SirBillybob

A recent Scottish study of a large cohort of healthcare workers has found that vaccination reduces transmission to household members, but that secondary prevention cannot be considered totalistic. Naturally, household members may be infected elsewhere, but there are data that quantify the relative risk of infection among household members of healthcare workers compared to households without healthcare workers. When adjusting the analysis for this confounder, that is, doubling the hazards ratio reduction by the approximately same magnitude two-fold degree to which household members of health workers exceed the comparator infection rates, the overall rate of infection among household members suggested a residual degree of infection cases that would not easily be exclusively attributable to contracting CoV from somebody other than the co-habiting healthcare worker. Of course another point not lost here is the occurrence of breakthrough infection among fully vaccinated healthcare workers. We need our healthcare workers and cannot quarantine them in bubbles with household members for weeks at a time in large enough numbers for inferential statistics sample power to truly tease out transmission vector directionality and exclusivity. This holds true for all strata. The vaccinated person has to be exposed to infection in order to transmit it, preventing the bubble. While that is happening, their close contacts are similarly exposed to the caprice of other sources of infection unless also solo-quarantined. The authors stressed the optimistic aspects of the results. More research is needed to advance knowledge about transmission potential by the vaccinated. Ironically, with inoculation uptake eventually as complete as possible, the answer becomes progressively more elusive, and that is a good thing. I believe that the erring on side of caution is a driver for investigating complementary mucosal (ie, nasal) vaccines to add to the armamentarium of systemic inoculation. At the very least, I won’t be canoodling without all parties IM-vaccinated, in a context of rolling case incidence that further diminishes exposure probability adjusted for contagion period and ascertainment bias corrected for estimated true prevalence.

A model shoot magazine recently stated Philippe Soulier was Paris-borne, but anything goes regarding this kind of info. It seems that he likely had some connection to Spain as well. Stock Bar Philippe is Québecois. Tall, pretty, blue eyes but not ruddy/blonde. He really did a number on himself. He was back at Stock a bit about 15 months ago but ‘roided out, barely recognizable compared to his earlier perfect (my opinion) self. Lately he hinted on his new sparse social media at being sick (metabolically?). He is advertising commercial sex work on a typical site but looks a mess.

It may be one, possibility two depending on the categories satisfied, of three categorical options: inoculation immunity, natural immunity thru recovery post-exposure, negative CoV viral test. The leadership is not keen on the vaccination passport idea per se, but will likely follow suit with the other six G7 nations particularly for travel documentation.

Not trying to micromanage but a busy Social Worker with now an appointed decision-maker may not have time to keep @Cooper in the loop and neither the SW nor the appointee know all of our MO context. I would hope that the appointee, perhaps considered the liaison for other interested 3rd parties like Cooper, can be put in touch with each other. Otherwise, we might not be privy to the eventual outcome.

I know Montrealers 60+ bypassing the net and phone lines, walking in to inoculation centres and a staff person books their vaccination for early April. Spa Scandinave greenlit my membership reactivation, allowing the communal features starting next weekend. It’s beginning to feel a bit like a 4-leaf clover day.

Similar dynamics occur, ie families with equal but divided players, where no single person or aggregate had been officially assigned executive decision-making status. It just further underscores the fallout of not having made arrangements. Even with clear directives things can go kerflooey. I have related professional experience with the theme in palliative contexts. My siblings and I decided, in conjunction with consulting my mother, that sole discretion would not be mine in her eventual last days (age mid90s) ... that I would be a resource my siblings could draw on, but one of her children without the trumping potential of “credentials” would be formally and legally identified the go-to for health providers. This worked out really well and helped to symbolically and practically distribute the roles as an offspring unit in a balanced way. My thoughts ended up being sought. Interestingly, I also felt content and useful taking on the more housekeeping tasks following an elderly parental death (by this I mean lingerie drawer and Tupperware hoarding level) that usually get dumped on female family members.

AFAIK, Nevada may have two tiers of substitute decision-making, POA for medical care that can be assigned to anyone by the patient (or a court/ board/committee in the absence of an existing POA?) and “surrogate consent” for end-of-life decisions that is restricted to a relative (in logical succession order in the absence of a pre-appointed relative) and in consultation with attending. Obviously, “surrogate consent” can be assigned to anyone by the patient prior to the event thru the advanced directives route. I am not sure who is allowed to step up and request the decision role. It’s rather ambiguous. If there is a distinction the Social Worker would be able to clarify.

If a unit co-owner within a condominium corporation or syndicate, there is often an emergency contact on the Board or management records. Similarly, if renting from a company there may be a contact on the lease application as people do pass away and these companies want to make it easier to deal with belongings, etc.

So weird, a smattering of face covering and a vague alluding to a bug. And that baseball could be loaded with virus. Everybody dies in the end?

Pfizer/BioNTech or another company may be looking for a new reciprocity agreement, trading a country’s cohort data for high-volume supply chain. Israel brilliantly did this but it just got fucked up with a massive shoulder-to-shoulder funeral procession confounding the scientific tracking protocols. Outdoors, but we’ll see.

I am following Novavax but no time for J&J right now. And my fingers are sore. The SA variant contains an escape mutation wrt to immunity conferred by the previous predominating CoV. Many people in the placebo group had had SARS-CoV earlier but caught the new variant. The genetic code used to manufacture spike protein facsimiles, contained in the vaccine, that is, proteins mimicking virus, would have not included the new variant’s genetic sequence. Hence, the efficacy differential relative to the UK study. In addition, the SA study is small and had only 1% overall infections. The interim analyses are done too quickly because you ideally want more infections for more reliable results. The ratio is 15:29 but a small alteration in case numbers for either arm, not matched by a commensurate shift in the opposite group, has larger consequences for the overall efficacy metric ... 16:28 pushes it below the standard efficacy threshold. Novavax introduces the viral genetic code into an insect virus that is given to moths. The vaccine protein is extracted from the sludge of a vat of moths that contains those insects’ genetically altered insect virus, but the proteins contain no actual CoV genetic material. Insects or plants are the typical ingredients used because they very rapidly and efficiently grow immense volumes of the protein particles that bamboozle our immune systems into developing immunity as if we got the actual CoV. Going forward, Novavax can simply tweak the CoV genetic code ‘spliced’ into the insect virus, for better variant coverage. It is a virus-like particle vaccine model (one of half a dozen overarching methodologies) and the quantities can be churned out very quickly and massively. Will be at India’s Serum Institute, good news for Canada I have not looked into the vaccine product’s adjuvant. If you get this vaccine, don’t wear your favourite cashmere for a while. Will Novavax pivot to a new genomic sequence in just launched 30K trial USA and MX? I do not know. I read that they got behind in manufacturing study doses, and are anxious to roll. Are they locked in to proteins not covering escape mutations? Again, beats me. If I were a research participant I would want to know. I wouldn’t want to dilute the chance of vaccine arm assignment with efficacy watered down by inadequate variant coverage.

FWIW, in spite of the hoopla, the new case incidence and volume of active cases has dropped dramatically in South Africa over the past week or so, in spite of the supremacy of the variant there. It ranks as a country 65th globally in new cases per capita. Mortality tends to lag, taking longer to shift curve direction, but is now also consistently dipping. However, these trends could be due to the measures influencing people behaviour but not an indication of the variant losing thrust.

What the misleading headline misses: The Pfizer/BioNTech cumulative case incidence graph shows about equal symptomatic case occurrence for both vacc and placebo up until about Day 14, where they then diverge. There were about 2-dozen infections up to Day 28 among those vaccinated, far more than the 9 cases used in efficacy analysis. The politician’s status is consistent with the (higher) number of asymptomatic cases that were not tracked in the study. Since symptomatic cases occurred both early in the vaccination cycle and, less frequently, later than 7 days post booster dose, it is no big surprise that we have a case making the headlines. But it was expected. If it occurred weeks following completed vaccination it would have been expected. It is not residual genetic material unless it is residual genetic material. Asymptomatic CoV is less contagious. Absence of evidence of transmission at this particular stage in the vaccination dosing is not evidence of transmissibility absence. With luck, it is wimpy if not innocuous. The later follow-up cases overall, that is, months after vaccination (as delineated below) would be more representative of earlier study entry ... with more vaccination group cases likely emerging among participants arriving later to the party, not included in the interim analysis. Study efficacy was tracked from Day 28. The case occurrences for those vaccinated are placed at Day 28, 36, 44, 55, 58, 62, 66, 80, and 97. The sole case defined as ‘severe’ was Day 62. Severity is rare and there were 3 such designations in the placebo group, consistent with disease trends. But it is a ratio that is too small to analyze and did not support protection from severity for the vaccinated. That said, 2 additional cases of severity designation occurred in the placebo group prior to the Day 28 endpoint. The news release is irresponsible and ambiguous. The headlines that say ‘after vaccination’ mislead those inclined to think vacc causes infection. The ones that say ‘despite vaccination’ do not subsequently clarify and remind that it is likely early days for his antibody durability and that infection following vaccination, across the spectrum of severity, occurred in the study, even weeks past the point at which inoculation will occur if in fact it is going to occur. Infection incidence will manifest in real-world vaccination uptake because sterilizing immunity eludes some recipients. Several key educational points could have been better made, including the one perhaps implicit in the headline ... being particularly guarded early in the vaccination dosing.

95% efficacy is not 95% real-world effectiveness. For mRNA vaccines the antibody titres and T-cell response of the handful of vaccinated that got CoV were not compared to a subsample that did not contract infection. So we do not know for sure whether presence of antibodies is a solid indicator of sterilizing immunity. It would be reassuring, so why not produce such simple results? I suppose that serology aspects of the large Phase 3 trial were less comprehensive and the timing of immunogenicity in concert with early stage infection would be complex. Otherwise, there seems to be radio silence on the reason for breakthrough of infections. It did not take long for the study cohort to reach enough cases for the acceptable threshold of statistical power, a few cases per 1,000 placebo group subjects. However, the duration used past Day 28 falls short of the ideal and planned minimum 2-month follow up for efficacy. A lot of subjects have passed Day 88, so we should be able to see more data based on another few months of infection occurrence. Where are the new figures? The placebo groups will not be offered vaccine for another few weeks. 95% efficacy is within a statistical confidence interval. For Pfizer/BioNTech, Age >55 years, the confidence interval is 80.6 to 98.8 ... the lower limit is further than the upper limit from the true estimate 93.7 ... anywhere from 1 in 5 vaccinated to 1 in 100 vaccinated can acquire infection. We simply do not know the true probability. Another reason to access longer-term data; the more cases in both assigned study arms, the narrower the confidence interval range.

This is American company Novavax. All over the news ... UK (15,000) and SoAfrica (4,400) cohorts. Might be best to look up their own press release because that is where other sources tend to extract their news summaries. Novavax now recruiting closer to home for additional efficacy research. 30,000 in USA and Mexico. It’s also a chance to get vaccine (50:50?) in a study if you are a long way off current vaccination options and want to chance getting placebo.

Even if it were to be absolutely true that those for whom vaccination confers immunity, along with protection in terms of acquisition of novel coronavirus, AND inability to transmit infection while neutralizing a happenstance exposure, so what? It is clear from the research trial that Pfizer/BioNTech vaccine does NOT work for at least 5% of recipients following Day 28. All positive cases were symptomatic. Though severe COVID was rare, 1 of the 5 cases had received vaccine. The severe case split is no less predictable than a single die roll result. In fact, the ratio of severe case status did nothing to support the idea that vaccine attenuates the possibility of severe case status among those for whom it is inevitable the vaccine does not inoculate. Everybody with symptomatic COVID has transmissible COVID, let alone asymptomatic people for whom vaccine had also been presumably ineffective. It is not a huge stretch to assume that if one can be vaccinated then sick and infectious, one can be contagious anywhere on the gradient from naïvely sick to severely sick within the subgroup of those administered vaccine that does not provide immunity for them. Granted, the asymptomatic may be less infectious, but their stealth makes up for it. All complicated by the the idea that perhaps 25% of infectious persons are responsible for 75% of new cases. This is not a complex logic puzzle. Some vaccinated individuals will contract COVID and transmit infection. The risk is identifiable and commensurate with prevalence at any point in time. It is not negligible, though the proportional degrees of illness on the severity continuum will likely be consistent with the pre-vaccine duration of the pandemic. There is no predicting who the unfortunate will be. Vaccine passports should have a Swiss-cheese design, because denialism reigns. Mitigation measures followed by the vaccinated and unvaccinated alike will help protect both categories. The unvaccinated/pre-vaccinated as a whole will have more bullets in their chamber but the vaccinated will not have zero bullets.

I am sure you mean the lighter shaded area directly on the scrotum, as some readers may misinterpret your question as being related to the red blemish on the thigh. My uninformed opinion is it could be an ingrown hair. The guy likely shaves his balls.

Yes, I now realize that the mountain’s elevation seems so deceptively high from the Belvedere, and because I experience its shadow quite a bit. In fact I hike up at times I can avoid direct sunlight. But it is just a few hundred metres in altitude. It would not at all obscure sunset’s horizon proximity extending to The Village.

This is pandemic life ... LOL. Observing the lamp-pole sun-position shadow rather than the hot stripper spinning around the stage-pole or the stripper’s pole casting a shadow in private dance mode.

Estimated early in the vid by the lamp pole shadow arc, in June, when sunset is past 20:30 .... it drops behind the mountain about an hour earlier, so I would say between 6 and 7 PM. Guessing.

Both vaccines mentioned earlier were just authorized for emergency use.

Rio’s pandemic measures remain fairly relaxed in spite of high case incidence. The mitigation laws are state-specific. You need a negative CoV test to board a flight to Brazil. In a few days, the same requirement to board USA-bound from anywhere will also apply. A new worrisome viral variant in Brazil needs to be followed closely. Some nations are already blocking flights originating in Brazil. UK is restricting flights from Portugal because Brazilians tend to connect in Lisbon.

The overhanging canopy was permanently retired prior to COVID19. I think World Pride had been set to occur in Toronto in 2024. May get a spillover of tourists taking in Montreal as well.

Not to mention that the apparent existence of two CoV variants from Brazil, worrisome due to possible ‘escape’ capacity in relation to previous case natural immunity and/or vaccine products under review, may prompt a growing number of countries to fortify their barriers against it. Britain has wisely slammed the door on South America (even Brazilian transit potential thru Portugal) while trying to figure out the mutation distinctions and commonalities among the UK, South Africa, and Brazil variants as well as their migration patterns.

The CoronaVac, when the data were not manipulated to exclude mild but transmissible cases of infection, actually is reported to have about 50% efficacy, with 2:1 ratio of CoV cases comparing placebo to vaccine and a rather high incidence of overall incidence relative to Brazil’s overall population over the 4-month duration of the trial. The Brazilian approval authority Anvisa is to meet this weekend to review both CoronoVac and AstraZeneca’s vaccine Covishield. However, both companies have received notice, even as recent as yesterday, that there remain many data components and unanswered questions that Anvisa wants resolved prior to decision. At this point, if both are approved it is likely that São Paulo state will utilize CoronaVac. The net benefit conferred might not be much better than either the incidence rate when it was one-third current case prevalence or the alleviation of mitigation measures by a factor of two-thirds.