[Sundaycommunity] Fwd: [Ruah] Vaccines and variants

[Catherine Walther]

Stay safe everyone, Catherine


Helpful article from The New York Times
Too bad most of the media coverage has been so unhelpful. This is worth
reading to the end.
Vaccines and variants
April 15, 2021
New York Times
The news about coronavirus variants can sound like a horror movie, with
references to a “double-mutant” virus, “vaccine-evading” variants and even
an “Eek” mutation. One headline warned ominously: “The devil is already
here.”

While it’s true that the virus variants are a significant public health
concern, the unrelenting focus on each new variant has created undue alarm
and a false impression that vaccines don’t protect us against the various
variants that continue to emerge.

“I use the term ‘scariants,’” said Dr. Eric Topol, professor of molecular
medicine at Scripps Research in La Jolla, Calif., referring to much of the
media coverage of the variants. “Even my wife was saying, ‘What about this
double mutant?’ It drives me nuts. People are scared unnecessarily. If
you’re fully vaccinated, two weeks post dose, you shouldn’t have to worry
about variants at all.”

Viruses are constantly changing, and new variants have been emerging and
circulating around the world throughout the pandemic. Some mutations don’t
matter, but others can make things much worse by creating a variant that
spreads faster or makes people sicker. While the rise of more infectious
variants has caused cases of Covid-19 to surge around the world, the risk
is primarily to the unvaccinated, for whom there is great concern. While
vaccination efforts are well underway in the United States and many other
developed countries, huge swaths of the world’s population remain
vulnerable, with some countries yet to report having administered a single
dose.

But for the vaccinated, the outlook is much more hopeful. While it’s true
that the vaccines have different success rates against different variants,
the perception that they don’t work against variants at all is incorrect.
In fact, the available vaccines have worked remarkably well so far, not
just at preventing infection but, most important, at preventing serious
illness and hospitalization, even as new variants circulate around the
globe.

The variants are “all the more reason to get vaccinated,” said Dr. Anthony
S. Fauci, the nation’s top infectious disease specialist. “The bottom line
is the vaccines we are using very well protect against the most dominant
variant we have right now, and to varying degrees protect against serious
disease among several of the other variants.”

Part of the confusion stems from what vaccine efficacy really means and the
use of terms like “vaccine evasion,” which sounds a lot scarier than it is.
In addition, the fact that two vaccines have achieved about 95 percent
efficacy has created unrealistic expectations about what it takes for a
vaccine to perform well.

Here are answers to common questions about the variants and the vaccines
being used to stop Covid-19.

Which variant am I most likely to encounter in the United States?

The variant called B.1.1.7, which was first identified in Britain, is now
the most common source of new infections in the United States. This highly
contagious variant is also fueling the spread of the virus in Europe and
has been found in 114 countries. A mutation allows this version of the
virus to more effectively attach to cells. Carriers may also shed much
higher levels of virus and stay infectious longer.

The main concern about B.1.1.7 is that it is highly infectious and spreads
quickly among the unvaccinated, potentially overwhelming hospitals in areas
where cases are surging.

Do the vaccines work against B.1.1.7?

All of the major vaccines in use — Pfizer-BioNTech, Moderna, Johnson &
Johnson, AstraZeneca, Sputnik and Novavax — have been shown to be effective
against B.1.1.7. We know this from a variety of studies and indicators.
First, scientists have used the blood of vaccinated patients to study how
well vaccine antibodies bind to a variant in a test tube. The vaccines have
all performed relatively well against B.1.1.7. There’s also clinical trial
data, particularly from Johnson & Johnson and AstraZeneca (which is the
most widely used vaccine around the world), that shows they are highly
effective against both preventing infection and serious illness in areas
where B.1.1.7 is circulating. And in Israel, for instance, where 80 percent
of the eligible population is vaccinated (all with the Pfizer shot), case
counts are plummeting, even as schools, restaurants and workplaces open up,
suggesting that vaccines are tamping down new infections, including those
caused by variants.

If the vaccines are working, why do I keep hearing about “breakthrough”
cases?

No vaccine is foolproof, and even though the Covid vaccines are highly
protective, sometimes vaccinated people still get infected. But
breakthrough cases of vaccinated people are very rare, even as variants are
fueling a surge in case counts. And the vaccines clearly prevent severe
illness and hospitalization in the few vaccinated patients who do get
infected.

So what’s the risk of getting infected after vaccination? Nobody knows for
sure, but we have some clues. During the Moderna trial, for instance, only
11 patients out of 15,210 who were vaccinated got infected. Both Pfizer and
Moderna now are doing more detailed studies of breakthrough cases among
vaccinated trial participants, and should be releasing that data soon.

Two real-world studies of vaccinated health care workers, who have a much
higher risk of virus exposure than the rest of us, offer hopeful signs. One
study found that just four out of 8,121 fully vaccinated employees at the
University of Texas Southwestern Medical Center in Dallas became infected.
The other found that only seven out of 14,990 workers at UC San Diego
Health and the David Geffen School of Medicine at the University of
California, Los Angeles, tested positive two or more weeks after receiving
a second dose of either the Pfizer-BioNTech or Moderna vaccines. Both
reports were published in the New England Journal of Medicine, and are a
sign that even as cases were surging in the United States, breakthrough
cases were uncommon, even among individuals who were often exposed to sick
patients. Most important, patients who were infected after vaccination had
mild symptoms. Some people had no symptoms at all, and were discovered only
through testing in studies or as part of their unrelated medical care.

Researchers are still studying whether the variants eventually might
increase the number of breakthrough cases or if vaccine antibodies begin to
wane over time. So far, data from Moderna show the vaccine still remains 90
percent effective after at least six months. Pfizer has reported similar
results.

A recent study of 149 people in Israel who became infected after
vaccination with the Pfizer vaccine suggested that a variant first
identified in South Africa was more likely to cause breakthrough
infections. However, those eight infections occurred between days seven and
13 following the second dose. “We didn’t see any South Africa variant 14
days after the second dose,” said Adi Stern, the study’s senior author, a
professor at the Shmunis School of Biomedicine and Cancer Research, Tel
Aviv University. “It was a small sample size, but it’s very possible that
two weeks after the second dose, maybe the protection level goes up and
that blocks the South Africa variant completely. It gives us more room for
optimism.”

For now, the variants don’t appear to be increasing the rate of infection
in vaccinated people, but that could change as more data are collected.
Read more about breakthrough cases here.

Are there other variants we should be worried about?

The C.D.C. is tracking more than a dozen variants, but only a few qualify
as “variants of concern,” which is a public health designation to identify
variants that could be more transmissible or have other qualities that make
them more of a risk. The main additional variants everyone is talking about
right now are the B.1.351, which was first detected in South Africa, and
the P.1, which was first identified in Brazil. While there are other
variants (including two “California” variants, B.1.427 and B.1.429, and a
New York variant, B.1.526), for now, it seems that the South Africa and
Brazil variants (which as of late March together accounted for about 2
percent of cases in the United States) are causing the most concern. While
a new variant can emerge at any time, existing variants also compete with
each other for dominance. One interesting new development: In countries
like the United States where B.1.1.7 is dominant, some of the other
variants seem to be getting crowded out, making them less of a worry.

Is it true that the variants first identified in South Africa and Brazil
can “evade” the vaccines?

There is a concern that the B.1.351 and the P.1 are better at dodging
vaccine antibodies than other variants. But that doesn’t mean the vaccines
don’t work at all. It just means the level of protection you get from the
vaccines against these variants could be lower than when the shots were
studied against early forms of the virus. Among the variants, the B.1.351
may pose the biggest challenge so far. It has a key mutation — called
E484K, and often shortened to “Eek” — that can help the virus evade some,
but probably not all, antibodies.

Remember that there’s a lot of “cushion” provided by this current crop of
vaccines, so even if a vaccine is less effective against a variant, it
appears that it’s still going to do a good job of protecting you from
serious illness.

How much protection will the vaccines give me against the variant first
seen in South Africa?

We don’t yet have precise estimates of vaccine effectiveness against
B.1.351, which may be the most challenging variant so far. But studies show
that the various vaccines still lower overall risk for infection and help
prevent severe disease. A large study of Johnson & Johnson’s one-dose
vaccine in South Africa found it was about 85 percent effective at
preventing severe disease, and lowered risk for mild to moderate disease by
64 percent. (Distribution of the Johnson & Johnson vaccine has been paused
as health officials investigate safety concerns.) The AstraZeneca vaccine
did not do much to protect against mild illness caused by B.1.351, but
scientists said they believed the vaccine might protect against more severe
cases, based on the immune responses detected in blood samples from people
who were given it. There’s less definitive research for the Pfizer and
Moderna vaccines against the variant, but it’s believed that these two-dose
vaccines could reduce risk of infection against the variant by about 60
percent to 70 percent and still are highly effective at preventing severe
disease and hospitalization.

“From everything we know today, there is still protection from the vaccines
against the South Africa variant,” said Dr. Stern.

Should I still worry that the vaccines are less effective against some
variants?

Part of the problem is that we misinterpret what efficacy really means.
When someone hears the term “70 percent efficacy,” for instance, they might
wrongly conclude that it means 30 percent of vaccinated people would get
sick. That’s not the case. Even if a vaccine loses some ground to a
variant, a large portion of people are still protected, and only a fraction
of vaccinated people will get infected. Here’s why.

To understand efficacy, consider the data from the Pfizer clinical trials.
In the unvaccinated group of 21,728, a total of 162 people got infected.
But in the vaccinated group of 21,720, only eight people became infected.
That’s what is referred to as 95 percent efficacy. It doesn’t mean that 5
percent of the participants (or 1,086 of them) got sick. It means 95
percent fewer vaccinated people got infected compared to the unvaccinated
group.

Now imagine a hypothetical scenario with a vaccine that is 70 percent
effective against a more challenging variant. Under the same conditions of
the clinical trial, vaccination would still protect 21,672 people in the
group, and just 48 vaccinated people — less than one percent — would become
infected, compared to 162 in the unvaccinated group. Even though overall
efficacy was lower, only a fraction of vaccinated people in this scenario
would get infected, most likely with only mild illness.

While far more research is needed to fully understand how variants might
dodge some (but not all) vaccine antibodies, public health experts note
that an estimate of 50 percent to 70 percent efficacy against a challenging
variant would still be considered an adequate level of protection.

“Seventy percent is extremely high,” said Dr. Stern. “Basically what this
means is that it’s even more important to get vaccinated. If you have 95
percent efficacy, you can create some form of herd immunity with less
people. With 70 percent efficacy, it’s even more important to get
vaccinated to protect others.”

Am I going to need a booster shot?

Vaccine makers already are working on developing booster shots that will
target the variants, but it’s not clear how soon they might be needed. “In
time, you’re going to see a recommendation for a booster,” said Dr. Peter
J. Hotez, dean of the National School of Tropical Medicine at Baylor
College of Medicine in Houston. “That booster will elevate everybody’s
antibodies and increase durability. The booster will probably be configured
to target the South African and Brazil variants.”

Given all these unknowns about the variants, shouldn’t I just stay home
even after I’m vaccinated?

Even amid the rise of variants, vaccines will significantly lower your risk
for infection and will protect you from serious illness and
hospitalization. People who are vaccinated can socialize, unmasked, with
other vaccinated people. While vaccinated people still need to follow local
health guidelines about wearing a mask and gathering in groups to protect
the unvaccinated, vaccinated people can travel, get their hair and nails
done, or go to work without worrying. And vaccinated  grandparents can hug
their unvaccinated grandchildren. Because there are still some outstanding
questions about the risk of vaccinated people carrying the virus, a
vaccinated person is still advised to wear a mask in public to protect the
unvaccinated — although those guidelines may be updated soon.

“The vaccines protect you, so go get vaccinated — that’s the message,” said
Dr. Fauci. “If you’re around other vaccinated people, you shouldn’t worry
about it at all. Zero.”
Jean Ann
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*May you walk in joy as love calls us on.*
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