COVID Transmissions for 2-1-2021
Good morning and welcome to COVID Transmissions.
It has been 441 days since the first documented human case of COVID-19. Welcome back from the weekend.
New vaccine news in today’s newsletter, and some disturbing news out of LA. Also, some news about pregnant women.
As usual, bolded terms are linked to the running newsletter glossary.
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Now, let’s talk COVID.
Johnson and Johnson vaccine: good news that’s hard to understand
On Friday, Johnson and Johnson released initial results for their single-dose vaccine, in a press release found here: https://www.jnj.com/johnson-johnson-announces-single-shot-janssen-covid-19-vaccine-candidate-met-primary-endpoints-in-interim-analysis-of-its-phase-3-ensemble-trial
The press release gives us 3 key numbers: efficacy against any COVID-19 disease (66%), efficacy against severe disease (85%), and efficacy against death (100%).
First and foremost, I want you to resist the temptation to compare this with other vaccine clinical trial results. This vaccine trial was conducted under different epidemiological conditions and in different patients than previous trials, and we have no head-to-head data comparing any vaccines. Importantly, also, the press release did not show us any 95% confidence intervals for the vaccine efficacy yet, so even if we were to compare, we couldn’t really make an argument as to whether this vaccine was any worse or better than the others.
Instead, what we can say is that this vaccine exceeded the basic threshold for vaccine efficacy (60%) that was hoped-for back before we had any results for any vaccine. What’s more, it did this with only one shot rather than two—meaning that we know that one dose has a clear impact. It’s worth noting that while some protection was seen starting at Day 14 postvaccination, the numbers that I’m telling you were all reported for Day 28 postvaccination and beyond.
There is, by the way, an ongoing trial to look at whether 2 doses of this vaccine are more protective than 1 dose. Because this is a chimeric, viral vector vaccine, I wouldn’t hold out big hopes for a huge boost effect—the immune response to the viral vector might interfere with a boost effect. We’ll see!
Now what’s even more amazing about this vaccine—and shows its potential to really make a difference—is the 85% efficacy against severe disease. That means keeping 85% of cases out of hospitals, which means better care for the people who are hospitalized and better outcomes for everyone. But what really blew me away in the press release was this statement:
Efficacy against severe disease increased over time with no cases in vaccinated participants reported after day 49.
This suggests that the vaccine’s effects continue to get better over time, and that it’s possible to reach 100% efficacy against severe disease with just this single shot. That’s incredible.
And of course, there is the fact that there was 100% efficacy against death, which is a huge part of what we’re looking for here.
Though, I’m left with many questions. I don’t think this press release gives me enough information. I would like to know how many disease events, severe disease events, and death events were captured in the data, because that will give me a sense of how confident I can be in these results. If the placebo arm in this trial had 10 deaths vs 0 in the vaccine arm, then I will have more confidence in the result than if it were 1 vs 0. The latter is more likely to be random variation, and we would expect a drop in efficacy.
I’m also interested in whether this vaccine—in fact, all of these vaccines—have any ability to prevent “long COVID,” the persistent symptoms that interfere with patients’ lives for months after having this disease. In the last issue, I shared an article about what may cause this syndrome, but no matter the cause, I’d like to be reassured that vaccines can prevent it.
Despite my questions, I find the news of this vaccine extremely reassuring. Part of that is because of its deployability. While the Johnson and Johnson vaccine is not likely to come to market quickly due to manufacturing issues, once it does, it has a great profile. It can be stored for up to 2 years in a standard freezer, and for at least 3 months at the temperature of a standard refrigerator. That significantly aids deployment. It requires only one dose to provide protection at a level that would substantially change the impact of COVID-19 on both individual patients as well as society at large.
Added to the arsenal of vaccines that have succeeded, we are reaching a point where I’m feeling more and more hopeful about our ability to end the pandemic by summer.
Antivax conspiracy theory protestors disrupt LA vaccination efforts
A group of conspiracy theorists, carrying signs indicating various fringe views about the nature of COVID-19 vaccines, shut down a vaccination site in LA for almost an hour on Saturday: https://www.latimes.com/california/story/2021-01-31/protest-dodger-stadium-vaccination-site-angers-city-leaders-security-questions
This is obviously abominable behavior on the part of these people. Their views are based on a wide range of false conspiracy theories, ranging from the idea that the mRNA vaccines are “gene therapy” (they are not), to views that Bill Gates somehow created these vaccines for purposes of mind control, to the notion that COVID-19 itself is a nefarious hoax. I’m sure if probed further, a number of other revolting opinions would be revealed to underpin the views of these protestors.
Now, I have no opposition to these folks’ right to protest. They can be as wrong as they want to be. However, they do not have the right to disrupt the delivery of proven medical care to others. There is a human health and safety issue at play here. LA is in particularly bad shape—you’ll recall perhaps stories about ambulance crews being asked not to bring in patients who they didn’t think had a good chance to survive, or maybe stories about a monthlong backlog for funeral homes and crematoriums. To interfere with vaccine distribution under those circumstances is a type of moral bankruptcy that I cannot understand.
I want to thank Carl Fink for sending me a heads up on this story.
Antibodies are passed to the fetus during gestation
In better news, we now have evidence that antibodies against COVID-19 can be passively transferred from parent to fetus through the placenta, at least according to a study published in JAMA: https://jamanetwork.com/journals/jamapediatrics/fullarticle/2775945
The efficiency of transfer isn’t perfect—in this study, only 72 of 83 infants born to a COVID-19 antibody-positive parent also tested positive for COVID-19 antibodies—but it is at least good to know that some aspects of immunity to COVID-19 can be transferred to newborns in utero.
The phenomenon of passive placental transfer is not new, by the way. We’ve known about this for a long time, and to a degree this was to be expected. However, you really can’t guarantee anything. Biology is never ever clear-cut, and everything happens by degrees. Doing a study like this gives us a sense of how general principles like this work in the specific case of this disease, and that’s important.
What am I doing to cope with the pandemic? This:
Preparing for the snow
There is a big snowstorm coming to a large section of the East Coast.
Last I heard, they were talking about 17 inches of snow in New York City where I am. So, I’ve been making stews and various other hearty things for us to stay inside and eat while the snow is falling.
I made a traditional Jewish cholent—an overnight stew of beef, potatoes, beans, and barley—over the weekend, and there are plenty of leftovers. I made sure our stocks of coffee and tea are full.
Bring on the snow!
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No corrections since last issue.
See you all next time. Enjoy your weekend!
Always,
JS
I keep hearing that various vaccine manufacturers (Moderna, Novavax) expect to be able to easily tweak their vaccines to focus on new variants. Do you have any information on how that might work in practice? More specifically:
What does the testing and approval process look like for an adjustment like this? Will they have to go through all three testing phases for every new version?
Do you expect the updated versions to be used exclusively as boosters? Would they replace the existing versions entirely? Or would it be feasible to mix them - half the shot designed for original COVID, the other half tailored to a variant, or something like that?
Thanks for the great newsletter! Just a semantic point, but one that I think matters... It's probably generally better to say "pregnant people" as opposed to pregnant women. While all of the people in the study may have identified as women (or maybe not), there are certainly people who get pregnant who don't identify as women. I see no reason this research wouldn't apply to them as well. Gender rules are shifting, and it's exciting!