity. Thanks, as always.

We should probably be paying for your site supporter membership for next year for all the useful info you've provided.

If someone wants to pay it and then take a round of donations, I'm in.

[pangloss]

Always worth the wait, but this time in particular, that's quite a response. Thanks for that explanation - no doubt from your perspective, the first five minutes of an introductory course on immunology; for me, a post so information-dense that I read it out loud twice to absorb it and I'm pretty confident a third time is warranted.

Were you, then, given the difficulty of getting long lived plasma cells out of a respiratory virus, not surprised at the waning efficacy of the shots? Were boosters something you always imagined were likely?


You did answer my question - I had to think for a while to understand the answer. But for sure we're not seeing that tolerogenic response, that's obvious from the numbers of who's ending up in the hospital. I hadn't heard that specific theory ("theory" is probably overly generous) but I had heard similar kinds of things about the ability to control the RNA replication process and how the replication would stop - actually, a guy I know who worked on mRNA about a decade ago as a PhD biochemist, I think (definitely PhD, I think biochemistry) had pretty serious reservations about it when the mRNA vaccines were first released, because he had seen some issue with a gate mechanism to stop RNA replication in whatever context he was messing around with it - his explanation went over my head. But he hasn't worked on anything related to it in years and years and he did get vaccinated, with Moderna, so I guess ultimately he wasn't THAT worried. But that was his fear, that they would turn out not to have tuned the shutoff switch correctly, and I think that was informed by his work on RNA replication. But that really does not seem to be an issue - in fact the impression I have now is that it naturally degrades very quickly.

Anyway I'm digressing, your explanation is excellent and if you don't mind I would like to forward it to a couple of people with whom I have an ongoing covid discussion.

I wish I could teach that in five minutes! I'm not sure how many lectures that content is spread across, but it's several. Please feel free to forward as you find useful.

I am not surprised at the waning efficacy of vaccines, but I'm surprised that it's waning this fast. I didn't really expect boosters to be an issue this soon. I think that boosters will be useful for the next year or so until most of the unvaccinated people have been infected. At that point, the rate of community transmission will drop and we'll reach our new normal. The virus will never go away though. I don't think that the vaccines will ever provide durable, long-lasting immunity because of the compartment issues (mucosal vs systemic) I mentioned. None of the current injected vaccines stimulate a good mucosal response, so immunologically, the best long term outcome is protection against severe illness. (An injectable vaccine that stimulates a good mucosal response is something of a holy grail for vaccinology.)

The plasma cell issue varies from vaccine to vaccine. I measured antibody responses against tetanus toxoid in a couple of dozen people, and they had toxoid-specific titers toward the high end of the range SARS-CoV-2-specific titers in people who recover from a typical COVID infection (not hospitalized). Tetanus boosters are recommended every ten years, but I don't know how often we get environmental boosts against tetanus. The tetanus vaccine also has an adjuvant, which, as far as I know, is lacking in the mRNA vaccines. For SARS-CoV-2, I'm pretty sure that a good vaccine adjuvant will help extend the duration of the response. Periodic re-infection will also likely play a role in preventing immunological memory from dropping too much.

After reading back over this, I should mention the HPV vaccine. HPV is sexually transmitted and causes cervical and throat cancer. The HPV vaccine is excellent, and it doesn't really fit into the paradigm I've described above. I don't have a good explanation except that I don't know as much about sexually transmitted infections and the immune response to them. The HPV vaccine also contains and adjuvant. This is a good contrast for me to consider, and I should be more aware of my respiratory bias.

The fact that the SARS-CoV-2 vaccines are made of mRNA never bothered. The RNAs have to have specific sequences for specific functions. Usually the problem people struggle with is that RNA is too fragile rather than it lasts too long. I'm definitely not an expert here, so I might have worried if I'd known more.

This was super useful detail that cuts through the complexity. Thanks, as always.

We should probably be paying for your site supporter membership for next year for all the useful info you've provided.

If someone wants to pay it and then take a round of donations, I'm in.

I appreciate the sentiment, but given how much I've learned here, I'm nowhere close to even yet--maybe after a couple more pandemics.

[Clusterfrack]

Bari Weiss interviews a UCSF Doc about Covid, vaccines, Ivermectin, and more. Truly excellent material.

https://podcasts.apple.com/us/podcas...s/id1570872415

[Maple Syrup Actual]

I subscribed to her podcast after the Josh Rogin episodes were mentioned here and consequently I get notifications of each new episode and listened to that the day it came out - yesterday? Early this week? Everything is a bit blurred together these days.

Anyway excellent interview. Just a calm, rational discussion about the state of the pandemic.

[Joe S]

Update from Ellifritz on post-Covid condition: https://www.activeresponsetraining.n...-with-covid-19

[pangloss]

Update from Ellifritz on post-Covid condition: https://www.activeresponsetraining.n...-with-covid-19

An example of "long COVID."

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[Balisong]

An example of "long COVID."

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And on a vaccinated fit individual. That really sucks. He definitely would have died without being vaccinated.

[Caballoflaco]

And on a vaccinated fit individual. That really sucks. He definitely would have died without being vaccinated.

Yeah, I wonder if the J&J vaccination he recieved might not have offered the same amount of protection as one of the mRNA shots. He was traveling in an area where Lambda was the dominant strain. Of courses this is conjecture, but based on some things I’ve been reading lately.

Not the only article I’ve found mentioning this. https://www.google.com/amp/s/www.sci...a-variant/amp/

In a pre-print paper that has not yet been peer-reviewed, researchers found that mRNA vaccines are effective against the Lambda variant. Both the Pfizer and the Moderna coronavirus vaccines used in the UK are mRNA jabs, meaning they contain genetic material that instructs the body's cells to produce coronavirus spikes, which then provokes an immune response.

The results of this paper suggest that vaccines in current use will remain protective against the Lambda variant.

However, in another pre-print paper, Lambda was found to have mutations that had "the ability to escape from neutralising antibodies elicited by CoronaVac”. CoronaVac is a vaccine being used in several Asian countries, and works by administering an inactive version of the SARS-CoV-2 virus, which then triggers an immune response.

[Joe S]

An example of "long COVID."

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This, for me, is the biggest reason I really don't treat it lightly. I got vaxxed primarily because I thought it the correct choice in terms of protecting my loved ones and greater society. I do not think the mortality risk is very high for me. But I might actually prefer to be dead than stuck with a pair of lungs that work that poorly.

Sobering about Ellifritz. He is in quite good shape physically, and while I'm sure that helped him, to realize he still 1. almost died and 2. is dealing with serious life-altering effects after the fact is scary.

[OlongJohnson]

A family friend's elderly mother has "won the lottery" and is one of the few people who has been diagnosed with Creutzfeldt-Jakob disease attributed to Covid infection. I have never met the woman, but it is a horrible way to go, and rough for her family. Yet another reason to avoid the thing.