COVID Transmissions for 3-25-2021
Choosing the right vaccine for you, per Dr. Peter Hotez
Greetings from an undisclosed location in my new apartment. Good morning and welcome to COVID Transmissions.
It has been 493 days since the first documented human case of COVID-19.
In 493, the war between Odoacer and Theodoric the Great for control of Italy, once the center of the Roman Empire, came to an end. Odoacer surrendered, with a carefully negotiated peace, following the 3-year siege of Ravenna. Theodoric then invited Odoacer to a banquet to celebrate the peace treaty. At the banquet, he killed Odoacer and sliced his body in half. Theodoric then proceeded to massacre Odoacer’s supporters.
I think this illustrates the dangers of celebrating the end of a difficult time prematurely. A lesson we should keep in mind in the pandemic; cases are on the rise in many places.
Today we will discuss some expert advice on vaccine choices, and the appearance of a particular SARS-CoV-2 variant of concern in house pets.
As usual, bolded terms are linked to the running newsletter glossary.
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Now, let’s talk COVID.
Peter Hotez: Guidance for vaccine decision-making
Peter Hotez is a legend in the medical community, particularly in the study of emerging and neglected infectious diseases. He is also a person whose work might have led to a COVID-19 vaccine being ready within months or weeks after the start of the pandemic, rather than within a year, if he had received funding to continue his efforts. Specifically, he was working on a vaccine platform to address emerging coronaviruses that could have been pre-tested and then readily adapted to this new threat. He just didn’t get the money to finish it, and that’s a story for another time.
All of that said, he is someone I tremendously respect, and he has written a very accessible guide for making decisions between the various available vaccines. I do not agree with it in every point made, but I do not think my opinion should be the only one transmitted through this newsletter.
His work here addresses several common questions I have received from readers and I think is something worth spreading. Please have a look: https://www.sciencedirect.com/science/article/pii/S1286457921000332
Variants of concern in human-adjacent animals (like pets)
One of the earliest stories I remember in the pandemic was the positive COVID-19 test result received for a tiger at the Bronx zoo. When zoonotic viruses like SARS-CoV-2 enter human populations, they can also go beyond human populations and into the animals that we keep. The Bronx Zoo tiger was just a high-profile example. SARS-CoV-2 has also been demonstrated to be able to infect cats, ferret- and weasel-like animals that are kept by humans, and other types of animal.
The symptomatic profile in animals is species-specific, but most pets appear to experience few symptoms or impacts. However, they do represent a potential reservoir of virus and could potentially transmit these viruses beyond the households in which they live. This is not likely a matter of tremendous concern—you are much more likely to get COVID-19 from another person than from a cat—but it is something to keep an eye on.
That’s why I’m sharing this story, which highlights the first isolation of the concerning B.1.1.7 variant from cats and dogs: https://www.sciencemag.org/news/2021/03/major-coronavirus-variant-found-pets-first-time
At this point these are isolated incidents, but it suggests that the mutations that characterize B.1.1.7 have not “restricted its host range”—virologist-speak for saying that it apparently can still infect as many species as its parental lineage can. We don’t know for certain that this is true, but it does appear to be from this information.
Another story to follow as time goes on. I’m interested to learn more.
What am I doing to cope with the pandemic? This:
Preparing for Passover
Normally, I wouldn’t leave Passover preparations so late. It is a tactically complicated holiday, that sort of requires everyone observing it to engage in spring cleaning of a rather extreme sort, in order to purge leaven from their homes. This year, I have just moved into a new home, so what I need to do is pretty minimal. Still, I need to get together some cookware and make it kosher for the holiday, so I’ve been working on that.
At this time last year, I was wondering what would happen with Passover at all, given the worsening pandemic and the extreme emergency developing in New York City. This year, although cases are on the rise alarmingly in the New York area, almost everyone in my immediate family is vaccinated and we will be able to have a small, but safe, outdoor gathering on our balcony. It feels a little bit like we are coming out of this time of trouble—something that is very fitting for what Passover is all about.
Reader Sara Jager left the following comment, regarding the safety of the AstraZeneca vaccine:
Thanks for your continuous work on this news letter! It is very informative.
I am European, more specifically Dane located in London. The big story over the last two weeks on mainland Europe has been AZ and the risk for blood clots. Here is a small article from BBC about it: https://www.bbc.co.uk/news/world-europe-56440139 It has not been covered much in the UK news compared to the Danish news. I am wondering if these press stories might have influenced AZ release of preliminary data?
There is still no more blood clots in the people that got AZ compared to the once that did not. The main concern is that the blood clots in question have an unusual combination of symptoms (blood clots, haemorrhages and low platelet counts). If this is related to the AZ vaccine it is very rare and I would still take the AZ jab if I was offered. For me the benefit outweighs the possible risk.
Keep up the good work :D
I love this comment because of the thought process it shows. Here is my reply:
Thank you for your comment, Sara! And for your kind words :)
I like the way you have looked at this issue and think it is worth holding up as an example--it is likely meaningful that the risk of blood clot in the general population is similar to the risk in those who received the AZ vaccine, but you have not simply accepted that at face value. You also consider that the etiology of blood clots observed in patients who also received the AZ vaccine is unusual, which is a matter requiring further investigation but not necessarily a vaccine-related safety signal. This is the kind of medical safety analysis that regulatory agencies do all the time.
I am reassured that, if I were to receive the AZ vaccine, my risk of blood clot appears to be same as if I had not gotten the vaccine. Perhaps the blood clot that I could get would be a little different were I to get that particular vaccine, but it seems to me the actual risk of such a medical event for the average patient remains the same.
I am certain we will learn more in the days to come, but essentially, I agree with your take on this.
Carl Fink also shared some thoughts on the AZ vaccine:
"AstraZeneca is an extremely well-established pharmaceutical company that really ought to know better." Not to mention, you know, their partners at the University of Oxford. I'm not in your field, but I hear their rep is pretty impressive.
I actually get my own first dose on Friday. (I've been fanatically isolating for the past week, because the last thing I want to do is the ending of a war movie, where someone gets killed two days before peace is declared.) I also delayed a while despite a comorbidity because I'm lucky enough to be able to work from home.
Something I read last week, I believe in Nature, that surprised me: the AZ half-dosing mess was also a timing mess. The people who initially got a half-dose of the vaccine also had a longer wait between doses than was specified by the protocol, and at least some researchers think that this longer wait was responsible for the improved effectiveness. Yet another protocol breach, but an interesting effect if it's real--there have also been reports that other vaccines continue to have strengthening effects for several weeks after the arbitrary cutoff point set by study protocols.
You're the expert, but to me that implies that booster shots, should they be required, will be quite effective.
I agree of course that the issues with the reporting and conduct of the AZ-Oxford trials is concerning, but I don’t want to sound like a broken record. That said, I did want to comment on the second part that Carl mentioned, because I agree it’s an interesting effect:
Yes, I've seen some reports indicating that the viral vector-based vaccines seem to get more effective over time (to a point). It also seems that waiting to boost these vaccines for a little longer may be helpful. I wonder if, perhaps, this is an effect of letting the immune response to the vector attenuate somewhat. I'm not really sure and am actively looking for more research to be done on this topic.
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No corrections since last issue.
See you all next time.
Always,
JS