Covid-19 / SARS-Cov2 - naučne/medicinske informacije i analize

[handys]

On 5/1/2021 at 4:05 PM, Eddard said:

Takođe, stižu i prvi ozbiljniji rezultati ispitivanja vakcinacije kod trudnica i dojilja, ukratko nema povećanog rizika niti neželjenih efekata (za mRNA vakcine) i CDC (za razliku od još uvek sporog i rezervisanog nemačkog RKI) savetuje trudnicama i dojiljama da se vakcinišu. Boldovano uzeti u obzir. Prevod nemačkog članka:

 

 

Jedan od citiranih originalnih članaka iz NEJM-a:

https://www.nejm.org/doi/full/10.1056/NEJMoa2104983

 

Drago mi je sto je tako, ali pitam se, da li uopste postoji neki medicinski razlog, nesto utemeljeno u biohemiji vakcina, da se pomisli da bi trudnice ili dojilje bile posebno ugrozene, ili da bi, na primer, vakcine mogle da uticu na sterilitet? Jasno mi je zasto postoje grupe na kojima se ispitivanja posebno moraju vrsiti (bice isto, verujem i sa decom svih uzrasta). Ali, da li naucnici anticipiraju neke mogucnosti pre istrazivanja, u smislu 'karakteristika vakcine x i y bi mogla da se negativno odrazi na trogodisnje dete, sterilitet, trudnice, itd, i u istrazivanju pratim da li ce doci do nezeljene reakcije'? Ili se prosto svodi na opservacione studije gde se daje vakcina i prate reakcije?

[djura.net]

Pretpostavljam da je oprez izmedju ostalog I zbog nekih negativnih iskustava, kao ono u USA pre (valjda) 60 godina kad su neke vakcine koje su davane trudnicama uticale da se radjaju deca sa odredjenim deformitetom. 

Ozbiljna je to stvar I zato mora mnogo stvari ispitati pre nego se potvrdi da je sve bezbedno I za trudnice.

Da je moja supruga sada u drugom stanju ja se ne bih osmelio da je nagovaram da se vakcinise, ali bin insistirao da svi koji dolaze s njom u kontakt budu iz kategorije revakcinisanih.

[Sunshine State]

1 hour ago, djura.net said:

Pretpostavljam da je oprez izmedju ostalog I zbog nekih negativnih iskustava, kao ono u USA pre (valjda) 60 godina kad su neke vakcine koje su davane trudnicama uticale da se radjaju deca sa odredjenim deformitetom. 

Ozbiljna je to stvar I zato mora mnogo stvari ispitati pre nego se potvrdi da je sve bezbedno I za trudnice.

Da je moja supruga sada u drugom stanju ja se ne bih osmelio da je nagovaram da se vakcinise, ali bin insistirao da svi koji dolaze s njom u kontakt budu iz kategorije revakcinisanih.

 

Jedna ispravka - nisu bile u pitanju vakcine, vec lek Thalidomide koji je davan trudnicama zbog mucnine.

 

 

[wwww]

First off: This is complex and I‘m tired of people pretending it‘s all obvious.

So a few general points about the decisions that have to be made here:

They are

- local, but with global implications

- based on imperfect data in an evolving pandemic

- about individual decisions as well as population-level effects (and these two things can point in opposite directions)

- about rational arguments on risk, when humans are often irrational about risks

- dependent on what alternatives are available

- about perception and politics as well as evidence

- about trust in the processes ensuring vaccine safety as much as trust in one particular vaccine

One more note: After VIPIT, then VITT, the name that seems to be taking hold is TTS (thrombosis with thrombocytopenia syndrome) and I’ll use this from now on.

 

So let’s take AZ (where we have the most data) and look at population level first: The rate of #TTS observed in countries seems to be somewhere between 1 in 40,000 vaccinations (Norway, Denmark) and 1 in 150,000 (Sri Lanka). About 1 in 5 of these patients have died.

The risk of severe #covid19 in the population is clearly higher. So at a population level the benefits of vaccination with AZ clearly outweigh not vaccinating at all as long as there is transmission. (Note that this does not apply to say New Zealand which is now using Pfizer)

This is essentially what WHO’s expert group SAGE said recently: “In countries with ongoing SARS-CoV-2 transmission, the benefit of vaccination in protecting against COVID-19 far outweighs the risks.”

https://www.who.int/publications/i/item/WHO-2019-nCoV-vaccines-SAGE_recommendation-AZD1222-2021.1

 

 

They did add:

“However, benefit–risk assessments may differ from country to country, and countries should consider their epidemiological situation, individual and population-level risks, availability of other vaccines, and alternate options for risk mitigation.”

Context matters!

 

It is more complicated when you get to an individual’s benefit-risk assessment. First, the risk: While there is uncertainty about the exact frequency of TTS, it’s essentially a fixed number, on the order of somewhere around 1 in 100,000 say.

 

Can we identify groups that are at higher risk? Not yet. Researchers say there is no strong evidence that women or men or younger or older people are at a higher risk. Nor is there a sign that a previous history of blood clotting or even HIT increases risk.

 

What about the benefit of immunization? That is clearly higher the older someone is and the higher the level of infections around them. I’ve tweeted graphs from @EMA_News showing how risks and benefits look in different age groups at different infection levels before:

 

We tried to condense this into two tables in our story, one for low-risk (55 infections per 100,000 people per month), one for high-risk (886 infections) setting. Numbers are per 100,000 people over 4 weeks:

 

 

You can see that in young people the benefits and risks over 4 weeks at low infection levels are not all that different. Of course, hospitalisations and deaths are not everything. “Don’t underestimate the impact of Long COVID,” for instance, @JeremyFarrar told me.

 

One way of thinking about the risk-benefit on an individual basis is: How many weeks of not being vaccinated add up to the same risk of dying from #covid19 as the risk of dying from #TTS when getting the shot?

 

The answer in Norway, for a woman aged between 45 and 49 years, is 79 weeks, according to @camisto . So it makes sense for a 45 year old woman to wait one and a half years for a different vaccine. Remember: Norway has few infections and has seen high levels of #TTS!

 

So this an extreme case but it lays out the crux of the problem clearly: On a population level you want everyone vaccinated asap. But on an individual level for some people in some places it makes absolute sense to wait for a different shot.

Again: It's about context. In many places waiting for a different vaccine makes little sense. As @MPaiMD told us: “Crossing the street is a risk. But if there’s a bear running toward you on your side of the street, that risk suddenly looks different. This virus is a bear.”

 

Two things to consider:

1. What happens long-term?

As immunizations ramp up, infections should hopefully go down and more vaccines become available. So over time more and more places will look a bit more like Norway. And so even this very low risk of TTS will loom larger.

2. Global equity

In many places the luxury of different vaccines is a distant dream. Most countries are desperate for any vaccine. I'll have to tackle what decisions in Europe/US/Canada mean for these countries and for perceptions of vaccine equity in a separate thread.

 

 

 

[wwww]

 

ovo je za Pfizer

BionTech vaccine is expected to be approved in US for children 12-15 next week. Admission for children aged 2 and over is expected from September. Very important steps for herd immunity and the protection of children. The development against mutations is running in parallel

[wwww]

 

 

[wwww]

They looked at hospitalisations, ICU admissions and deaths from #covid19 separately.

Also 3 scenarios for monthly infection rates: low (55 per 100,000 people) medium (401 per 100,000 people) high (886 per 100,000 people)

Here are the graphs for hospitalisations:

 

Here are the three graphs for ICU admissions:

 

Here are the three graphs for deaths from #covid19:

 

The graphs show very clearly how the benefits of the vaccine outweigh the risks much more clearly the higher the infection rates and the older the recipients. This is not new.

But these graphs are exactly what I wanted people to have to understand risk-benefit calculations.

 

As I’ve said before: These decisions are highly context dependent.

For young people in countries with low infection rates or with other vaccines available, the risk-benefit balance is a lot worse than for older people or younger people in countries with high-infections rates.

 

That also means that as immunization campaigns progress in countries and they move into younger age groups and (hopefully) infection rates are going down, the benefit-risk balance will become worse. So Vaxzevria may be a help early on, but other vaccines will likely take over.

Source is here:

https://www.ema.europa.eu/en/documents/chmp-annex/annex-vaxzevria-art53-visual-risk-contextualisation_en.pdf

 

 

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[wwww]

https://www.nejm.org/doi/full/10.1056/NEJMc2104974?query=featured_home

Effectiveness of the BNT162b2 Covid-19 Vaccine against the B.1.1.7 and B.1.351 Variants

 

Quote

The estimated effectiveness of the vaccine against any documented infection with the B.1.1.7 variant was 89.5% (95% confidence interval [CI], 85.9 to 92.3) at 14 or more days after the second dose (Table 1 and Table S2). The effectiveness against any documented infection with the B.1.351 variant was 75.0% (95% CI, 70.5 to 78.9). Vaccine effectiveness against severe, critical, or fatal disease due to infection with any SARS-CoV-2 (with the B.1.1.7 and B.1.351 variants being predominant within Qatar) was very high, at 97.4% (95% CI, 92.2 to 99.5). Sensitivity analyses confirmed these results (Table S3).

 

 

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[todorovic]

Ne bih da zvucim kao da se pravim pametan, ali meni vecina ovih radova/clanaka vezanih za astru deluju poprilicno amaterski napisani. 🙂
Ovi iznad radovi se zasnivaju na analizi 280k slucajeva, a analiziraju dogadja koji se desava u 1 u 100k. U takvoj analizi greska moze biti 1 000%
Sa druge strane isto je bio neki rad sa oksforda, koji je pokazivao slucajeve tromboze kod pfizer i on je isto zasnovan na nekih manje od 500k slucajeva. Nije ni cudno sto mogu da izvuku tako suprotne rezulate kad se radi analiza na tako malom broju slucajeva.

 

Takodje, zanimljivo mi je da nigde nisam nasao rad o tome koliko su pouzdani podaci koje imamo trenutno o slucajavima tromboze u opstoj populaciji. Koliko se ova specificna tromboza lako otkriva i koliko je realno i da su ti brojevi znacajno veci, jer nemamo tako detaljnu analizu kao sto imamo posle astre. Hocu reci cim neko dobije simptome slicne trombozi i primio je astru, sigurno ce se raditi test na trombozu, ali u kom procentu ce se raditi isti test ako nije primio astru?

Svi do sada objavljeni radovi pominju broj tromboza posle astre, ali niko ne oduzima od toga broja broj ocekivanih tromboza u opstoj populaciji. Na ovo me je podsetio podatak koji sam danas procitao da u UK imaju 1 trombozu u milion primljenih vakcina posle druge doze. To je navedeno kao podatak, ali ako se ja dobro secam price od pre mesec dana to je i ocekivan broj tih tromboza u opstoj populaciji.

[wwww]

3 minutes ago, todorovic said:

Ne bih da zvucim kao da se pravim pametan, ali meni vecina ovih radova/clanaka vezanih za astru deluju poprilicno amaterski napisani. 🙂
Ovi iznad radovi se zasnivaju na analizi 280k slucajeva, a analiziraju dogadja koji se desava u 1 u 100k. U takvoj analizi greska moze biti 1 000%
Sa druge strane isto je bio neki rad sa oksforda, koji je pokazivao slucajeve tromboze kod pfizer i on je isto zasnovan na nekih manje od 500k slucajeva. Nije ni cudno sto mogu da izvuku tako suprotne rezulate kad se radi analiza na tako malom broju slucajeva.

 

Takodje, zanimljivo mi je da nigde nisam nasao rad o tome koliko su pouzdani podaci koje imamo trenutno o slucajavima tromboze u opstoj populaciji. Koliko se ova specificna tromboza lako otkriva i koliko je realno i da su ti brojevi znacajno veci, jer nemamo tako detaljnu analizu kao sto imamo posle astre. Hocu reci cim neko dobije simptome slicne trombozi i primio je astru, sigurno ce se raditi test na trombozu, ali u kom procentu ce se raditi isti test ako nije primio astru?

Svi do sada objavljeni radovi pominju broj tromboza posle astre, ali niko ne oduzima od toga broja broj ocekivanih tromboza u opstoj populaciji. Na ovo me je podsetio podatak koji sam danas procitao da u UK imaju 1 trombozu u milion primljenih vakcina posle druge doze. To je navedeno kao podatak, ali ako se ja dobro secam price od pre mesec dana to je i ocekivan broj tih tromboza u opstoj populaciji.

pa ne mogu da povecaju brojeve onih koji su primili AZ i onih koji su imali ovaj vid tromboze da bi dobili dobru statistiku. To je sto je. Bitno je da se transparentno o tome izvesti, a koje su stvarne brojke videcemo tek kad se dovoljan broj ljudi vakcinise AZ-om.

 

Inace, ima i slucajeva ove tromboze kod onih koji su dobili JJ i P&B. Za P&B znam da je bilo manje slucajeva na veci broj vakcinisanih s P&B, samo sto bi tu trebalo da se detaljnije analizira populacija koja je vakcinisana. U Nemackoj su AZ-om do ove pojave vakcinisani mladji, a P&B-om stariji ljudi, sto takodje moze da utice. Takodje, AZ su u vecem % primile zene, sto onda mozda takodje utice na "rezultate"/statistiku: da ova tromboza vise pogadja zene. Tj. uzorak nije reprezentativan.

 

Znam da slican tip tromboze (s slepljivanjem krvnih plocica indukovano heparinom) bas onako konkretno izucava nekoliko naucnika. Za sada nisu uspeli da zakljuce kod kojih tacno ljudi se javlja ova pojava. A to je veoma bitno, jer, iako je ovo vrlo retka pojava, za onog koga strefi - to je 100%. Mada, bitno je i da se ne vreme prepoznaju simptomi i da se na vreme reaguje odgovarajucom terapijom. Nadam se da znaju kako da ovo lece.

[ciao]

Izgleda da istrazivanja leka za covid napreduje, Pfizer ozbiljno radi na leku, laboratorijska ispitivanja su izgleda dala zadovoljavajuce rezultate, sad ide klinicko pa sve redom i ako sve bude ok moze se ocekivati krajem godine. lek se uzima onog mpomenta kada pocnu problemi sa disanjem.

 

https://www.journaldugeek.com/2021/05/09/pfizer-developpe-un-comprime-pour-guerir-de-la-covid-19/

 

Nema dileme da bi bilo mnogo jednostavnije imati lek koji popijes onda kada  fasujes virus i pocnu problemi umesto da se svake godine vakcinise cela planeta

[wwww]

What risk factors lead to a severe # COVID19 course in people under the age of 80? Several health insurance companies have compiled a ranking together with the RKI.

People suffering from leukemia are at a particularly high risk. Around every third person infected in this group is affected by a severe course of COVID19. Patients with metastatic tumor diseases and dementia are also at risk.

With data from over 30 million people with statutory health insurance, it is one of the largest studies on COVID19 and previous illnesses in Germany.

The list of previous illnesses can help general practitioners to identify particularly vulnerable patient groups even more specifically and to protect them as early as possible with a vaccination.

 

https://www.rki.de/DE/Content/Infekt/EpidBull/Archiv/2021/Ausgaben/19_21.pdf?__blob=publicationFile

 

 

 

Would you prefer #Astrazeneca and already be protected from Corona or no vaccination for the time being? The answer depends not only on age, but on the individual risk of infection.

In some federal states such as Bavaria and Berlin, younger people can be vaccinated with Astrazeneca at their own risk. Now Federal Minister of Health Spahn wants to lift the prioritization for the vaccine nationwide.

It is important: Even if the vaccination sequence is canceled, the recommendation of the Stiko (komisija za vakcine) still applies. The recommends Astrazeneca vaccinations only for people over 60 years of age, as thrombosis has occurred in very rare cases in younger people.

An analysis by the EMA has shown that if the incidence is higher, the benefits of an Astrazeneca vaccination outweigh the risks in all age groups. However, if the incidence is lower, the benefit outweighs only those over 60 years of age.

The personal risk of infection depends not only on the incidence, but also on whether you have many contacts or not - privately or professionally.

Important to know: the EMA analysis is only a snapshot. And: It doesn't take gender into account. The rare thrombosis cases mainly affect women. You are likely to be at a higher risk than men.

So should I get Astrazeneca vaccinated or not? In the end, this is an individual decision that everyone has to make for themselves - based on the scientific facts.

 

 

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As @mugecevik told @AnnaSophieGross in our story, "Right now the most important thing is that the vaccines are working against this variant". And it really is as simple as that until we learn more. As I’ve been saying, keep *watching*, but don’t keep *worrying*.

Here’s our full story: https://ft.com/content/8e134734-c3f0-4694-9bdb-9d03e67dadec And here’s @PHE_uk

’s report today https://www.gov.uk/government/news/confirmed-cases-of-covid-19-variants-identified-in-uk

 

Final comments: I’ve deliberately included the "numbers are rising!" charts alongside the caveats about why that is not necessarily reason to worry. I think it’s important to show the raw data, even if there are many reasons to take it with a pinch of salt.

I also want people to realise 2 things can both be true: numbers rising, and the situation not necessarily being scary. It’s not either or. If someone shows you a scary chart of rising numbers, ask whether it really is scary given what else we know (and hey, perhaps it will be).

 

 

 

 

[wwww]

To compare influenza versus COVID-19, here is a nice overview graphic of the infection fatality rate (IFR) for both diseases:

The death rate from infection (IFR) is estimated in studies. These studies use data that do not factor in the frequency of testing. In short, the infection death rate (IFR) is independent of testing, but the case fatality rate (-CFR) is dependent on testing.

The new variant B.1.1.7 seems to have a slightly higher IFR. Vaccination of course significantly lowers the IFR!

I created this with a linear y-axis. From a scientific point of view, it is now quite useless because the influenza line is in the relatively low IFR range (compared to COVID) and you can therefore hardly read any values. But that's exactly the point again.

 

[wwww]

But the decline can also be faster: With increasing vaccination and seasonality, you could possibly be under 50 in 2-3 weeks --- if people's behavior doesn't change.

However, the decline can also be slower.

The following example shows how much the estimates depend on the assumptions about contacts and infection:

If there is only 1 infection more for every 20 infections, then that makes the difference between R = 0.9 (which we currently have about) and R = 0.95.

To get under 50 you need from now on:

with R = 0.9 around 5 weeks,

with R = 0.95 around 10 weeks.

And if you instead avoid 2 more infections each 20, then you reach R = 0.8, and in 2-3 weeks the incidence is 50.

 

With vaccination progress, testing and seasonality, this should in principle be feasible. -

(With low incidences one would also be well prepared if a new VOC like the one from India causes problems.)

In principle, a full vaccination reduces transmission by 90-95% - if the vaccinated behave exactly the same way.

The more contacts a vaccinated person has, the more this effect is reduced. There are first observational studies showing that infection is effectively reduced by 70-90% in vaccinated people.

 

Edited May 10, 2021 by wwww

[wwww]

 

 

 

[djole]

On 5/10/2021 at 2:17 AM, wwww said:

 

 

 

 

Would you prefer #Astrazeneca and already be protected from Corona or no vaccination for the time being? The answer depends not only on age, but on the individual risk of infection.

In some federal states such as Bavaria and Berlin, younger people can be vaccinated with Astrazeneca at their own risk. Now Federal Minister of Health Spahn wants to lift the prioritization for the vaccine nationwide.

It is important: Even if the vaccination sequence is canceled, the recommendation of the Stiko (komisija za vakcine) still applies. The recommends Astrazeneca vaccinations only for people over 60 years of age, as thrombosis has occurred in very rare cases in younger people.

An analysis by the EMA has shown that if the incidence is higher, the benefits of an Astrazeneca vaccination outweigh the risks in all age groups. However, if the incidence is lower, the benefit outweighs only those over 60 years of age.

The personal risk of infection depends not only on the incidence, but also on whether you have many contacts or not - privately or professionally.

Important to know: the EMA analysis is only a snapshot. And: It doesn't take gender into account. The rare thrombosis cases mainly affect women. You are likely to be at a higher risk than men.

So should I get Astrazeneca vaccinated or not? In the end, this is an individual decision that everyone has to make for themselves - based on the scientific facts.

 

 

 

Ne ulazim u samu pouzdanost podataka, ali ovde treba primetiti jednu stvar: ova analiza važi ali ukoliko se izloženost ne menja, odnosno ukoliko nastavite da živite kao i do sada, što u Nemačkoj podrazumeva (barem ono što sam ispratio) da nema bioskopa, pozorišta, koncerata, utakmica, nema kafića, klubova, itd itd. Poenta vakcine i jeste, ma šta neko pričao, da se epidemija zaustavi i da se vratimo normalnom životu. Dakle, rizik od AZ za mlade ljude je uporediv sa rizikom od kovida, samo ako ćemo i dalje svi nositi maske i pridržavati se već pomenutih mera. A u Srbiji se većina ljudi, a pogotovo mladih svakako ne pridržava ovih mera.

[urosg3]

Ukinuta tzv "vanredna situacija" u Kragujevcu, eh šta ti je da ljudi disciplinovano nose maske, a ne kao pre par nedelja...

[ciao]

Sin kolege otisao pre dve godine na neko usavrsavanje u Singapur, kolega ocajan kaze ne zna kad ce ponovo videti sina uopste - pojavilo se u poslednje vreme cak 20 novih slucajeva i rekli im da je drzava zakljucana za izlaz i ulaz bar do 2022  

[wwww]