Coronamonomania Thrives in Darkness, Part 22

In Minnesota and some other parts of the country the next few weeks will likely be a tug of war between more favorable meteorological conditions for transmission and the level and strength of adaptive immunity from a combination of vaccination and prior infection.  And it is complicated by the continued use of PCR test thresholds that create lots of non-case cases.

More evidence that it really is completely safe to open schools, especially considering the harm from not opening them.  (Medrxiv Paper)   The research was done in England and involved an intensive monitoring of a small group of students and their families.  Only five cases were identified.  There was no secondary transmission in the school in any of the cases.  Only one case of transmission to a family member.  In several of the cases the cycle number was so high that the students were likely not infectious or maybe even infected.

Good to look at the research to prepare for the coming “vaccine doesn’t work” terrorism.  This study looked at antibody levels following use of the Pfizer vaccine.  It found robust levels, including in saliva, which makes sense since respiratory viruses enter via, well, the upper respiratory tract.  Those saliva antibodies would be particularly useful in preventing infection and infectiousness.  The vaccine also appeared to work pretty well against variants, with somewhat reduced effectiveness against the “South Africa” strain.  (Medrxiv Paper)

Here is another study on the Pfizer vaccine.  (Medrxiv Paper)  The study comes from Denmark and looks at effectiveness in two priority groups, long-term care residents (with an average age of 84) and health care workers, after the first and second dose.  Cases following vaccination were tracked.  Among other things this study suggests value to using two doses.  Some have misinterpreted this study to suggest relatively low levels of effectiveness, but that is erroneous.  The comparison began almost immediately after vaccination.  Full effectiveness of adaptive immunity takes some time to develop.  Within a week after the second dose, a very strong reduction in cases occurred among health care workers and a fairly strong one among the long-term care residents.  This is consistent with prior evidence of a generally weaker response to vaccines from elderly persons.

One more time on the potential benefits of prior seasonal coronavirus infections leading to antibodies which assist in defending against CV-19.  (Medrxiv Paper)   Blood plasma from people who have recovered from CV-19 is sometimes used as a therapeutic as it should contain CV-19 specific antibodies.  A group of people treated this way were studied.  Better outcomes occurred when the blood plasma used had a higher level of seasonal coronavirus antibodies.

The learning curve in medicine can be difficult and can lead to terrible outcomes for patients who get the disease early.  We were willy-nilly throwing people into ICUs and onto mechanical ventilation.  It took a while to figure out that this was actually making the disease worse.  This paper explores outcomes over time.  (Medrxiv Paper)   The setting was almost 56,000 patients treated in the Veterans’ Administration health system.  This patient group tends to be elderly and have multiple chronic conditions and other health problems. The hospitalization rate dropped from 44% of cases to 16%, ICU use from 20% to 5%, ventilation from 13% to 2% and death from 12.5% to 4.4%.  The mix of therapeutics used also changed over time.  While better care guidelines are likely largely responsible, the statistics also reflect an epidemic that was front-loaded, with those most susceptible to serious illness being infected early on.

And if for some reason you don’t believe that a lot of people went to the hospital for one reason and ended up getting CV-19 there, read this study from Scotland.  (Medrxiv Paper)   Dealing with patients highly vulnerable to serious illness, the researchers found that being in a hospital didn’t help many of them because they contracted CV-19 in that setting.  As many as a third or more of severe cases got the virus in the hospital.  And in a little nugget, the risk of severe illness was far lower in households with young children that in those without.