COVID-19 infection after vaccination and what to do next


ABC News 07 September, 2021 - 09:25am 30 views

Medicine is an imperfect science – but you can still trust its process

The Conversation US 07 September, 2021 - 04:10pm

Associate Clinical Professor of Medicine, University of California San Diego

University of California provides funding as a founding partner of The Conversation US.

As an intensive care physician in Southern California who endured the onslaught of COVID-19 in 2020, it has been deeply disheartening to experience chillingly familiar scenes all over again. The ICUs in the University of California San Diego Health hospital network where I work are again overflowing – especially with patients who need ventilators. Families peer through tinted hospital windows for glimpses of loved ones. And hospital administrators scramble to keep up with necessary staffing and beds to accommodate the influx of patients.

What is so vexing is that COVID-19 is still the culprit, despite the availability of highly effective vaccines that slashed U.S. COVID-19 daily case numbers and hospitalizations within months. The vaccines also allowed economies to begin to recover and provided a way for people to experience some sense of normalcy again.

In early spring, the efficacy of the vaccine engendered hope that herd immunity – in which infectious viral spread is prevented through a high proportion of the population’s being immune to the disease – could be within reach in months. Instead, pandemic panic is again suffocating us, largely because a large part of the public still shuns vaccination – with only 62% of the eligible U.S. population fully vaccinated as of early September 2021.

I wanted an answer to the obvious question: Why?

So I turned to my patients for answers. At the bedside in their hospital rooms, I first asked about how they were feeling and performed detailed exams before addressing the elephant in the room. “Did you receive the COVID-19 vaccine?” And if not, I gently asked, “Did you have a specific reason you could share with me, so I can understand better?”

Somewhat surprisingly, patients candidly told me their reasons for avoiding the vaccine.

A common response I heard was that it was simply inconvenient. “I was too lazy and I didn’t get around to it,” some admitted, looking away sheepishly as they did so. Curiously, they did not consider the myriad “inconveniences” of becoming infected, such as medical complications – including death – and associated costs for treatment, lost work, dependence on others for basic necessities such as child care, the risk of infecting family members, the potential for developing long-haul COVID-19 and more.

Others expressed a fervid distrust of vaccine-testing methods, stating that people had been “guinea pigs in past vaccine experiments that later caused autism.” Yet more than 25 studies in the past 20-odd years have disproved any causal link between vaccines and autism.

Some felt that the forceful public messaging to get vaccinated belied true motivations of the authorities, adding: “I mean, why are they pushing this so hard? Something must be wrong with it.” Yet few question the strong public health stance on healthy eating practices and exercise, or wearing seat belts while driving.

Still others feared the possibility of life-threatening side effects: “Thousands had heart attacks from the vaccine – it’s all on the CDC website,” they told me. So I took a close look at the CDC website to understand their claims better.

Reports of heart inflammation occurred in 699 cases out of 177 million vaccinated people, or 0.0004%, with causal links to the vaccines still being investigated. Development of blood clots causally associated with the Johnson & Johnson vaccine are also extremely rare, occurring in 28 cases out of 8.73 million doses given as of May 7, 2021 – a rate of 0.0003%. This extremely low risk of blood clots is still significantly lower than the risk of blood clots from an actual COVID-19 infection.

In some cases, political affiliation can partially explain vaccine antipathy. But my patients’ responses highlighted two other themes to me.

First, people often forget that medicine is an art based on applied science, not a deductive science based on irrefutable forces in nature like gravity. Patients and families often ask me in the ICU to predict what will happen to loved ones unequivocally, only to be disappointed when I avoid speaking in certainties.

Once viewed as omniscient authorities, doctors now openly acknowledge that limitations of medical data require scrutiny and careful application to particular circumstances. COVID-19 has reinforced our appreciation that there are no perfect cures or 100% guarantees of success. Rather, medicine is governed by what is probable. What are the chances I still may have cancer if the test result returns negative? Am I more or less likely to survive pneumonia by taking this specific antibiotic?

Doctors must then engage in thoughtful analysis of the strengths and weaknesses of scientific methods and data to optimize and tailor our recommendations for individual patients – without the luxury of perfect or even complete datasets to rely on. The vaccine has clearly been shown – its rare side effects notwithstanding – to provide an overwhelmingly high likelihood of benefit over potential risks to almost all individuals. This includes people who have been previously infected with COVID-19. Yet the unvaccinated continue to fixate on rare side effects to justify skipping the shot.

Many of my patients also seem to view vaccines and other public health-based recommendations like offers to buy a used car – with skepticism and independence, threatening to walk away at any moment. Doing one’s part to stop the spread of disease is a culturally nuanced civic virtue, like safe driving, which transcends absolute autonomy. In the U.S., most drivers willingly do not drive while intoxicated, cross lanes without warning or block other cars that are trying to merge. These are norms that make driving in the U.S. relatively efficient, safe and even pleasant compared with some other countries.

The path to herd immunity, like highway safety, requires majority participation without immediate guarantees of complete personal freedom. Vaccines succeed not because they are 100% risk-free to the individual but because collective efforts focus on achieving the common good.

Oddly, at the same time that my patients rejected the vaccine, they showed strong interest in receiving other types of medicine “shots” like monoclonal antibodies – which mimic natural antibodies – or anti-inflammatory medications. While some of these treatments have demonstrated benefits in certain situations – others have not. And some present the risk of very serious harm.

I reminded my patients that the COVID-19 vaccine stimulates a person’s own immune system to make antibodies that can neutralize the virus and that surpass the capabilities of commercially created antibody formulations. So the vaccines help prevent infection and development of serious illness from COVID-19 in the first place. People who experience the rare breakthrough infections following vaccination generally have a shorter and milder course of COVID-19 infection and are far less likely to end up hospitalized than those who are unvaccinated. Vaccines also confer longer-term protection, whereas the other medications are used reactively – when a serious infection has already begun – and those medications have shorter-term results.

In the past, many vaccines that successfully vanquished societal outbreaks of polio, measles and mumps are now routinely administered in childhood with minimal objection, despite the fact that there is no such thing as zero risk.

As I continue to have conversations with patients who suffer greatly from COVID-19 illness as a direct consequence of having avoided the vaccine, my own pain – for being an ineffective healer and witness to such loss – is inexorable. Overcoming this fourth wave of COVID-19 still feels out of reach until our vaccination efforts can somehow better emphasize the effectiveness of vaccines, even when scientifically imperfect, and prioritize civic health care responsibilities over pure autonomy. If not, I fear that our battle against COVID-19 will rage on.

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Vaccines Versus Covid-19: The Great Immunity Debate

Bloomberg 07 September, 2021 - 04:10pm

Greek health workers protest vaccine regulations

AP Archive 07 September, 2021 - 04:10pm

One in 5,000: The Real Chances of a Breakthrough Infection

Yahoo! Voices 07 September, 2021 - 01:32pm

The news seemed to suggest that even the vaccinated were highly vulnerable to getting infected and passing the virus to others. Sure enough, stories about vaccinated people getting COVID — so-called breakthrough infections — were all around this summer: at a party in Provincetown, Massachusetts; among the Chicago Cubs; on Capitol Hill. Delta seemed as if it might be changing everything.

In recent weeks, however, more data has become available, and it suggests that the true picture is less alarming. Yes, delta has increased the chances of getting COVID for almost everyone. But if you’re vaccinated, a COVID infection is still uncommon, and those high viral loads are not as worrisome as they initially sounded.

How small are the chances of the average vaccinated American contracting COVID? Probably about 1 in 5,000 per day, and even lower for people who take precautions or live in a highly vaccinated community.

The estimates here are based on statistics from three places that have reported detailed data on COVID infections by vaccination status: Utah; Virginia; and King County, which includes Seattle, in Washington state. All three are consistent with the idea that about 1 in 5,000 vaccinated Americans have tested positive for COVID each day in recent weeks.

The chances are surely higher in the places with the worst COVID outbreaks, like the Southeast. And in places with many fewer cases — like the Northeast, as well as the Chicago, Los Angeles and San Francisco areas — the chances are lower, probably less than 1 in 10,000. That’s what the Seattle data show, for example. (These numbers don’t include undiagnosed cases, which are often so mild that people do not notice them and do not pass the virus to anyone else.)

Here’s one way to think about a 1-in-10,000 daily chance: It would take more than three months for the combined risk to reach just 1%.

“There’s been a lot of miscommunication about what the risks really are to vaccinated people, and how vaccinated people should be thinking about their lives,” as Dr. Ashish Jha of Brown University told my colleague Tara Parker-Pope.

For the unvaccinated, of course, the chances of infection are far higher, as Dr. Jeffrey Duchin, the top public-health official in Seattle, has noted. Those chances have also risen much more since delta began spreading.

Another way to understand the situation is to compare each state’s vaccination rate with its recent daily COVID infection rate. The infection rates in the least vaccinated states are about four times as high as in the most vaccinated states.

If the entire country had received shots at the same rate as the Northeast or California, the current delta wave would be a small fraction of its current size. Delta is a problem. Vaccine hesitancy is a bigger problem.

These numbers help show why the talking point about viral loads was problematic. It was one of those statements that managed to be both true and misleading. Even when the size of the viral loads are similar, the virus behaves differently in the noses and throats of the vaccinated and the unvaccinated.

In an unvaccinated person, a viral load is akin to an enemy army facing little resistance. In a vaccinated person, the human immune system launches a powerful response and tends to prevail quickly — often before the host body gets sick or infects others. That the viral loads were initially similar in size can end up being irrelevant.

I will confess to one bit of hesitation about walking you through the data on breakthrough infections: It’s not clear how much we should be worrying about them. For the vaccinated, COVID resembles the flu and usually a mild one. Society does not grind to a halt over the flu.

In Britain, many people have become comfortable with the current COVID risks. The vaccines make serious illness rare in adults, and the risks to young children are so low that Britain may never recommend that most receive the vaccine. Letting the virus continue to dominate life, on the other hand, has large costs.

“There’s a feeling that finally we can breathe; we can start trying to get back what we’ve lost,” Devi Sridhar, the head of the global public health program at the University of Edinburgh, told The Times.

I know that many Americans feel differently. Our level of COVID anxiety is higher, especially in communities that lean to the left politically. And there is no “correct” response to COVID. Different people respond to risk differently.

But at least one part of the American anxiety does seem to have become disconnected from the facts in recent weeks: the effectiveness of the vaccines. In a new ABC News/Washington Post poll, nearly half of adults judged their “risk of getting sick from the coronavirus” as either moderate or high — even though 75% of adults have received at least one shot.

In reality, the risks of getting any version of the virus remain small for the vaccinated, and the risks of getting badly sick remain minuscule.

In Seattle on an average recent day, about 1 out of every 1 million vaccinated residents have been admitted to a hospital with COVID symptoms. That risk is so close to zero that the human mind can’t easily process it. My best attempt is to say that the COVID risks for most vaccinated people are of the same order of magnitude as risks that people unthinkingly accept every day, like riding in a vehicle.

Delta really has changed the course of the pandemic. It is far more contagious than earlier versions of the virus and calls for precautions that were not necessary a couple of months ago, like wearing masks in some indoor situations.

But even with delta, the overall risks for the vaccinated remain extremely small. As Dr. Monica Gandhi, an infectious-disease specialist at the University of California, San Francisco, wrote on Friday, “The messaging over the last month in the U.S. has basically served to terrify the vaccinated and make unvaccinated eligible adults doubt the effectiveness of the vaccines.” Neither of those views is warranted.

© 2021 The New York Times Company

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Steelers LB Joe Schobert, others change jersey number changes

WUSA9 06 September, 2021 - 08:01am

The Pittsburgh Steelers updated their official roster on Monday and this included multiple jersey number changes. Pittsburgh is preparing to take on the Buffalo Bills this week so let’s get you up to date on these changes.

Inside linebacker Joe Schobert, who hinted as a number change a few weeks ago will be wearing No. 93 this season. Hopefully you hadn’t ordered your Schobert jersey yet. Two rookies also make jersey changes. Edge rusher Jamir Jones will wear No. 40 and inside linebacker Buddy Johnson is going with No. 45.

Additionally, new cornerback Ahekllo Witherspoon is going to wear No. 25 for the Steelers. Pittsburgh worked a trade with the Seattle Seahawks last week to bring in Witherspoon.

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