This guy hits the bullseye on the target on vaccines

[The Walk of the Penguin Mich]

This is exactly my gut response to the announcement of EUA for a covid vaccine.

threadreaderapp.com/thread/1301310012401299457.html?fbclid=IwAR3RNbBxHmTPA48zuUlYw9xVbmnaZk1BRsaX--trljNGnj2TNHJ6CTb2M8E

[thyme4change]

Yes, and no. I like the math and the macro look at the situation in the article, but to be honest, I don't get the flu vaccine every year to protect the general population, and i didnt vaccinate my children against the chicken pox to save other kids. Once we get a Covid vaccine, I will vaccinate my family to protect my family. If other people benefit from that, great.

I think we have proven a critical mass of Americans won't do the right thing for society. So, i am really sorry to at risk people who can't get vaccinated, but welcome to America, you are on your own.

[Artemis Windsong]

I'll probably be a late adopter of the vaccine.

[djAdvocate]

i'll be one of the first. I am pretty trusting in the science, tho.

[thyme4change]

I suspect there will be a tiered roll out and my household won't qualify. I am cool if a bunch of people go before me: medical personnel, first responders, essential workers and others that have to be up close and personal with vast amounts of people to make a living, along with elderly and immuno-crompromised. It isnt that I don't trust the vaccine, but I will make sure I am not taking a dose that someone really needs. I will get mine in turn.

[Rukh O'Rorke]

Sept 9, 2020 19:25:56 GMT -5 djAdvocate said:

i'll be one of the first. I am pretty trusting in the science, tho.

I'll go last. Lots of mistakes are made, and when things are rushed, more mistakes happen. 

I'm not particularly into vaccines and don't ever get any 'extras' such as the flu vaccines. MMR, polio, tetanus, sure. Benefits far outweigh risks.

And 50% effective - that is not a real draw for me. Seems it would lead to decreases in safeguards without offering a good chance of protection.

and I'm not sure where I fall on the me/we spectrum. I'm pretty socially responsible, but given how much of an asshole almost everybody is anymore, the motivation for altruism in me has never been lower.

[djAdvocate]

there is no data on the vaccine yet, because there is no vaccine, yet.

but I will admit that I was not thinking of the efficacy of the vaccine when I made that comment in such an unqualified way.

[kadee79]

I'm old, I have under-lying conditions...I will wait awhile.  I'm not going to rush into any new stuff until we see if there are more reactions.  I get reactions to several drugs, don't need one to a shot too.

[pulmonarymd]

The problem with thinking about efficacy is that it misses the point. Efficacy looks at prevention. That is the major endpoint, but not the only one. Even though the influenza vaccine is only 49-70%(depending on year) effective, people who are vaccinated who then are infected, have a lower risk of hospitalization and death. The shingles vaccine is about 60% effective. Having seen shingles, I would not want it. So having a 60% less chance of getting it seems to be a good thing. If the first coronavirus vaccine only decreases the risk of severe disease, that would be a good start

[movingforward]

Sept 10, 2020 14:31:45 GMT -5 pulmonarymd said:

The problem with thinking about efficacy is that it misses the point. Efficacy looks at prevention. That is the major endpoint, but not the only one. Even though the influenza vaccine is only 49-70%(depending on year) effective, people who are vaccinated who then are infected, have a lower risk of hospitalization and death. The shingles vaccine is about 60% effective. Having seen shingles, I would not want it. So having a 60% less chance of getting it seems to be a good thing. If the first coronavirus vaccine only decreases the risk of severe disease, that would be a good start

About 5 years ago my brother came extremely close to dying from the flu. The doctor at the hospital stated that if he had gotten the flu shot he probably would have developed a "watered down" version as opposed to the terrible one he ended up with.

My dad had the shingles a couple of years ago on his face. Luckily, it did not go into his eye. Both his GP and his Ophthamologist said that the singles vaccine had helped it not spread the way it normally would have. He really ended up with a very mild case of the virus. I truly believe getting the vaccine helped.

Vaccines are more about keeping people out of the hospital and getting deaths down. Like I said on another thread, covid isn't going to disappear. It will become just another virus. We need to get the deaths down to flu like levels and move on with our lives.

[movingforward]

Sept 9, 2020 20:58:47 GMT -5 thyme4change said:

I suspect there will be a tiered roll out and my household won't qualify. I am cool if a bunch of people go before me: medical personnel, first responders, essential workers and others that have to be up close and personal with vast amounts of people to make a living, along with elderly and immuno-crompromised. It isnt that I don't trust the vaccine, but I will make sure I am not taking a dose that someone really needs. I will get mine in turn.

This is exactly how I feel. I work with pharma companies and I trust in their abilities to develop a safe vaccine, but (to my knowledge) I have no underlying conditions, in my mid-40's, etc. There are lots of other people that need it before myself.

[NomoreDramaQ1015]

Sept 10, 2020 14:31:45 GMT -5 pulmonarymd said:

The problem with thinking about efficacy is that it misses the point. Efficacy looks at prevention. That is the major endpoint, but not the only one. Even though the influenza vaccine is only 49-70%(depending on year) effective, people who are vaccinated who then are infected, have a lower risk of hospitalization and death. The shingles vaccine is about 60% effective. Having seen shingles, I would not want it. So having a 60% less chance of getting it seems to be a good thing. If the first coronavirus vaccine only decreases the risk of severe disease, that would be a good start

I read a book on the 1918 flu and some of the ways people died.  That book was freaking graphic.   I know it's not how it works but after reading that book I ran not walked to get my flu shot and almost insisted on a second dose just to be safe. 

I'm pretty low risk for both COVID and the flu but the thing is I don't know which number I'm going to hit.  The odds may not be in my favor.

I got small children I don't want to leave motherless.  I also like the idea of not dying period.  So a 60% efficacy rate is good for me.  I'd rather be sicker than a dog and quarantine for a couple weeks than six feet under.

[NastyWoman]

Sept 10, 2020 14:31:45 GMT -5 pulmonarymd said:

The problem with thinking about efficacy is that it misses the point. Efficacy looks at prevention. That is the major endpoint, but not the only one. Even though the influenza vaccine is only 49-70%(depending on year) effective, people who are vaccinated who then are infected, have a lower risk of hospitalization and death. The shingles vaccine is about 60% effective. Having seen shingles, I would not want it. So having a 60% less chance of getting it seems to be a good thing. If the first coronavirus vaccine only decreases the risk of severe disease, that would be a good start

I agree with all of this but I will admit that I would not be willing to get the vaccine in one specific time in my life: if I were still in my childbearing stage (fat chance with the 30th anniversay of my 39th birthday coming up in a few weeks) I eould probably not get the vaccine. 

It would all be too new for any potential effects on an unborn child to be known, so I would pass for now. As a chemist in one of my former professional lives, I was involved in measuring industrial pollution in the work place and in the years I did that the limits of what was considered safe was for different pollutants was more than once lowered, so that has made me more cautious regarding side effects, but that is about it. 

[pulmonarymd]

Sept 11, 2020 14:00:16 GMT -5 NastyWoman said:

Sept 10, 2020 14:31:45 GMT -5 pulmonarymd said:

The problem with thinking about efficacy is that it misses the point. Efficacy looks at prevention. That is the major endpoint, but not the only one. Even though the influenza vaccine is only 49-70%(depending on year) effective, people who are vaccinated who then are infected, have a lower risk of hospitalization and death. The shingles vaccine is about 60% effective. Having seen shingles, I would not want it. So having a 60% less chance of getting it seems to be a good thing. If the first coronavirus vaccine only decreases the risk of severe disease, that would be a good start

I agree with all of this but I will admit that I would not be willing to get the vaccine in one specific time in my life: if I were still in my childbearing stage (fat chance with the 30th anniversay of my 39th birthday coming up in a few weeks) I eould probably not get the vaccine. 

It would all be too new for any potential effects on an unborn child to be known, so I would pass for now. As a chemist in one of my former professional lives, I was involved in measuring industrial pollution in the work place and in the years I did that the limits of what was considered safe was for different pollutants was more than once lowered, so that has made me more cautious regarding side effects, but that is about it. 

I can respect this, but it interesting how vaccines are held to an unreasonable standard. Right now, if you are hospitalized with covid, the only treatment that has been shown to be effective is steroids. They decrease mortality by about 20%. Yet, everyone would willingly take this treatment. A treatment with an efficacy of 60% is amazing. Very few treatments are this effective.

I think being cautious if you are in a low risk group when a new treatment becomes available is prudent. But it is also going th prolong our current crisis. Not an easy trade off

[NastyWoman]

Sept 11, 2020 14:28:10 GMT -5 pulmonarymd said:

Sept 11, 2020 14:00:16 GMT -5 NastyWoman said:

I agree with all of this but I will admit that I would not be willing to get the vaccine in one specific time in my life: if I were still in my childbearing stage (fat chance with the 30th anniversay of my 39th birthday coming up in a few weeks) I eould probably not get the vaccine. 

It would all be too new for any potential effects on an unborn child to be known, so I would pass for now. As a chemist in one of my former professional lives, I was involved in measuring industrial pollution in the work place and in the years I did that the limits of what was considered safe was for different pollutants was more than once lowered, so that has made me more cautious regarding side effects, but that is about it. 

I can respect this, but it interesting how vaccines are held to an unreasonable standard. Right now, if you are hospitalized with covid, the only treatment that has been shown to be effective is steroids. They decrease mortality by about 20%. Yet, everyone would willingly take this treatment. A treatment with an efficacy of 60% is amazing. Very few treatments are this effective.

I think being cautious if you are in a low risk group when a new treatment becomes available is prudent. But it is also going th prolong our current crisis. Not an easy trade off

It is true that we hold vaccines to a high standard (and I am a pro-vaxxer) but I do believe the analogy you use here is faulty. If I (general I) am in the hospital with a disease and I am being told that the only treatment will reduce my chances of dying by only 20%, of course I will go for that. I am already sick. But a vaccine is a preventative measure in my mind so I am taking the risks while healthy. Different starting points for making a decision.

[movingforward]

Sept 11, 2020 13:33:38 GMT -5 NomoreDramaQ1015 said:

Sept 10, 2020 14:31:45 GMT -5 pulmonarymd said:

The problem with thinking about efficacy is that it misses the point. Efficacy looks at prevention. That is the major endpoint, but not the only one. Even though the influenza vaccine is only 49-70%(depending on year) effective, people who are vaccinated who then are infected, have a lower risk of hospitalization and death. The shingles vaccine is about 60% effective. Having seen shingles, I would not want it. So having a 60% less chance of getting it seems to be a good thing. If the first coronavirus vaccine only decreases the risk of severe disease, that would be a good start

I read a book on the 1918 flu and some of the ways people died.  That book was freaking graphic.   I know it's not how it works but after reading that book I ran not walked to get my flu shot and almost insisted on a second dose just to be safe. 

I'm pretty low risk for both COVID and the flu but the thing is I don't know which number I'm going to hit.  The odds may not be in my favor.

I got small children I don't want to leave motherless.  I also like the idea of not dying period.  So a 60% efficacy rate is good for me.  I'd rather be sicker than a dog and quarantine for a couple weeks than six feet under.

Exactly! And I don't plan to spend the rest of my life hiding under the bed waiting for something to be 100% (because that isn't a life!) So a vaccine of 60% efficacy will work just fine for me.

[pulmonarymd]

Sept 11, 2020 14:35:04 GMT -5 NastyWoman said:

Sept 11, 2020 14:28:10 GMT -5 pulmonarymd said:

I can respect this, but it interesting how vaccines are held to an unreasonable standard. Right now, if you are hospitalized with covid, the only treatment that has been shown to be effective is steroids. They decrease mortality by about 20%. Yet, everyone would willingly take this treatment. A treatment with an efficacy of 60% is amazing. Very few treatments are this effective.

I think being cautious if you are in a low risk group when a new treatment becomes available is prudent. But it is also going th prolong our current crisis. Not an easy trade off

It is true that we hold vaccines to a high standard (and I am a pro-vaxxer) but I do believe the analogy you use here is faulty. If I (general I) am in the hospital with a disease and I am being told that the only treatment will reduce my chances of dying by only 20%, of course I will go for that. I am already sick. But a vaccine is a preventative measure in my mind so I am taking the risks while healthy. Different starting points for making a decision.

I get that. But that is the relative improvement. When you look at it from number needed to treat or absolute reduction, it looks less impressive.

You will see reports of advances in treatment reported in the news as impressive breakthroughs all the time. When you actually look at what they do, the reality is much less impressive than reported.

Vaccines and public sanitation are the 2 greatest advances in the history of medicine. More lives have been saved due to these treatments than any other treatments we have. But given the public’s beliefs, you wouldn’t know it.

Finally, we can never know have many lives are saved by preventing an illness. Far less sexy, but far more effective

[The Walk of the Penguin Mich]

Sept 11, 2020 14:46:21 GMT -5 pulmonarymd said:

Sept 11, 2020 14:35:04 GMT -5 NastyWoman said:

It is true that we hold vaccines to a high standard (and I am a pro-vaxxer) but I do believe the analogy you use here is faulty. If I (general I) am in the hospital with a disease and I am being told that the only treatment will reduce my chances of dying by only 20%, of course I will go for that. I am already sick. But a vaccine is a preventative measure in my mind so I am taking the risks while healthy. Different starting points for making a decision.

I get that. But that is the relative improvement. When you look at it from number needed to treat or absolute reduction, it looks less impressive.

You will see reports of advances in treatment reported in the news as impressive breakthroughs all the time. When you actually look at what they do, the reality is much less impressive than reported.

Vaccines and public sanitation are the 2 greatest advances in the history of medicine. More lives have been saved due to these treatments than any other treatments we have. But given the public’s beliefs, you wouldn’t know it.

Finally, we can never know have many lives are saved by preventing an illness. Far less sexy, but far more effective

However, effectiveness of a vaccine is not the only criteria.  You also need to look at possible side effects of it too and balance them off.  Astra Zenica's already paused their clinical trial to tease out if the side effect was one that was caused by the vaccine.  

www.bloomberg.com/news/articles/2020-09-09/astrazeneca-study-halted-after-spinal-cord-issue-nih-chief-says

I was reading one article that suggested that this was a  possible concern for this vaccine, this and it possibly increasing the risk of MS.  I am somewhat heartened in that they didn't try to sweep this under the carpet.

[pulmonarymd]

Sept 11, 2020 14:55:40 GMT -5 The Walk of the Penguin Mich said:

Sept 11, 2020 14:46:21 GMT -5 pulmonarymd said:

I get that. But that is the relative improvement. When you look at it from number needed to treat or absolute reduction, it looks less impressive.

You will see reports of advances in treatment reported in the news as impressive breakthroughs all the time. When you actually look at what they do, the reality is much less impressive than reported.

Vaccines and public sanitation are the 2 greatest advances in the history of medicine. More lives have been saved due to these treatments than any other treatments we have. But given the public’s beliefs, you wouldn’t know it.

Finally, we can never know have many lives are saved by preventing an illness. Far less sexy, but far more effective

However, effectiveness of a vaccine is not the only criteria.  You also need to look at possible side effects of it too and balance them off.  Astra Zenica's already paused their clinical trial to tease out if the side effect was one that was caused by the vaccine.  

www.bloomberg.com/news/articles/2020-09-09/astrazeneca-study-halted-after-spinal-cord-issue-nih-chief-says

I was reading one article that suggested that this was a  possible concern for this vaccine, this and it possibly increasing the risk of MS.  I am somewhat heartened in that they didn't try to sweep this under the carpet.

Transverse myelitis, guillen barre syndrome, other neurological conditions, anaphylaxis, serum sickness, and a whole host of other possible complications. Reason why this needs to be done in a careful, but expedited fashion. All treatments require risk/benefit calculations. Reason why a certain minimal effectiveness is re we hired for approval. If we actually were willing to sacrifice to control the pandemic, the issue would be less pressing, as fewer lives would be lost

[djAdvocate]

Sept 11, 2020 14:35:04 GMT -5 NastyWoman said:

Sept 11, 2020 14:28:10 GMT -5 pulmonarymd said:

I can respect this, but it interesting how vaccines are held to an unreasonable standard. Right now, if you are hospitalized with covid, the only treatment that has been shown to be effective is steroids. They decrease mortality by about 20%. Yet, everyone would willingly take this treatment. A treatment with an efficacy of 60% is amazing. Very few treatments are this effective.

I think being cautious if you are in a low risk group when a new treatment becomes available is prudent. But it is also going th prolong our current crisis. Not an easy trade off

It is true that we hold vaccines to a high standard (and I am a pro-vaxxer) but I do believe the analogy you use here is faulty. If I (general I) am in the hospital with a disease and I am being told that the only treatment will reduce my chances of dying by only 20%, of course I will go for that. I am already sick. But a vaccine is a preventative measure in my mind so I am taking the risks while healthy. Different starting points for making a decision.

in a way......

but if you are in a 15% risk group, and the vaccine is 60% effective, you just reduced your risk to 6%.  I would rather than 16:1 odds than 7:1 odds in favor of LIVING.  am I missing something?

[The Walk of the Penguin Mich]

Sept 11, 2020 16:38:20 GMT -5 djAdvocate said:

Sept 11, 2020 14:35:04 GMT -5 NastyWoman said:

It is true that we hold vaccines to a high standard (and I am a pro-vaxxer) but I do believe the analogy you use here is faulty. If I (general I) am in the hospital with a disease and I am being told that the only treatment will reduce my chances of dying by only 20%, of course I will go for that. I am already sick. But a vaccine is a preventative measure in my mind so I am taking the risks while healthy. Different starting points for making a decision.

in a way......

but if you are in a 15% risk group, and the vaccine is 60% effective, you just reduced your risk to 6%.  I would rather than 16:1 odds than 7:1 odds in favor of LIVING.  am I missing something?

If you are in the 15% risk of dying group, it means that you are likely in that age group of being over 70.  The problem with that age group is that they are incapable of mounting an effective immune response, even to a vaccine.  So the vaccine that is 60% effective in the general population might only be 15% in your age group.  

[pulmonarymd]

Sept 11, 2020 16:47:06 GMT -5 The Walk of the Penguin Mich said:

Sept 11, 2020 16:38:20 GMT -5 djAdvocate said:

in a way......

but if you are in a 15% risk group, and the vaccine is 60% effective, you just reduced your risk to 6%.  I would rather than 16:1 odds than 7:1 odds in favor of LIVING.  am I missing something?

If you are in the 15% risk of dying group, it means that you are likely in that age group of being over 70.  The problem with that age group is that they are incapable of mounting an effective immune response, even to a vaccine.  So the vaccine that is 60% effective in the general population might only be 15% in your age group.  

Ok, but let’s compare that to some other treatments. Thrombolitic therapy for heart attacks was incredibly effective. For the most serious heart attack, mortality decreased from 20% to 6% at one year. But if you treated every type, it was much less impressive. Ventilating critically ill people in the optimal way decreases mortality from 40 to 30%. In each of these instances, you still have the significant chance of chronic long term conditions or death. Again, decreasing your chance of dying by doing a minor, Sade intervention is a no brained in any rational society. There are very few other preventative medicine interventions that compare in effectiveness

[djAdvocate]

Sept 11, 2020 16:47:06 GMT -5 The Walk of the Penguin Mich said:

Sept 11, 2020 16:38:20 GMT -5 djAdvocate said:

in a way......

but if you are in a 15% risk group, and the vaccine is 60% effective, you just reduced your risk to 6%.  I would rather than 16:1 odds than 7:1 odds in favor of LIVING.  am I missing something?

If you are in the 15% risk of dying group, it means that you are likely in that age group of being over 70.  The problem with that age group is that they are incapable of mounting an effective immune response, even to a vaccine.  So the vaccine that is 60% effective in the general population might only be 15% in your age group.  

OH!

I had assumed that the efficacy was the same across all groups.

wrong?

where is pmd when we need him?

[pulmonarymd]

Sept 11, 2020 17:07:18 GMT -5 djAdvocate said:

Sept 11, 2020 16:47:06 GMT -5 The Walk of the Penguin Mich said:

If you are in the 15% risk of dying group, it means that you are likely in that age group of being over 70.  The problem with that age group is that they are incapable of mounting an effective immune response, even to a vaccine.  So the vaccine that is 60% effective in the general population might only be 15% in your age group.  

OH!

I had assumed that the efficacy was the same across all groups.

wrong?

where is pmd when we need him?

Effectiveness varies based on individual factors. Reason why herd immunity is also important and enhances effectiveness of vaccines. Just to show how effective public health measures are, the flu essentially disappeared in April in the US due to social distancing. Southern Hemisphere had one of its mildest flu seasons on record.

Haven’t disappeared, just recovering from a prostatectomy 3 days ago.

[NastyWoman]

Sept 11, 2020 16:38:20 GMT -5 djAdvocate said:

Sept 11, 2020 14:35:04 GMT -5 NastyWoman said:

It is true that we hold vaccines to a high standard (and I am a pro-vaxxer) but I do believe the analogy you use here is faulty. If I (general I) am in the hospital with a disease and I am being told that the only treatment will reduce my chances of dying by only 20%, of course I will go for that. I am already sick. But a vaccine is a preventative measure in my mind so I am taking the risks while healthy. Different starting points for making a decision.

in a way......

but if you are in a 15% risk group, and the vaccine is 60% effective, you just reduced your risk to 6%.  I would rather than 16:1 odds than 7:1 odds in favor of LIVING.  am I missing something?

I would go for the vaccine. As I said the only thing that might hold me back would be if I were planning to have a child (again fat chance) but it would be my fear of harm to that theoretical child, nothing else. 

The vast majority of women in their child bearing age are, unlike me (those pesky anniversaries), not in a high risk group. For them it would be a different equation and decision to make. 

[The Walk of the Penguin Mich]

Sept 11, 2020 17:07:18 GMT -5 djAdvocate said:

Sept 11, 2020 16:47:06 GMT -5 The Walk of the Penguin Mich said:

If you are in the 15% risk of dying group, it means that you are likely in that age group of being over 70.  The problem with that age group is that they are incapable of mounting an effective immune response, even to a vaccine.  So the vaccine that is 60% effective in the general population might only be 15% in your age group.  

OH!

I had assumed that the efficacy was the same across all groups.

wrong?

where is pmd when we need him?

I don’t know what the efficacy of the vaccine currently is.  Right now, the goal is to get 50-60% efficacy in the population.  Since old people do not respond as well,you can’t assume that they’d be protected equally well.  The current high dose flu vaccine for older people has 4x as much active ingredient, another flu vaccine has a different adjuvant to compensate for this.  I guesstimated that if it takes 4x as much antigen to elicit an immune response, that’s where I pulled around 15% from.

However, the best way of improving the effectiveness of the vaccine for the elderly would come from others surrounding that person not carrying the disease.  If the likelihood of coming in contact with a carrier decreases, the herd immunity helps a lot for this group.  

[pulmonarymd]

Vaccine efficacy is very hard to estimate. So any number is pulling it out of your ass at this point. Even with influenza, estimates are guesstimates at best

[alabamagal]

Sept 11, 2020 17:58:27 GMT -5 NastyWoman said:

Sept 11, 2020 16:38:20 GMT -5 djAdvocate said:

in a way......

but if you are in a 15% risk group, and the vaccine is 60% effective, you just reduced your risk to 6%.  I would rather than 16:1 odds than 7:1 odds in favor of LIVING.  am I missing something?

I would go for the vaccine. As I said the only thing that might hold me back would be if I were planning to have a child (again fat chance) but it would be my fear of harm to that theoretical child, nothing else. 

The vast majority of women in their child bearing age are, unlike me (those pesky anniversaries), not in a high risk group. For them it would be a different equation and decision to make. 

But there is now a bigger emphasis for pregnant women to get vaccines. For whooping cough it is no recommended to get vaccinated during every pregnancy, that was never a consideration when I was having kids 30 years ago. Maybe it is because there are more anti-vaxxers now. And as a future grandparent I got my shot last week, along with flu shot, so I can visit my granddaughter in Nov. when I was having kids, the big concern was rubella, they would check for immunity.

The concern during pregnancy is that you stay healthy and also convey some of the immunity to the baby, at least until they are ready for vaccination.

[dippyegg]

  I don't know a lot about the vaccine or reinfection.  I was wondering, if someone has HAD covid, will they also get the vaccine or do they have some presumptive immunity?

[pulmonarymd]

Given our present knowledge, everyone gets vaccinated, regardless of prior infection