Considerations in boosting Covid-19 vaccine immune responses
thelancet.com
thelancet.com
https://mobile.twitter.com/michaelzlin/status/14380883906967...
A lot of these arguments seem to be strategic rather than scientific. Many people want to see wider vaccinations worldwide before anyone gets a booster, so they downplay evidence boosters are effective in order to steer people toward their preferred policies.
Everyone I personally know who is skeptical about institutional guidance advocating the vaccine or protective measures like mask mandates and lockdowns can cite a litany of previous lies or half truths by the same institutions. They did not start as medical institution skeptics — the last 18 months turned them into skeptics.
While giving ammo to conspiracy theorists and eroding trust in public health institutions. Worst of both worlds, same as the CDC no-mask-necessary bullshit right at the start of the pandemic.
Shooting from the hip seems to be fine as long as it has the effect of administering more vaccine doses, but everything else is to be ridiculed and held to much stricter standards of scientific proof.
https://www.covid19treatmentguidelines.nih.gov/tables/table-...
Because the treatments that work (ie: Monoclonal Antibodies) are being hugely invested into right now. IIRC, the government just spent a few billion dollars buying more doses of them.
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The thing about COVID19 vaccine boosters is that the CDC has basically blessed them, but the FDA has not yet. As such, there's a vigorous debate going on right now whether the 3rd dose is needed. (Immunocompromised individuals are already allowed to get the 3rd dose however. The only questions with regards to the booster is the general public). Yes, different agencies will disagree on things. CDC is most focused on public health, FDA is most focused on safety. Their goals / purposes are different, and therefore will lead to situations where they disagree like this. The White House then has to resolve the difference and make a stance. Since the White House is having meetings on the subject, it makes the news a lot.
For some "alternative treatments", like Ivermectin, there's no major body who believes it works in the USA. CDC says it doesn't work. FDA says it doesn't work. NIH doesn't have any research showing any reasonable degree of efficacy.
The CDC's stance is "we don't know, there's trials ongoing", not "it doesn't work".
CDC has a webpage pointing to the FDA / NIH web-pages.
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As far as I can tell, "IVM doesn't work vs COVID19" is the official stance of US health research institutes. There are further studies because the politics of it kinda demand a study, but no one expects the studies to have a good result. (Nothing like monoclonal antibodies, which are being used to save lives right now).
This isn't a "we don't know" stance. FDA is very explicit to not use IVM for COVID19.
https://www.fda.gov/consumers/consumer-updates/why-you-shoul...
> Currently available data do not show ivermectin is effective against COVID-19. Clinical trials assessing ivermectin tablets for the prevention or treatment of COVID-19 in people are ongoing.
From https://emergency.cdc.gov/han/2021/han00449.asp
> Ivermectin is not authorized or approved by FDA for prevention or treatment of COVID-19. The National Institutes of Health’s (NIH) COVID-19 Treatment Guidelines Panel has also determined that there are currently insufficient data to recommend ivermectin for treatment of COVID-19. ClinicalTrials.govexternal icon has listings of ongoing clinical trials that might provide more information about these hypothesized uses in the future.
Those are "we don't know" stances. Or at least, "we're not certain".
But it works. And people are freaking out about COVID19 so much that its free. Maybe we should start a debate about the moral hazards of giving highly expensive (though effective) COVID19 treatments to population centers who have refused to take the $20 vaccine?
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If people want the "cheap miracle drug that works", that was dexamethasone, at a price tag of like $15 or so. And the vaccine of course. I don't know why they're going for IVM.
As a steroid, its an innately risky treatment (steroids suppress your immune system). But its been shown that the cheap steroid dexamethasone, when used in correct doses, can greatly decrease mortality rates. So yeah, take with assistance of a doctor (to make sure your situation is the right use case), but we already have a "cheap miracle drug" success story here if people just want some hope or optimism in their lives. Dexamethasone was credited for cutting out 50% of deaths or something along that magnitude.
https://journals.plos.org/plosone/article?id=10.1371/journal...
https://bmcinfectdis.biomedcentral.com/articles/10.1186/s128...
I’m not saying that logic is flawed, but we should at least be consistent. If healthcare is a human right, you can’t then judge my life choices that got me there.
Numerous hospitals have reached triage of care. We now have to talk about how to conserve scarce resources. We need to pick "winners and losers". No one likes this discussion, but it must happen.
* https://www.washingtonpost.com/health/2021/08/16/joel-valdez...
* https://s3.documentcloud.org/documents/21062484/signed-mec-l...
Now that we're reaching this level of crisis, hospitals are beginning to ration off care. I know the ethicists have theorized the proper ethics to this situation over the past year, but as citizens / voting members of the public, its our job to form an opinion about these ethics think-tanks, and whether or not we should support certain viewpoints or not.
Health care cannot "be a right" if we cannot afford said health care for everyone. If we cannot afford health care for everyone (literally not enough hospital beds), some mechanism needs to be used to prioritize who gets care or not. No amount of policy can squeeze blood from a stone: if we don't have enough hospital beds anymore, then we must systematically deny care in some regards. (And whatever system we choose will hopefully be fair)
Money, for all of its problems, is an effective prioritization methodology... and simple to understand. You give care to those who can afford it. People always criticize the methodology but in the absence of better choices, I'm going to default to it.
I think there's some hypotheticals saying that maybe the vaccinated should have priority (since the unvaccinated are the group who is causing the crisis, we should "punish" the unvaccinated in this regards). I think I can accept that as an answer as a higher priority.
1. You can either kick out some people in beds (making room for the new patients).
2. Or, you turn away the patients (and wish them the best of course).
Those are the only two choices. When you're out of beds, you're out of beds. Governors across the country have been pulling in student nurses, and increasing nurse pay to encourage retired nurses back into the hospitals. But eventually, you run out of nurses / beds / resources, and run up against this hard limit. We have an ability to magically summon new nurses, but all those abilities have been used up by now (we had a nursing shortage _before_ COVID19 happened after all)
The correct answer, from an "ethics" perspective, is to be ready for the situation, and ethically prioritize the different cases.
But all of them "need" the hospital bed. But the physics of the situation means that some of them are going to go home without treatment.
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Then tomorrow, 20 more patients come in, and you repeat the process. The day after that, another 20 patients. Etc. etc. You then repeat this situation until the COVID19 surge is over.
The $31 joke is about IVM: lice / parasite remover that people are taking because they think it cures COVID19. At least, that was my interpretation of the joke.
https://www.nih.gov/research-training/medical-research-initi...
We also happen to have months worth of studies of IVM already. Given what has happened in literally the last dozen studies, we have a good idea of what will probably happen in that study.
That's 16 high quality studies on IVM already in the link I posted above. Do you think the results of study #17 will change things?
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I mean, maybe it will. But I wouldn't bet on it. Studies in science have this thing where they usually replicate results.
https://www.mdpi.com/1999-4915/13/6/989
https://www.medrxiv.org/content/10.1101/2021.07.21.21260223v...
https://journals.lww.com/americantherapeutics/fulltext/2021/...
So we just don't know, and it's too early to place any bets one way or the other. That's how science works.
https://www.buzzfeednews.com/article/stephaniemlee/ivermecti...
https://gidmk.medium.com/is-ivermectin-for-covid-19-based-on...
Not to even mention that the only realistic effect it would have is blunting the effects of IL-6. There’s better options for antagonizing IL-6 with less of a side effect profile, specifically tocilizumab and sarilumab.
If you refer to blocking nuclear import, ORF6 in SARS-CoV and other sarbecoviruses already does that to begin with. Adding SARS-CoV ORF6 to a MHV model actually made it more pathogenic, so there is little benefit to not blocking nuclear import.
Here are some associated material on the topic:
https://journals.asm.org/doi/10.1128/JVI.01012-07
https://journals.asm.org/doi/10.1128/jvi.01308-07
https://journals.asm.org/doi/full/10.1128/JVI.79.17.11335-11...
https://www.sciencedirect.com/science/article/pii/S221112472...
https://journals.plos.org/plosmedicine/article?id=10.1371/jo...
The quality of COVID-19 research has been pretty bad across the board with researchers racing to publish and journals doing weak reviews. But I haven't seen any credible allegations of fraud against the specific studies that I linked above.
There are multiple other hypothesized mechanisms of action beyond antagonizing IL-6. It's not completely clear what, if anything, is actually happening in vivo.
https://journals.lww.com/americantherapeutics/fulltext/2021/...
Otherwise we would have to maintain the same sort of equipose about literally ever possible substance - peanut butter could be an effective COVID treatment, until someone does a proper study, we just don't know.
I listed the ivermectin review in my post earlier. HCQ is reviewed here by the NIH: https://www.covid19treatmentguidelines.nih.gov/tables/table-...
The fact of the matter is: HCQ and IVM have been extensively studied. They've been fully rejected based off of evidence. When a treatment works (ex: cheap corticosteroids like dexamethasone), the NIH announces and the hospitals start using it immediately.
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Vaccines, dexamethasone, and monoclonal antibodies all work. So all hospitals are offering these services to any COVID19 patient.
IVM, HCQ and other "alternative treatments" are snake-oil bullshit.
https://www.newsweek.com/israel-world-leader-vaccine-booster...
Shouldn't we be seeing the exact opposite if the current crop of vaccines were the best solution?
I believe this effect is not exclusive to covid vaccines.
I wish the US was doing as well a Israel right now! Hundreds and hundreds of Americans would not be dying every single day if we were.
OPs Lancet article shows there is not a consensus on effectivity of boosters, but you will never hear that from the left media.
I understand science is a process, and things that we might think are true/false/undetermined now might change based on new evidence. My complaint isn’t that scientist aren’t magically getting everything right first try, but that there is clear bias in the media towards some narrative and while most people happily will take that for granted with right wing news sources, they think left wing news sources are somehow immune to spreading misinformation.
The only double standard here is that, for once, the media isn't suffering the latest idiotic conspiracies with "both sides" nonsense but is appropriately putting them in the "eating crayons" box. For once, the media is actually taking public health seriously.
As for proof, you know, propose a treatment, get approvals, run trials, analyze data. Zero people are doing that with Ivermectin. It's flat-Earther crackhead territory and I have absolutely no qualms about dismissing it out of hand. Meanwhile, vaccines have billions of data points that aren't just correlations, they are causative, and there's an entire sum of human knowledge of biology behind them, instead of some vague superstitious belief that magic potion kills one bad thing in your body, therefore it must kill other bad things. Also, people are eating tubes of topical Ivermectin. You have got to be freaking kidding me. What a shitshow.
Ivermectin, like HCQ, has antiviral properties and prevents binding of some viruses, like the dengue virus and covid-19.
You use it as a prophylactic to prevent replication of the virus.
Details how Ivermectin prevents Covid19 from binding: https://www.nature.com/articles/s41429-021-00430-5/figures/1
There have been many studies showing it's effective at preventing serious infections of Covid-19.
In fact, the conclusion from TFA itself:
> Considering the urgency of the ongoing COVID-19 pandemic, simultaneous detection of various new mutant strains and future potential re-emergence of novel coronaviruses, repurposing of approved drugs such as Ivermectin could be worthy of attention.
This is their conclusion. Not a sample of their conclusion. Their entire conclusion. Not "It is effective." Not "It works like this." Not "Here are studies that show it works". This article is "hey, some drugs have crossover effects, we should look at them." I mean, they literally wrote that.
I will repeat, again. Ivermectin is not an approved anti-viral medication. There are all kinds of things that have "anti-viral properties". Like UV light and bleach. These are not treatments for COVID.
Meanwhile there is a fricking vaccine. It's a scientifically designed, as-close-to-perfectly engineered solution to active your own immune response to respond to exactly the spike protein, has been administered to billions of people worldwide and has overwhelming data that it fucking works. They're not even in the same league. People who are taking Ivermectin, and people who are advocating it widely can be dismissed without further evidence. Otherwise, just show up to a pharmacy and pick a random drug off a back shelf. Drugs do weird things, sometimes they interact with viruses! Ship it? No.
Please do Science, not whatever the fuck is behind the Ivermectin craze right now. Should it be studied? I mean, sure. But it is so clearly not even a decent treatment, we should probably move on from it.
From "TFA":
In principle, a molecule can act as an anti-viral drug if it “inhibits some stage of the virus replication cycle, without being too toxic to the body’s cells [21].”
Bleach doesn't quite meet that standard. Ivermectin helps according to the clinical trials, and that lines up according this study. It's not their opinion, it's backed by evidence.
Yes we have the "fricking vaccine", but the spike protein is the problem as its toxic. Whether the vaccine's spike protein is toxic is up in the air, like Covid, the long term effects of mRNA "vaccines" are unknown entirely.
If something works better that we've been putting in humans for a lot longer, why not look into it? Why dismiss it as dewormer?
Calm down and stop running to the opposite side of the ring.
This is just such an absurd scientific and immunologically ignorant answer that I see get trotted out again and again that I need to respond.
The mRNA vaccine is literally a scientific miracle. We introduce a piece of RNA, which is basically in the form of the RNA that viruses use to hijack the protein generating machinery of our cells, in order to produce an antigen our immune system can respond to without the runaway potential of an actual infection.
The mRNA is broken down, antigen production stops, and our immune system is primed against a new foreign and potentially deadly pathogen.
There is no conceivable mechanism for long term effects (and here I am responding to claims around impotence, infertility, ‘changing your Genome’) - you’re literally just getting the immunological benefits of antigen stimulation without having to go through an infection. It’s Nobel prize winning. Just because it’s new doesn’t mean it isn’t highly well understood and characterised. It’s such an ignorant statement it literally hurts
Why does this matter? Perhaps it's not wise to mRNA vaccinate against every infectious disease under the Sun until the dust settles on the covid campaign. Hold that Nobel Prize for a while.
You listed 1 drug proven to work, Fluvoxamine, with two that have repeatedly failed in well designed RCTs…
The problem with HCQ and Ivermectin are they are both being oversold as a near-certain cure. They’ve been politicized and you see the media reacting to that. Traditional media by debunking, social media by ineffectively trying to slow the spread of the false claims that you don’t need a vaccine or masks or social distancing because of HCQ and Ivermectin.
HCQ is pretty clearly a dud. Ivermectin has a chance of having a small effect like 10% or 20%.
Fluvoxamine is the real deal but why are you complaining about media censorship here? Google News for “Fluvoxamine” shows plenty of positive coverage e.g. https://www.vox.com/future-perfect/22619137/fluvoxamine-covi...
> The limited, promising literature around fluvoxamine prompted its inclusion in the large-scale study of treatments for Covid-19 run by Ed Mills at McMaster University and primarily conducted in Brazil. Dubbed the TOGETHER study after other prominent mega-clinical trials like RECOVERY and SOLIDARITY by other organizations, it randomized patients across eight prospective treatments, including metformin (a diabetes medication), hydroxychloroquine (an antimalarial), and ivermectin (an antiparasite).
> The team announced their results at an August 6 symposium that was sponsored by the National Institutes of Health. Most of the treatments failed: Their study couldn’t detect an effect. “A lot of drugs against Covid just don’t work very well,” Mills told me. Two other treatments were still in progress, and it was too early to rule out the chance that they’ll work.
> But fluvoxamine was a different story. In the trial, it improved patient outcomes substantially — and while it’s not the first drug to do that, ease of delivery and price give it the potential to have an outsized impact on patient care, especially outside the rich world