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Defer the second dose for three months


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BBC tonight reporting that AstraZeneca says its first dose gives sustained immunity thorough at least 76 days, so the UK decision to defer second doses till three months out, based initially on some rational thinking, now has experimental support. And a single dose is effective against transmission, very good news.

Dear old Kate, I definitely will get my second dose, a booster of a vaccine is very well understood to confer far superior immunity. That is not the point. The point is to give as many people as possible their first dose, conferring them sufficient immunity to ensure they will not suffer severe disease, as soon as possible and giving us a chance to beat back these new variants. I never said don't get the second dose. I will and everyone should, just at three months instead of 21/28 days.

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24 minutes ago, TheDragon said:

BBC tonight reporting that AstraZeneca says its first dose gives sustained immunity thorough at least 76 days,

I see the BBC ranks alongside the New York Times in your sources.  You forget to point out that the AstraZeneca vaccine has an effectiveness of only 70%.  Nor that the German authorising agency has recommended it shouldn't be used for over 65's.  Nor that the "sustained immunity" varies based on age, dose and time between doses.  Again - your views are dangerous recommending NOT following manufacturers recommendations.

24 minutes ago, TheDragon said:

The point is to give as many people as possible their first dose, conferring them sufficient immunity to ensure they will not suffer severe disease, as soon as possible and giving us a chance to beat back these new variants. I never said don't get the second dose. I will and everyone should, just at three months instead of 21/28 days

Which is a ludicrous and even dangerous approach as you are increasing the time that individuals do not have full protection.  Effectively you are creating individual virus factories with low but incomplete immunity (you don't even know who has what level) that potentially aid the development of more dangerous variants that are resistant to the vaccines.  As a microbiologist you should know better and can draw on your knowledge of the development of antibiotic resistance.

Doesn't it surprise you that the Governments that you point out that have been shocking at managing the pandemic are the same ones pushing the deferring of the second dose?

Whereas those that have done significantly better are not?

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  • 3 weeks later...

So today we get near-approval of the "single-shot" JnJ vaccine, and as far as I can tell its effectiveness is basically the same as a single dose of the Moderna/NIH and BioNtech/Pfizer vaccines. The effectiveness of a single dose of these two mRNA vaccines has now been confirmed by vast numbers in both Israel and the UK. So why doesn't the USA at least defer the second dose of the mRNA vaccines so we can get many more their first dose? Around here most doses are now being used for second doses, with only a few first doses being given.

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I agree. I revise my previous opinion. The UK numbers look promising enough to defer a second dose. 

Either this, or lockdowns really, really do work, but naysayers can't have it both (resp. neither) way.

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CBS reporter tonight on news notes that the UK approach of 12 weeks between doses of the BioNtech/Pfizer and Oxford/Astrazeneca is helping them contain their variant, while the US approach of sticking to the 3/4 week interval might not. And Fauci pleads for accelerated vaccine rollout to contain the endogenous and UK/SA/Br variants, but apparently still will not endorse delaying the second dose. Meanwhile my local PHD says this on their website, which does not help us get enough people vaccinated quickly. We are at nearly 30% of eligible county residents with their first dose, but stalling now. Delaying the second dose would allow us to get well over 50% and along with those who have already had covid put us within reach of herd immunity.

2nd Dose Appointments for those Vaccinated at IHotel. This week's allocation is mainly 2nd doses for previously vaccinated 1A/1B individuals. We expect to have more first doses allocations next week and the week after.

We are not currently setting up first dose clinics. Please keep an eye on our website and social media pages for information about when additional vaccines become available

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According to the New England Journal of Medicine...

We used documents submitted to the Food and Drug Administration2 to derive the vaccine efficacy beginning from 2 weeks after the first dose to before the second dose (Table 1). Even before the second dose, BNT162b2 was highly efficacious, with a vaccine efficacy of 92.6%, a finding similar to the first-dose efficacy of 92.1% reported for the mRNA-1273 vaccine (Moderna).3

With such a highly protective first dose, the benefits derived from a scarce supply of vaccine could be maximized by deferring second doses until all priority group members are offered at least one dose. There may be uncertainty about the duration of protection with a single dose, but the administration of a second dose within 1 month after the first, as recommended, provides little added benefit in the short term, while high-risk persons who could have received a first dose with that vaccine supply are left completely unprotected. Given the current vaccine shortage, postponement of the second dose is a matter of national security that, if ignored, will certainly result in thousands of Covid-19–related hospitalizations and deaths this winter in the United States — hospitalizations and deaths that would have been prevented with a first dose of vaccine.

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Indeed Jules, and the data from Israel and the UK backs that up. A month after the first does of Pfizer you have 100% protection from hospitalization and death.

And now Canada is moving to deferring the second dose for three or even four months.

https://abcnews.go.com/International/wireStory/canada-vaccine-panel-recommends-months-covid-doses-76239947

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That's cause they are single payer, poorer than US, and won't be getting enough to fully vaccinate everyone by summer. The way we will. 

And nobody knows how long the pfizzer one shot lasts as opposed to two shots. Be damn inconvenient if it was a lot shorter. 

 

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8 minutes ago, NeedAClew said:

That's cause they are single payer, poorer than US, and won't be getting enough to fully vaccinate everyone by summer. The way we will. 

And nobody knows how long the pfizzer one shot lasts as opposed to two shots. Be damn inconvenient if it was a lot shorter. 

 

No, it is because we didn't maintain our own vaccine production facilities, and instead relied on promises from the pharma companies that they would support us when the time came.   Keep in mind that the pharma companies are suspicious of Canada because we want to reduce the length of time they can hold patents.  

Needless to say, we are now building our own vaccine production facilities, since we were fucked over by the pharmas.

If you think that single payer is poorer in any way than the US system, you definitely do need a clue.

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2 minutes ago, NeedAClew said:

Good idea in any case. 

I will say that the US VA system is better than what we have in Canada for our vets.   Oh, wait, its single-payer, isn't it.

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8 minutes ago, Rain Man said:

I will say that the US VA system is better than what we have in Canada for our vets.   Oh, wait, its single-payer, isn't it.

Yes but a small portion of citizenry and political pressures to do decent job. 

Single payer has to try to manage system  costs. Some don't even let over 55s immigrate for fear of their health care costs. 

We have mix of single payer and fragmented payers, even for one person over 65vand working with employer plan. 

And we are rich and are spending a buttload on vaccines and on administration. Where I live, they don't even ask if you have insurance, they just shoot you up for free. Well, my tax dollars at work.

So actually, we got US/Bill Gates/Dolly Parton single payer for vaccine and vaccination. But no cost minimization. 

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2 minutes ago, NeedAClew said:

Yes but a small portion of citizenry and political pressures to do decent job. 

Single payer has to try to manage system  costs. Some don't even let over 55s immigrate for fear of their health care costs. 

We have mix of single payer and fragmented payers, even for one person over 65vand working with employer plan. 

And we are rich and are spending a buttload on vaccines and on administration. Where I live, they don't even ask if you have insurance, they just shoot you up for free. Well, my tax dollars atbwork.

Sounds like god-damned socialism to me...

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On 2/24/2021 at 9:14 AM, TheDragon said:

So today we get near-approval of the "single-shot" JnJ vaccine, and as far as I can tell its effectiveness is basically the same as a single dose of the Moderna/NIH and BioNtech/Pfizer vaccines. The effectiveness of a single dose of these two mRNA vaccines has now been confirmed by vast numbers in both Israel and the UK. So why doesn't the USA at least defer the second dose of the mRNA vaccines so we can get many more their first dose? Around here most doses are now being used for second doses, with only a few first doses being given.

Around here it's mostly first doses still. 

J&J was tested in rougher environments, we actually don't know how Moderna would have done in Brazil. Around here they are counting on J&J for most new groups, since the oldies are getting second shots of whatever the first was. J&J and masks. 

 

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On 1/22/2021 at 4:29 PM, TheDragon said:

Unbelievable to me that the US has little sense of urgency to get vaccination done before these various more rapidly spreading variants overcome our hospitals just like is happening in the UK. They at least have the intelligence to defer the second dose for three months to get more people the first dose. Biden should issue an executive order that only first doses be given for now, with the second dose delayed till after his first 100 days. That way we vaccinate almost twice as many as the current approach. Then we would be well on our way to stopping this pandemic, and at a minimum we would prevent perhaps 100,000 deaths because if we can vaccinate everyone over 65 in the next month that would stop any of them from dying of covid. Plenty of evidence that the first dose gives most of your protection and prevents almost all instances of severe disease. We now know that having survived covid, patients get at least 6 months immunity, and no reason to believe it would be less with the vaccine, even just one dose. The failure to get vaccine into arms is a national disgrace. There are vast resources to get this done, from retired medical folk who can do the injections to pharmacies well experienced at doing it, what the fuck is wrong with this great country. For the first time ever I agree with Florida governor deSantis to get the vaccine to all over 65 first, and our Illinois Governor Pritzker has authorized the same so our county did that this week and all my 65+ friends are scheduled for next week or got it last week like me. Let's get on with it. We could send people to the moon in the 1960s but we can't do mass vaccination efficiently and sensibly in 2021?????????????????

Where is the evidence on efficacy level of 1 dose ?

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8 hours ago, TheDragon said:

Indeed Jules, and the data from Israel and the UK backs that up. A month after the first does of Pfizer you have 100% protection from hospitalization and death.

And now Canada is moving to deferring the second dose for three or even four months.

https://abcnews.go.com/International/wireStory/canada-vaccine-panel-recommends-months-covid-doses-76239947

So you are saying that the deferment of the second dose is backed up by evidence gained through an "experiment" in the field that ignored the recommended protocol based on the trials done to get emergency approval.

is that ethical?

BTW your selextive quoting of Iraseli data is misinformation.  But that's cool you can get away with it here.

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1 hour ago, Kate short for Bob said:

BTW your selextive [sic!]  quoting of Iraseli data is misinformation.  But that's cool you can get away with it here.

Trust him. He's an expert.

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Israel collaborated with Pfizer for early access on a large scale to do a massive nation-wide effort to see how it goes in the real world. Yes, they have the second shot after 21 days, but the data from day 14-21 shows few hospitalizations or subsequent deaths. Furthermore, since the second dose surely does not make a major difference till a week after it is given the data from day 21-28 is also informative and very protective.

In the UK they are only giving a single dose till very recently, and they have massive Pfizer data on it, showing near complete protection against hospitalization and deaths after three or four weeks. Because they started with 80+ individuals there were a few hospitalizations and deaths amoung them, but the 70+ and 60+ data look very good for almost complete protection against severe disease, the same as a single shot of JnJ. And of course, JnJ is now testing a booster or second shot to bring them up to 95% protection against symptomatic disease, same as the two mRNA vaccines.

The UK may have messed up several things on this pandemic, but they got this right. Canada is following their lead, and I anticipate that various European countries, which have been very slow on vaccination, even screwing up and saying 65+ should not get the Oxford/Astrazeneca shot, now retracted that shit, will follow suit. 

Really annoying is my home country of South Africa abandoning their initial supply of Oxford-Astrazeneca on the basis of a tiny local trial, when it would definitely prevent severe disease. So they are now using JnJ, which is no better, but all happy that it is a single shot when the OA single shot would have the same effect. Shameful.

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22 hours ago, TheDragon said:

Israel collaborated with Pfizer for early access on a large scale to do a massive nation-wide effort to see how it goes in the real world. Yes, they have the second shot after 21 days, but the data from day 14-21 shows few hospitalizations or subsequent deaths. Furthermore, since the second dose surely does not make a major difference till a week after it is given the data from day 21-28 is also informative and very protective.

In the UK they are only giving a single dose till very recently, and they have massive Pfizer data on it, showing near complete protection against hospitalization and deaths after three or four weeks. Because they started with 80+ individuals there were a few hospitalizations and deaths amoung them, but the 70+ and 60+ data look very good for almost complete protection against severe disease, the same as a single shot of JnJ. And of course, JnJ is now testing a booster or second shot to bring them up to 95% protection against symptomatic disease, same as the two mRNA vaccines.

The UK may have messed up several things on this pandemic, but they got this right. Canada is following their lead, and I anticipate that various European countries, which have been very slow on vaccination, even screwing up and saying 65+ should not get the Oxford/Astrazeneca shot, now retracted that shit, will follow suit. 

Really annoying is my home country of South Africa abandoning their initial supply of Oxford-Astrazeneca on the basis of a tiny local trial, when it would definitely prevent severe disease. So they are now using JnJ, which is no better, but all happy that it is a single shot when the OA single shot would have the same effect. Shameful.

If you don't expect your country to get enough vaccine until after the summer, cheeseparing measures might be a consideration.

Not the case in US. 

And if 78 year old lung transplant people can't get an appointment, it's not due to lack of vaccine. Either nobody helped them preregister or register, nobody helped them sign up at partner sites, or the locality is incompetent and or has crap IT. None of those are solved by only giving one dose. 

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  • 3 weeks later...

Data from the UK's experiment with deferring the second dose for three months is looking very good. They have first doses into 30 million people, that's nearly half the population of 66m, approaching 2/3 of those eligible at the moment, and almost all those vulnerable to severe cases and death. Second doses are starting now, at about 3m. The data shows clearly that immunity from the single dose starts to kick in between day 10-14 and by day 30 gives 75% protection against symptomatic infection and essentially complete protection against hospitalization and death. You have to be very old and have serious co-morbidities to die of covid a month after a single dose. This is for BioNTech/Pfizer and Oxford/Astra-Zeneca, and is essentially the same as the single-dose JnJ/Jansen vaccine trial results. As a result the death rate in the UK has fallen precipitously, even as cases that also dropped precipitously due to their winter lockdown are leveling off (the latter presumably due to the lifting of restrictions and young people still getting infected). Pretty much good news all round, in the UK covid is now a largely survivable disease soon to become a mere "flu" or even "cold" as they will have everyone vaccinated this summer.

Why on earth the US is not doing the same to head off the third wave that is well underway now is completely beyond me. My county is just starting first doses again, having spent most of March giving second doses. We have 35% of eligible people with first dose and 28% with second dose, doing well, but we could have been at 60% with first dose by now, and instead spent April giving second doses. Oh well, I don't think we will have a third wave here, and even if we do it will only be young people, the hesitant, and the anti-vaxers. We are well down from our winter peak of cases, our hospital has only a few in ICU, so let's see if we can keep it there and even drive it further down.

 

Screen Shot 2021-03-27 at 5.41.38 AM.png

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Had my first shot of Pfizer today, and in the info the nurse is giving before the shot, she said 92% efficiency after 2 to 3 week of the 1st shot. I already have my apointment for the 2nd dose, in 4 month.

I already feel a bit of Bill Gates in me, wait... big update just got in, I have to reboot many times...

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  • 2 weeks later...

So Australia is also going with the three-month delay between first and second doses. Good for them, they are presumably paying great attention to the fantastic success of the UK approach, plus perhaps a little supply limited. Strange that New Zealand is not following suit.

locally Illinois is now starting into third wave, sadly, just hope the vaccination program can blunt it. Almost entirely driven by variants at this time, well over 50% of cases in our town are now variants, as the CDC predicted months ago.

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38 minutes ago, TheDragon said:

So Australia is also going with the three-month delay between first and second doses. Good for them, they are presumably paying great attention to the fantastic success of the UK approach, plus perhaps a little supply limited.

Geez is there no end to the way you twist the facts?

The deferment is for the Astra Zeneca vaccine and is not based on supply issues but evidence that for that particular vaccine the efficacy of the vaccine is increased by waiting 3 months.  As you well know the AZ vaccine is completely different to the Pzifer and Moderna vaccines in terms of its mode of action.

That aside Australia is experiencing supply issues and more importantly some hesitancy due to the reported clotting problems.

Australia purchased 80m doses of Astra Zeneca and it will be used in the majority of vaccinations.

As for the variant's explain this - the B1.1.7 variant was first identified in the UK in September of last year and in the USA in December.  If it is so contagious why did it take so long to become the dominant variant?  I suggest you apply your obviously limited science training to reviewing the NextStrain website AGAIN.

I'll give you a hint - the variants that make up over 70% of the sub-samples measured by NextStrain for North America have been in circulation since May 2020!  They AREN'T NEW!  B1.1.7 represents 16%.

 

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Try to explain the behaviour of a virus. Something that really don't care, like some of us.

Let say it started in December 2019 in Asia. You can correct me as you like for the starting date. It took two to three months to ramp up in North America, in normal living mode.

Recently, B1.1.7 started in September 2020 across the pond. With slowed down human movement, totally useless according to some of us, it took six months to ramp up in North America.

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13 hours ago, Kate short for Bob said:

Geez is there no end to the way you twist the facts?

 

 

Can't see how I twisted anything, but your knickers certainly seem to be in a major twist.

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9 hours ago, PeterSailor said:

Try to explain the behaviour of a virus. Something that really don't care, like some of us.

Let say it started in December 2019 in Asia. You can correct me as you like for the starting date. It took two to three months to ramp up in North America, in normal living mode.

Recently, B1.1.7 started in September 2020 across the pond. With slowed down human movement, totally useless according to some of us, it took six months to ramp up in North America.

The virus mutates constantly due to the type of virus it is unlike many other viruses.  Each single infection produces mutations (single point mutations) but not all mutations occur in an area on the virus that has an effect on infectiousness i.e. in the spike protein.  You may have seen caricatures of the virus as a round globe with spikes on it.  The spikes are the bit that attack human cells and insert the viral genetic material into the cell to replicate.  That is a simplistic way of looking at it.

You are correct with the dates that you are referring to.

The B1.1.7 variant was first identified in Kent, UK in September 2020.  The hysteria started after a report from NERVTAG and SAGE that indicated the variant MAY be more infectious and deadly than other variants.  The scientists who made this claim have a history of making such claims based on very little scientific evidence.  One of those associated with the claim was Dr Neil Fergusson the lead developer of the infamous and highly inaccurate Imperial College Pandemic Model.

This "news" was timed to explain the rise in cases in the UK and to justify further draconian lockdowns.  There still hasn't been any substantial evidence to show that the B1.1.7 variant is more infectious.  

There have been dominant variants since the beginning of the pandemic.  It took 4 months for B1.1.7 to become the dominant variant in Britain in January 2021.  The case rate PEAKED at the same time!  Now correlation doesn't always equal causation but if this variant is so bad why did it take so long to be dominant and only did so AFTER the cases peaked?

Of course some will say that "Lockdowns obviously worked in the UK".  But compare that to Sweden where deaths peaked at the end of December and although the B1.1.7 variant has been present for nearly an equivalent period of time!

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