COVID:19 Update, Tuesday, August 31, 2021

Updates and Reminders: breakthrough infections, vaccine resistance, policies that make no sense, variants and immunity, conflicting research...

Today I just want to do a refresher on some of the science.

1. Breakthrough infections - Let's chat about what this means, how common it is, and why/how it happens. First, while it sounds ominous in the news, as of the last data available, breakthrough infections are happening to about 0.1 to 0.29 percent of all fully vaccinated people in the United States. So it isn't many. There are several main reasons this can happen: a) the person got vaccinated but never developed immunity. This is rare but not uncommon. Sometimes, for reasons we do not understand, a person will get vaccinated but never develop immunity. This happens with every single vaccine out there and is not unique to COVID. b) the virus is different enough from the original and/or the person is exposed to a high enough dose of the virus that it evades the vaccine. The vaccines we are taking were originally designed with the original version of COVID in mind - it was not designed for Delta. So it makes sense that as the virus mutates we will see some breakthrough cases. Also, as people are vaccinated they tend to reduce precautions. This allows them to have greater exposure (i.e. higher dosing) to the virus. Despite this, even if the disease is able to break through, the vaccine still protects against severe disease (which is really its primary function). Right now, 95% of all hospitalized COVID patients are unvaccinated.

2. Vaccine Resistance - vaccine resistance is not to be confused with vaccine hesitance. Resistance is the ability of the virus to eventually evade the vaccine completely, sort of like antibiotic resistance where you see bacteria developing the ability to evade treatment with antibiotics. This happens over time and we are not there yet. However, when we have about 1/2 of us vaccinated and about 1/2 of us not vaccinated it really increases this risk. The more the virus has the opportunity to hop from person to person and adjust to the vaccine, the more likely it will eventually become vaccine-resistant. There is no way to avoid this other than increase the number of people who are vaccinated.

3. A question I get often- people ask me pretty regularly why we can't vaccinate against the common cold. The fact that we can't is often used as an argument for things such as distrusting this vaccine, blaming the pharmaceutical industry for nefarious things, or supporting conspiracies, so I want to address that. There is one basic disease/pathogen science you must first understand. An illness can be caused by more than one pathogen/germ. This is why we give the germ one name and the disease/illness another name. For example, meningitis can be caused by a bacteria or a virus. Two different germs that cause the same illness. Sars-Cov2 is the germ that causes COVID. The common cold is actually one illness caused by any of a multitude of germs. Those germs all fall into the coronavirus family - but there are around 200 different viruses/germs that can actually cause what we refer to as the common cold. We cannot create a single vaccine that would protect you from 200+ viruses nor would anyone sign up for 50+ vaccines/shots in order to prevent a cold. It just isn't practical. Additionally, as the virus mutates and more variants are created, we may run into issues similar to what we see with the flu vaccine - with the flu, we vaccinate against the most deadly forms of the flu and then only against a small number of the total variants within that type. Attached you will find a list of the currently known variants of COVID. Again, I want to thank, Ricardo Padilla, soon to be MPH for his work on this list.

4. Policies that make no sense - there are for sure policies being made that make no sense. Sometimes these are pointed out to me as conspiracies or proof of other evil things that are to be resisted. Honestly, I think they are a result of people with no formal epidemiological/public health/medical training trying to manage something they have had only a crash course in. People are implementing ridiculous policies on both sides of the proverbial fence. I have no idea why or what they are thinking - but I do know those people are not experts on infectious disease, medicine, or public health. I would like to think they are doing the best they can without expert advice or an expert on staff. Occasionally these look silly on the surface but have some sound reasoning behind them - some of them are blown way out of proportion or misrepresented in the news, and some of them are just ridiculously bad policy. Some states are going way overboard with restrictions and some are going way overboard the other way. But taking animal drugs, gargling bleach, and overdosing on vitamins are also bad policies. People do some weird things when they are desperate and uncertain.

5. Conflicting research - this is another thing I get asked about quite often and I believe the confusion is simply because people who do not conduct research are a little rusty regarding how it works (that class was a very long time ago for most people). So research study A comes out and says XYZ, then study B comes out and says ABC, and people get really confused because the two studies seem to conflict. While this can be frustrating and confusing, it is actually scientific research at work. This is exactly how it is supposed to work. One study doesn't prove anything, the findings have to be reproducible. Meaning other studies have to find that same thing. The way a study is designed, the size of the study, the limitations, etc. all contribute to the quality of the study. Different study designs carry different weights in regards to reliability. Think of it as the difference between a Pinto and Rolls Royce. Each has its place, but the Rolls Royce carries more prestige. Research is similar. Now, in the midst of a pandemic, sometimes all you have is one study - so you go with that - because it is something, and something is better than nothing in an emergency. But you don't stay there. When better information becomes available you adapt and adjust. Another complication is that sometimes people reading studies don't fully understand what they are reading, or they draw incorrect conclusions. I see this in the media rather frequently. So just because someone is reporting that a study said XYZ, doesn't mean that is actually what it said. I am very careful to read the original study and importantly, evaluate the limitations of the study. I also try to never report on the findings of a single study, in the beginning of this we had to, but now we don't. But conflicting findings in research are normal, necessary, and a good thing.

6. Anti-vaccer and vaccine-hesitant are not the same things - just a reminder that people who are hesitant to get a vaccine are not the same as people who are fundamentally opposed to vaccines. There is a significant difference. The vaccine-hesitant are those who have questions or uncertainties. They simply haven't been convinced to get vaccinated yet - but they are not opposed to vaccines in general. All of us should have been vaccine-hesitant to begin with. We had questions, and we were nervous. Some of us have found our answers, weighed our options, and decided to get vaccinated. Others are still searching and researching. Anti-vaccer's are opposed to all vaccines, period.

FINAL THOUGHTS: Today I want to encourage you to be someone that anyone can talk to. Be the person that people can bring their crazy questions to without fear of judgment. Be someone who is a safe place, someone who encourages others to seek out answers and ask all their questions, no matter how odd those questions may be. Be a shelter for others in this crazy storm. And keep washing those hands.

Variants.xlsx

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