COVID Transmissions for 8-27-2021
Is Israel experiencing vaccine failure? Also, Johnson and Johnson booster data
Greetings from an undisclosed location in my apartment. Welcome to COVID Transmissions.
It has been 647 days since the first documented human case of COVID-19. In 647, the Chinese Emperor sent a mission to India to learn sugar manufacturing techniques. History isn’t always about battles and disease! Sometimes it can be…sweet.
Today we’ll discuss a wide variety of things: the need for masks. Airborne transmission. Data from Israel—and my skepticism about alarmist treatments of it in the press. And lastly, some new J&J vaccine data.
If you make it through all that…have a great weekend!
Bolded terms are linked to the running newsletter glossary.
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Now, let’s talk COVID.
Experts predict that wearing masks again could prevent 50,000 of 100,000 predicted US deaths by December 1st
Look, I was sharing stories about this last year at this time and now I’m doing it again. I’m so tired of this. Why are people so against wearing a piece of cloth on their damn faces? Can someone explain it to me?
We’ll need to do other things too—limit gatherings, avoid crowds, stay home when sick—but masking is central to it.
The difference between doing this and not doing this is 50,000 lives. That’s enough people to fill the Colosseum in Rome. Mask up when you are in public indoors.
https://apnews.com/article/science-health-coronavirus-pandemic-6df4471c64e40e7e319ae368d4c1db0b
Science magazine review on aerosol transmission of respiratory viruses
This is one that I’ll be reading a few times, because it comes from a set of authors who have become luminaries of communication on airborne virus transmission. Science magazine has a review—a synthesis of existing research—discussing the topic of airborne transmission of viruses and its implication for disease control, both for COVID-19 and other diseases: http://science.sciencemag.org/content/373/6558/eabd9149.full
The Daily Beast tells a scary story about Israel with very little backing it up
I’m only sharing this because I’ve seen it making the rounds and it’s scaring people, which I don’t think is right. The Daily Beast did an article about how the apparent failure of vaccines in Israel should be a cautionary tale for the US, but I really have a lot of bones to pick with this one: https://www.thedailybeast.com/ultra-vaccinated-israels-debacle-is-a-dire-warning-to-america
First of all, this article refers to Israel as “ultra-vaccinated.” That is not correct. Israel is around 60% vaccinated. That is better than most other places, but it is not “ultra” vaccination. It is below meaningful community immunity thresholds and it allows COVID-19 to continue to spread freely.
Next, the article makes a big deal out of how Israel is peaking in daily cases around previous highs, but it’s ignoring one key part of the equation—the Delta variant. That variant is about twice as contagious as the viruses that were circulating during the last historic peak. At this peak, we have approximately the same number of cases, for a virus that is twice as contagious? Do you see the problem? If the virus is twice as contagious, all other things being equal, we might expect the peak to be at least twice as high—in fact perhaps quite a lot higher, because virus spread is exponential and not linear. Except, currently, the apparent peak is the same as the pre-Delta peak. That strikes me as a sign that the virus is actually being kept under better control than we might expect—perhaps some new medical advance is responsible for this.
This doesn’t preclude the idea that the outbreak could get worse, and without a doubt, Israel needs to do things to get this under better control, but the “dire warning” here is needlessly frightening. One thing it sets up is the potential to undermine confidence in vaccines, and it cites Israeli data on vaccine waning in order to do so.
The problem is, none of those data have been published in a meaningful way that allows them to be scrutinized scientifically. These have been press releases of preliminary data only, and without the details, there are easy ways to explain why there would be a difference. It could be that the Israeli explanation is correct, but I’m skeptical because no other country is reporting the same pattern. I think another explanation is likely, but do keep in mind that without the data transparently reported it’s very hard to offer more than opinion.
Firstly, Israeli data seem to use positive SARS-CoV-2 testing as the case definition. This is a bad case definition! When you test positive but you don’t get sick, the vaccine worked! This is particularly bad because when you stack vaccine effectiveness against this case definition up against efficacy from the Phase 3 trials, you are comparing apples to oranges. The Phase 3 trials looked at COVID-19 symptomatic disease with PCR confirmation. 95% efficacy was a number for reduction of disease, not reduction of positive tests. It has been estimated since that reduction of positive tests is more like 60-70% for the very best vaccines; in Israel they now estimate this around 40-55%, which is actually not that big a drop, particularly considering we are talking about a situation where a lot of people aren’t getting sick at all.
What’s more, the vaccine trials that gave eye-popping numbers were conducted under conditions wherein patients were advised to mask, avoid crowds, and do other things to avoid getting sick—not to mention that they were tested against less-contagious variants. Shortly before Delta arrived in Israel, the country relaxed all of its COVID-19 control restrictions because vaccination had caused disease rates to plummet. Vaccine effectiveness in Israel over the course of this summer has been measured during an outbreak that began without nonpharmaceutical interventions in place—a fact which could very easily explain some of the differences in vaccine effectiveness here.
Last, and I think most important, looking at the death numbers, deaths in Israel are around a quarter of what they were during the last peak, despite “case” numbers being comparable to that peak. It looks like COVID-19 is killing fewer people who test positive there, something that is certainly explained by vaccine effectiveness. Nothing is perfect, and of course there are also still 40% of people who haven’t been fully vaccinated, so there are still deaths—but they are proportionally reduced to a really meaningful degree.
Data from around the world have shown us that while vaccine effectiveness has dropped somewhat, it is actually pretty modest, with the fall being 10 to 20 percentage points against disease. Effectiveness against hospitalization and death have barely fallen at all, despite the Delta variant. Israel is the only outlier, and I think there are extenuating circumstances, particularly their case definition, that make things look worse there than elsewhere. What I see in Israel is evidence that Delta means we still need masks, not evidence that vaccines are failing.
Vaccines are saving lives in Israel, and they are saving lives everywhere else too. The “dire warning” may be truer than I gave it credit for, but it isn’t a warning about vaccines—from the information I have right now, it’s a warning that we need to get back to other control measures that we thought we didn’t need anymore.
Johnson and Johnson releases some 2-dose data
J&J has released some data on the use of a second shot for that vaccine: https://www.npr.org/sections/coronavirus-live-updates/2021/08/25/1030909283/johnson-and-johnson-covid-vaccine-booster-six-months
I want to start by saying that these are not the data I was looking for. The data that were released are Phase 1 and 2 data that look at antibody levels. They showed that a boost increased antibody levels. That is good news, but it isn’t good news that I think we can currently rely on to tell us much at all. Antibody levels are not vaccine efficacy. Right now, we do not have a sense of correlates of protection for immunity to COVID-19. Antibodies have not been shown to correlate with protection. Some trials where vaccines showed robust antibody responses have been misleading—the CureVac vaccine, which ultimately failed to be more than 50% protective in Phase 3 trials, showed good antibody responses in Phase 2 trials.
However, I do want to say that I think the J&J vaccine has a good chance of having better performance than that. One dose is already just shy of 70% protective. It even seems to stay pretty protective in the face of the Delta variant, something that the AstraZeneca vaccine wasn’t able to manage with a single dose. Boosting it is likely to be more protective, in my opinion, because boosting the similarly-designed AZ vaccine made it more protective.
Except, that’s just an opinion. I don’t have direct evidence for it. The direct evidence will come from a Phase 3 clinical trial, which I have been clamoring to see for quite some time. Though the most recent release has been touted as evidence that a booster will make the J&J vaccine “more protective,” it isn’t evidence of that. It’s just a hint. I want the full story, with direct evidence. Get on it, J&J!
What am I doing to cope with the pandemic? This:
Getting my running pace in shape
As I’ve tried to train more and get fitter, my running pace has been a big focus—at least lately. When I started out, I didn’t worry too much about pace because endurance mattered more. Running faster, nominally, burns more calories than running slower, but that difference comes out in the wash when running slower means you can also run longer. Sprinting for 30 seconds may burn more than 30 seconds of jogging, but you can’t sprint for 30 minutes. The distance matters more.
However, once you can “go the distance,” as it were, pace starts to matter a bit more. On long distances, running faster can burn a meaningfully larger number of calories. But also, importantly, it means you can cover more distance in the same amount of time—which definitively means burning more calories. Going 4 miles instead of 3 miles makes for a real difference in calories burned. But you might not have time to run 4 miles slowly.
Since exercise time is precious, I’ve been working to get my pace down to about 8 minutes per mile for 4-5 miles. From there I’d like to get more distance in, but nothing happens overnight. Still, I’m getting close to that goal, and happy to see it.
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Always,
JS