A quick shoutout to the IB here, the man is doing his best to have us overtake Florida in age-adjusted deaths. We have left Sweden in the dust on a per capita basis and I believe we can yet show Florida who can really mis-manage an epidemic response. Unfortunately, we will never get in the league of such champions as New York, New Jersey and California. We are currently at 1482 per million of population, unadjusted.
A reader sent me an interesting actuarial analysis of death rates overall and with CV-19 for Minnesota. It shows exactly what you would expect from following the data; there is no extra risk of death from CV-19 except in the very old. And CV-19 caused a steepening of the death age structure, there has been a higher proportion of deaths in the very old during the epidemic than there was before. I anticipate that at some point we will actually see deaths dip below the pre-epidemic average or rate, as there has been a significant pull-forward of deaths. That phenomenon is already present in Sweden.
And off we go to the research races. First up a large study of breakthrough infections in the veteran population. Vaccine effectiveness against infection dropped from 92% in March to around 54% in mid-August. The J & J vaccine had the biggest drop, followed by Pfizer and Moderna. Age was not noticeably a factor in the increase in breakthru infections, but this wasn’t a particularly sophisticated analysis. The authors claim the increase is due to Delta, but that is inconsistent with actual studies on immune response levels, which suggest that the biological explanation predominates. And of course, the authors reveal their ideological bent by suggesting that the results mean we all should just be masked up and locked down forever. (Medrxiv Paper)
This study actually looks at the effectiveness of vaccines against Delta. The study was conducted in the UK and found that a full course of the Pfizer vaccine was 84% against Delta. However, this is primarily a modeling study, not real world data. (Medrix Paper)
This was a review of the role of schools in spread of the virus. It found 15 studies adequate to be included. The general finding was that while schools could be a source of spread, transmission was generally very low. The authors attribute this to use of interventions to reduce spread, but that is just their gloss on the findings. (Medrxiv Paper)
Households are a major source of transmission and this study from the Netherlands examines what effect vaccines appear to have on household transmission. For comparison, the same group had identified effectiveness against Alpha transmission as 73%, for transmission from a vaxed member of the household to an unvaxed one. Transmission in regard to Delta for the same pattern was estimated at 63%, which appears lower but you must remember the waning of effectiveness over time, and that Delta became dominant after vaccination began, so I suspect the reality is that effectiveness is equal against both variants. If the contact of the index case was vaccinated as well, the additional protection from the index case being vaxed was 40%. (Medrxiv Paper)
This is an interesting paper because it demonstrates that it is very possible to distinguish between adaptive immunity from prior infection and that from vaccination with a simple antibody test. If the research continues to show that infection provides at least as strong a reponse as vaccination, then it is inexcusable to not treat people with prior infection as in essence being vaccinated. An incidental finding was that among ER attendees, prevalence of infection had risen to 24% by spring of 2021. (Medrxiv Paper)
Another study for the vitamin D afficianados out there. This study indicates that vitamin D levels may have a dual effect. If they are too high, they may actually be associated with CV-19 disease, and the same is true if they are too low. The study was conducted among health care workers in the UK. Certain minorities had greater incidence of vitamin D deficiency, which could be genetic or diet related. (Medrxiv Paper)
Worth another look is this review of the research on masking, and other physical efforts, to prevent transmission of respiratory viruses. It was last updated by the Cochrane Institute in the fall of 2020. The Cochrane Institute is viewed as one of the pre-eminent sources of evidence-based Medicine. It found that the evidence did not support a benefit to masking in most situations. (Cochrane Review)