All Things COVID-19
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GLG
Well-Known Member
Using a study that is designed to test the effectiveness of vaccine with a two dose strategy as per the vaccine supplier timeline does not prove your point. How can you tell if the 2nd dose was the reason that the % went up? I could be the added days was reason why the % went up.
What you need is a study that measures the effectiveness of one dose over time to see when it kicks in (days) and how long it lasts. When the effectiveness starts to drop to a certain point that's when you give the booster 2nd dose. That way you optimize the vaccination strategy. This is what BC and Quebec are figuring out and so far the data is very good. This is the reason why we got the green light and why the other provinces are following suit. The implications for the rest of the world are substantial. Not all countries have the good fortune to be sitting on an endless supply of vaccines like yourself. It's critical that we optimize as lives are at stake.
wildmanyeah
Crew Member
"Data are mounting to show that one dose can be highly effective in the short term. In the Pfizer vaccine trial results, there was 91% protection in the first 7 days after the second dose, a period in which the second dose has not yet kicked in. The 91% efficacy observed at 4 weeks is entirely attributable to the first dose."
Op-Ed: Forget Second COVID Vaccine Doses for Now
It's far more important to get first doses to as many people as possible
GLG
Well-Known Member
WHAT IS THE EVIDENCE FOR EXTENDING THE SARS-COV-2 (COVID-19) VACCINE DOSING SCHEDULE?
ABSTRACT: Vaccine rollout for SARS-CoV-2 (COVID-19) in British Columbia is underway with two approved mRNA vaccines (Pfizer-BioNTech and Moderna). Traditionally, an inactivated or attenuated pathogen may have been used as a vaccine, whereas mRNA and DNA vaccines provide genetic material that instruct the body’s cells to produce a viral spike protein antigen. Presently, both mRNA vaccines are approved for use as a two-dose schedule given either 21 days or 28 days apart. However, there is a relative scarcity of vaccine compared to the population of British Columbia. BC’s public health officials have proposed a delay between the primary vaccination and booster to 35 days from the recommended 21 and 28 days. Based on unpublished data available to the National Advisory Committee on Immunization through Health Canada for both the Pfizer-BioNTech and Moderna vaccines, there was no difference in vaccine efficacy between the people who got their second dose at day 19 and the people who got it at day 42. Various jurisdictions around the world are permitting a prolonged second dosing interval. Despite the paucity of clinical trial data, it is likely that increasing the interval between the first and second doses of COVID-19 mRNA vaccines by Pfizer-BioNTech and Moderna is safe, both in the intervening period between doses and for long-term efficacy. Extending the vaccine schedule is likely warranted in order to allow the widest population to receive the first dose.
More:
https://bcmj.org/articles/what-evidence-extending-sars-cov-2-covid-19-vaccine-dosing-schedule
ABSTRACT: Vaccine rollout for SARS-CoV-2 (COVID-19) in British Columbia is underway with two approved mRNA vaccines (Pfizer-BioNTech and Moderna). Traditionally, an inactivated or attenuated pathogen may have been used as a vaccine, whereas mRNA and DNA vaccines provide genetic material that instruct the body’s cells to produce a viral spike protein antigen. Presently, both mRNA vaccines are approved for use as a two-dose schedule given either 21 days or 28 days apart. However, there is a relative scarcity of vaccine compared to the population of British Columbia. BC’s public health officials have proposed a delay between the primary vaccination and booster to 35 days from the recommended 21 and 28 days. Based on unpublished data available to the National Advisory Committee on Immunization through Health Canada for both the Pfizer-BioNTech and Moderna vaccines, there was no difference in vaccine efficacy between the people who got their second dose at day 19 and the people who got it at day 42. Various jurisdictions around the world are permitting a prolonged second dosing interval. Despite the paucity of clinical trial data, it is likely that increasing the interval between the first and second doses of COVID-19 mRNA vaccines by Pfizer-BioNTech and Moderna is safe, both in the intervening period between doses and for long-term efficacy. Extending the vaccine schedule is likely warranted in order to allow the widest population to receive the first dose.
More:
https://bcmj.org/articles/what-evidence-extending-sars-cov-2-covid-19-vaccine-dosing-schedule
Port Eliza Fishing
Well-Known Member
That is pure speculation, the study was done based on the best knowledge from the scientists and researchers at Pfizer, and a similar conclusion was reached be Moderna of 2 doses. There is a principal of evidence based medicine, and the evidence, by way of a large, well controlled clinical trial is 2 doses spaced 21 or 28 days apart produce 95% efficacy. Nothing has replaced that evidence.
Optimize the vaccine strategy? you do realize the efficacy was 95%? Nothing gets 100%. Altering the dosing can only have 2 outcomes. 1. be as good as the outcome studied in the trial or 2. be worse than the outcome studied in the trial. BC isn't trying to figure this out at all, the optimal dosing strategy has already been discovered, the BC experiment is to see if they can muck with it and still be as good.
My 81 year old father in Vancouver with a history of stroke and mild hypertension will be getting a dose in April (maybe) and August, so he will spend 4 months not knowing to what degree he is protected. Even after the 4 months he will not know if the 1st one wore off partially or completely and how protected he is by the 2nd dose. NO ONE KNOWS THAT. My mother would gladly give up her dose so he, as a person at risk (more risk than her, she is still at risk) , can be properly protected by getting his doses as studied, but that's not an option. He's an unwilling guinea pig in the BC experiment.
People at high risk of morbidity or mortality of Covid-19 should not be part of this experiment. Give them their doses with the proven regimen, and experiment on the younger healthier population if they must.
cracked_ribs
Well-Known Member
It's also pretty important to keep in mind that this is like deciding whether it's better at the scene of a car crash to tourniquet bleeds on the people who are bleeding out, or start resuscitation on the ones who aren't breathing.
There could be valid medical arguments for either, and it's not necessarily wrong to say "given what we know now, I think we'll save more lives with tourniquets first." Okay, fine. But why are you making this choice?
If you brought enough resources, you'd be doing both.
We're making this choice because we don't have enough vaccines to just start loading them in. That's it. We can't do what other countries are doing because the procurement process was a disaster.
Sure, it could be true that giving 6 percent of people one shot is better than giving 3 percent of people two.
You know what's better than either?
Not sucking at managing a pandemic, and having enough resources to deal with the problem like a first world freaking country.
There could be valid medical arguments for either, and it's not necessarily wrong to say "given what we know now, I think we'll save more lives with tourniquets first." Okay, fine. But why are you making this choice?
If you brought enough resources, you'd be doing both.
We're making this choice because we don't have enough vaccines to just start loading them in. That's it. We can't do what other countries are doing because the procurement process was a disaster.
Sure, it could be true that giving 6 percent of people one shot is better than giving 3 percent of people two.
You know what's better than either?
Not sucking at managing a pandemic, and having enough resources to deal with the problem like a first world freaking country.
wildmanyeah
Crew Member
Yes this does not excuse in the slightest how poorly they have dealt with the vaccine rollout.
I also don’t think Henry and others want to put their butt on the line I’m sure it would be much easier to just follow the recommendation from the drug companies
I also don’t think Henry and others want to put their butt on the line I’m sure it would be much easier to just follow the recommendation from the drug companies
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GLG
Well-Known Member
How a four-month gap between shots could end Canada’s pandemic, two months earlier
THE EDITORIAL BOARDPUBLISHED MARCH 3, 2021
In the immortal words of materialist philosopher Mike Tyson, “Everyone has a plan until they get punched in the mouth.”
Last fall, Canada entered the ring with what appeared to be a winning vaccination plan. The Trudeau government presented it as one of the world’s best. It involved buying vaccines from multiple companies, and hedging the nation’s bets by contracting for far more doses per capita than any other country. Canada expected to end the COVID-19 fight with arms raised, as a world vaccination champion.
That was the plan. It looked like a good plan.
But as soon as the bell rang, Canada got punched in the mouth – repeatedly. The country was hit with delayed deliveries, even as our peers saw production and shipments ramp up. The best-laid plans got clocked. Canada’s vaccination rate is near dead last in the developed world.
This country started the week aiming to inoculate all adults by September; the United States, in contrast, was aiming to get the job done by July. On Tuesday, U.S. President Joe Biden said that coming increases in shipments from U.S. factories mean his country can get there in May.
As for Canada, we’ll cross the finish line, eventually. But the expected path of vaccine imports, combined with a lack of domestic production, puts us on a timetable for suppressing the virus and returning our economy to normal that is well behind the Americans, British and Europeans.
But what if Canada could nearly double its inoculation rate, without doubling the number of shots?
Quebec pointed the way in December. And British Columbia is now taking things even further.
On Monday, B.C. extended its gap between the first and second vaccine dose to four months. Dr. Bonnie Henry, the Provincial Health Officer, says this will allow the province to give all adults at least one shot by July, rather than the previous target of September.
Quebec began its inoculation campaign last year with a similar move, setting a three-month gap between the first and the second dose. And on Wednesday, the federal National Advisory Committee on Immunization recommended following B.C.’s lead, and moving to a four-month gap. By Wednesday evening, Newfoundland and Labrador and Alberta said they would do so, with other provinces expected to join them.
It means that Canada could get to herd immunity, and the end of the pandemic, two months faster than expected, even if vaccine doses arrive no faster than expected.
When Health Canada gave two vaccines the green light late last year, the recommended wait between the first and second jab was three weeks for the Pfizer vaccine, and four weeks for Moderna.
That was based on research trials by those companies, which were done on an accelerated basis, without time to test just how long first-dose protection lasts.
Since then, real-world evidence appears to show that the gap between first and second shots can be extended, with little or no loss of protection.
In a recent letter in The New England Journal of Medicine, Dr. Danuta Skowronski and Dr. Gaston De Serres – the heads of the BC Centre for Disease Control and Quebec’s Institut national de santé publique – made the case.
“There may be uncertainty about the duration of protection with a single dose,” they wrote, “but the administration of a second dose within one 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… hospitalizations and deaths that would have been prevented with a first dose of vaccine.”
Is this change in strategy one of expediency? Of course it is – and that’s not a criticism. As one of Mr. Tyson’s philosophical antecedents, the Prussian general Helmuth von Moltke, put it, “Strategy is a system of expedients.” Canada may not have all the doses it wants, right now, but if first-dose protection lasts longer than originally believed, then the vaccination timetable can still be sped up – allowing an earlier reopening of the economy, and saving lives.
When reality socks it to your plans, change plans.
https://www.theglobeandmail.com/opi.../+Media&utm_campaign=Shared+Web+Article+Links
cuttlefish
Well-Known Member
I would liken all this pandemic response to the analogy of building the plane while it is in the air. This particular plane appears to be flying at warp speed.
It gets a little tiring for me reading all the armchair epidemiologists/Monday morning quarterbacks second guess every little change of plan.
It gets a little tiring for me reading all the armchair epidemiologists/Monday morning quarterbacks second guess every little change of plan.
GLG
Well-Known Member
This is from the New England Journal of Medicine and does a good job of framing the argument. Obviously I'm on the side of delay the second dose but that does not mean that there are not good reasons to stick to the original plan.
Siri R. Kadire, M.D.
You chair the Governor’s task force on rollout of the Covid-19 vaccine. Given concerns about the limited availability of the two-dose mRNA vaccine, you have been asked to weigh in on the debate regarding the most effective use of the currently available doses. Should people who have already received a first dose of vaccine have their second dose delayed by a number of months until there is a greater supply, so that more people can receive a first dose? Or should those who have gotten the first dose receive the second dose according to the standard schedule, 3 to 4 weeks after the first dose, as recommended by the Food and Drug Administration (FDA)? You must consider the benefits and risks of the two approaches, on both individual and population levels, and decide what to recommend to the task force.
Delayed Second Dose versus Standard Regimen for Covid-19 Vaccination
List of authors.- Siri R. Kadire, M.D.,
- Robert M. Wachter, M.D.,
- and Nicole Lurie, M.D., M.S.P.H.
Case Vignette
A Task Force on Administration of Covid-19 VaccineSiri R. Kadire, M.D.
You chair the Governor’s task force on rollout of the Covid-19 vaccine. Given concerns about the limited availability of the two-dose mRNA vaccine, you have been asked to weigh in on the debate regarding the most effective use of the currently available doses. Should people who have already received a first dose of vaccine have their second dose delayed by a number of months until there is a greater supply, so that more people can receive a first dose? Or should those who have gotten the first dose receive the second dose according to the standard schedule, 3 to 4 weeks after the first dose, as recommended by the Food and Drug Administration (FDA)? You must consider the benefits and risks of the two approaches, on both individual and population levels, and decide what to recommend to the task force.
Treatment Options
Which one of the following approaches would you take? Base your choice on the literature, your own experience, published guidelines, and other information sources.- Recommend delaying the second dose.
- Recommend following the standard regimen.
- Option 1: Recommend Delaying the Second Dose
- Option 2: Recommend Following the Standard Regimen
GLG
Well-Known Member
We are going to have to agree to disagree and I'll leave it at that.
GLG
Well-Known Member
If someone wants to read an accumulation of papers, posts and OP's on the delayed 2nd dose strategy here is a page that has gathered them up.
https://reallycorrect.com/ReallyCor...ovid-19-vaccine-deferred-dose-2-boost-timing/
https://reallycorrect.com/ReallyCor...ovid-19-vaccine-deferred-dose-2-boost-timing/
ILHG
Crew Member
Ok, so I'm sure some may not agree with me, but it's my choice.
Our most venerable are forced to wait for a second shot & risk their life so every adult can have a first dose by end of June(ish). If healthy folks like myself decline the vaccine then the excess vaccines will be given to to the most venerable as second shots. The second shots will follow the same order as the first shots. This is an opportunity where I can save a life.
I will gladly continue to live my life like I have the last year, protecting my own health with distancing & hygiene. When the time comes that everyone over 65 who wanted their second shot has got it then I will take mine.
The only reason the government is moving forward with this foolish plan is because of a lack of vaccine & public uproar about how far behind we are. The healthy pepole need to consider those who are not as lucky, & insure they have the oprotunity for FULL vaccine protection. Isn't that what we have been doing this whole time? I know i am good Covid citizen, not because I am scared of Covid. It's to protect those who need it the most.
Pepole like my mom dont just get sick from Covid. For them Covid means sure death. So if you dont need a vaccine right now, wait & let the folks who need it get the FULL benefit of it.
**** what the governments big plan is.
Our most venerable are forced to wait for a second shot & risk their life so every adult can have a first dose by end of June(ish). If healthy folks like myself decline the vaccine then the excess vaccines will be given to to the most venerable as second shots. The second shots will follow the same order as the first shots. This is an opportunity where I can save a life.
I will gladly continue to live my life like I have the last year, protecting my own health with distancing & hygiene. When the time comes that everyone over 65 who wanted their second shot has got it then I will take mine.
The only reason the government is moving forward with this foolish plan is because of a lack of vaccine & public uproar about how far behind we are. The healthy pepole need to consider those who are not as lucky, & insure they have the oprotunity for FULL vaccine protection. Isn't that what we have been doing this whole time? I know i am good Covid citizen, not because I am scared of Covid. It's to protect those who need it the most.
Pepole like my mom dont just get sick from Covid. For them Covid means sure death. So if you dont need a vaccine right now, wait & let the folks who need it get the FULL benefit of it.
**** what the governments big plan is.
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Corey_lax
Crew Member
I will gladly give up my first shot if it means my 92 year old grandmother can get two shots. I’ll do that for my parents as well. I would do that for all my family members and anyone that is over 60 years old. But I don’t have a choice in the matter.
my father in-law and bro-in-law (37 years old) already got their first shot. They got it because my mother in-law has status but she didn’t get the shot yet because she had issues with the h1n1 shot and is hesitant to get this one without further talk with her doctor. But they would have given it to people more in need. I don’t need the shot for months. Take care of the people that need it the most and our cases and transmission of the virus will drop dramatically and I’ll get the shot when I’m almost last in line. If everyone over 70 has their shots, we’re gonna be looking good as far as cases are concerned and severity of cases
my father in-law and bro-in-law (37 years old) already got their first shot. They got it because my mother in-law has status but she didn’t get the shot yet because she had issues with the h1n1 shot and is hesitant to get this one without further talk with her doctor. But they would have given it to people more in need. I don’t need the shot for months. Take care of the people that need it the most and our cases and transmission of the virus will drop dramatically and I’ll get the shot when I’m almost last in line. If everyone over 70 has their shots, we’re gonna be looking good as far as cases are concerned and severity of cases
Actually when we have everyone over 60 vaccinated we should see a reduction in hospitalizations and deaths but as 80% of cases are in the 20 to 50 year age group actual daily case counts will not drop and will rely solely on on social distancing protocols.
They could actually go up as once people see that seniors are protected they may throw caution to the wind.
Just my opinion.
Sounds like J&J will be approved in the next few days. I think once that starts rolling in we will be in pretty good shape. Then probably can go back to double dosing the vulnerable to get them to their 90% while single dosing everyone else to keep the R0 number going down.
ILHG
Crew Member
I hope I am wrong but I read that J&J doses wont show up until the fall? I believe it was September....???
wildmanyeah
Crew Member
I think it might be only be made in the USA, have not looked into it to much
I think that is when all of the first 10M are to be received by. Hopefully, they start actually receiving tranches of doses earlier, however, I don't think J&J has given Canada a timeline yet from what I have read.
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