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January 29th, 2021 – Vaccines, Variants, Masks, And More…

Hello,

This week brought many developments in the fight against COVID-19. Summarized below are most of the announcements with links to the sources if you have interest in reading more. As always if you were forwarded this newsletter and would like to receive it weekly, you may register for free here.

Be Safe,

Sam


1) Natural Immunity

Millions of people have recovered from COVID-19. This week, the National Institute of Health published its study on the duration of immunity after infection. The study concluded that:

  • “The immune systems of more than 95% of people who recovered from COVID-19 had durable memories of the virus up to eight months after infection”.
  • “The results provide hope that people receiving SARS-CoV-2 vaccines will develop similar lasting immune memories after vaccination.”

Original theories suggested that immunity may only last 3 months, after which antibody levels seemed to drop. However, this new study confirms what many physicians noted early on in the pandemic. Our immune systems remember the exposure to SARS-CoV-2 and are able to mount an appropriate defense when the virus is encountered again, up to eight months after the initial infection.


2) Novavax Vaccine

The drug manufacturer Novavax released a statement summarizing its phase 3 trial in the UK, with more than 15,000 participants. According to Novavax, the data shows the vaccine to be 89.3% in preventing COVID-19. It also claims that over half the study population had the B117 variant first identified in the U.K. and that the vaccine was equally effective against it. However, Novavax also reported that its smaller phase 2 trial in South Africa showed a reduced 60% effectiveness against the B1351 variant. Full data from these trials is yet to be published but this is still very good news. The Novavax vaccine uses replicated spike protein to generate immunity through a single dose stored at normal refrigerator temperature. The company hopes to produce 2 billion doses in 2021.


3) Johnson & Johnson Vaccine

Johnson & Johnson also released a preliminary analysis of its phase 3 trial of the single dose Janssen COVID vaccine. They claim the vaccine demonstrated:

  • 85% effective overall in preventing severe disease and demonstrated complete protection (100%) against COVID-19 related hospitalization, 28 days after vaccination
  • 72% effective in the US and 66% effective overall at preventing moderate to severe COVID-19, 28 days after vaccination
  • Protection against severe disease across geographies, ages, and multiple virus variants, including the SARS-CoV-2 variant from the B.1.351 lineage observed in South Africa

Thought this data has not been publicly published for review, it is also good news of yet another option to combat COVID-19.


4) Moderna Vaccine and Variants

A new lab study compared the antibodies produced by the Moderna vaccine against the B1117 (U.K) and B1351 (South Africa) variants. They found the “neutralizing capacity” to be full effective against B1117 but have a reduced  (6 fold less) against B1351. Despite that, the study concluded that “these data demonstrate reduced but still significant neutralization against the full B.1.351 variant”. Moderna also stated in a press release that despite the reduced response to B1351, the antibody levels were still sufficient to provide immunity. The company is also “advancing an emerging variant booster candidate (mRNA-1273.351) against the B.1.351 variant first identified in the Republic of South Africa”


5) Pfizer Vaccine and Variants

A similar lab study tested the Pfizer COVID vaccine against common worldwide variants. The antibody response was found to be effective against multiple strains, including B1117 and B1351. Pfizer reported last week that its vaccine was effective against the B1117 (UK) variant. The company states it will continue monitoring its vaccine effectiveness against new variants as they emerge.


6) Astra Zeneca Vaccine

The Astra Zeneca vaccine, developed in cooperation with Oxford, has now been approved for use in the U.K. and in the European Union for adults over the age of 18. It was found to be 70% effective, with some question about its effectiveness in people over age 65. The initial trials had only 10% of their population above the age of 65. The two dose vaccine has not yet been approved in the US.


7) B1351 (South Africa) Variant In The U.S.

The SARS-CoV-2 variant originally detected in South Africa has now been detected in two locations in the U.S. It was first detected in a Minnesota traveler who had returned from Brazil. This week it was also detected in two people in South Carolina without travel history, suggesting there is already community spread in the U.S.


8) Antibody Medications Shown To Be Effective

Eli Lilly announced  positive results of its phase 3 BLAZE-1 trial with a combination of two anti-COVID antibodies (bamlanivimab and etesevimab). The trial focused on high risk patients with a recent diagnosis of COVID-19. The drug combination showed a decrease in hospitalizations and death from 7% to 2%. There were no deaths in the treatment group and 10 deaths in the group that did not receive the combination treatment.  Eli Lilly also announced that their Blaze4 phase 2 trial recently ended, and found that a half dose of the combination drug was just as effective as fa ull dose. Though the full data sets of either trial are yet to be published, Eli Lilly plans to reduce the dose of the medication in order to make more doses available.

Similarly, Regeneron announced this week preliminary phase 3 data showing its antibody treatment to also be successful in preventing hospitalizations and death in high risk patients exposed to COVID-19 by household members. Those who received it did not develop any symptoms. Regeneron stated it plans on completing its phase 3 trial later this quarter and publishing the data.


9) Double Masks?

There has been significant discussion recently about the utility of wearing two masks. The WHO has been recommending multi-layered masks for some time. Recently, France and Germany have increased the recommendation for masks, specifically requiring a kN95 for public transport.

A few sources have suggested that a single layer cloth mask is improved by adding a surgical mask to it. The surgical mask uses electrostatic forces to trap the virus while the cloth mask serves as a filter layer. Opinions are varied as to which one you wear on the outside. Some have suggested  putting the washable cloth closest to your mouth, others have suggested the surgical mask would be more comfortable closer to the mouth.

Bottom line: A well-fitted mask with at least two layers remains best. If a person who is experienced in wearing one well (adequate coverage, no nose sticking out) wants more protection, then a second layer of a surgical type improves the filtration, and the combination is almost equivalent to a N95. The key here is fit. Multiple layers are no use if the mask doesn’t fit correctly. It is more likely to be helpful for those taking public transportation, unless they can get their hands on a kN95. The CDC has published a useful guide to mask selection.


10) Schools

The CDC published its recommendations on schools and COVID-19 this past week, in the Journal of the American Medical Association. The recommendations include evidence for some school and sports related outbreak scenarios. However, overall, they recommend keeping schools open with ” a commitment to implement community-based policies that reduce transmission when SARS-CoV-2 incidence is high (eg, by restricting indoor dining at restaurants), and school-based policies to postpone school-related activities that can increase risk of in-school transmission (eg, indoor sports practice or competition). ” A helpful editorial on these recommendations from the NYTimes can be found here:


11) Hope

This week has brought us some hope. New cases have dropped for the past two weeks, nationwide, signaling the first true decrease the country has seen since the pandemic began. We have had plateaus, but this decrease is very good news. It signals an end to the holiday surge. Though deaths have not dropped, they are expected to in the next few weeks. They typically lag behind new cases by 3-4 weeks. With two vaccines in distribution and multiple medications showing promise in preventing hospitalization and death, we may finally be rounding the corner on this pandemic. Time will tell if the development of variants brings new surges, but for now this improvement is a welcome development.

2 thoughts on “January 29th, 2021 – Vaccines, Variants, Masks, And More…

  1. A reader asked “ Doesn’t it seem like the Johnson & Johnson vaccine should have the second injection, to raise the effectiveness to the same level as the other two-shot series? I am looking at those effectiveness numbers and thinking that they look a lot like the first injection levels of the Moderna and Pfizer products.”

    It’s a good question.

    Stat interviewed the chief science officer for the J&J vaccine project (phase 3 study titled ENSEMBLE) and asked this same question. His answer:

    “In a pandemic, if you can, with a single-dose vaccine, very quickly eliminate the severe consequences of death, hospitalization, and severe disease, that’s what’s important for society,” Paul Stoffels, the company’s chief scientific officer, told STAT

    It’s an explanation for why they tried for a single dose. At the start of vaccine development, we were told the US would be happy with any vaccine over 50% effective. What we got with Moderna and Pfizer is impressive. In comparison, this seems less impressive, but it is still good. The poorest performance for the J&J vaccine was in South Africa (57%), presumably due to the variant prevalent there. But, the J&J vaccine is easier to store, has a longer shelf life, and is a single dose. That’s a big deal worldwide where ultra cold storage is not a possibility.

    There is another phase 3 trial that began in November titled ENSEMBLE 2, which seeks to determine if a two dose regimen is safe and efficacious. It is not comparing one vs two doses, but placebo vs two doses. But, once complete, the two trials taken together should hopefully answer the questions: Are two doses superior to one? Are two doses more effective against the known SARS-CoV2 variants? The first trial took about 5 months for data to be reported. If the second trial takes as long, we should have something by March.

    Sam

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