When COVID19 ends, mask wearing will continue & introverts will continue social distancing
Note: I will remain vigilant to the evolving science of COVID19 by checking Health-Twitter, CDC/WHO-Twitter, UCSD Campus Updates, & other trustworthy news outlets. Upon receipt of new information, I will revise/rewrite/reconsider and overall update previously posted material on COVID19.
Table of Contents (click to Fast Travel)
- Vaccine Passports: Protection, Not Preference
∘ Student Confidence
∘ Fall 2021 Exam Grades
- Long COVID19
∘ National Institute for Health Research March 16th, 2021
· Syra Madad et al. (NYC Health Hospitals)
· Immunological Memory For Up to 8 Months After Infection
∘ Jennifer Dan et al. (February 5th, 2021)
· Shane Crotty (UC San Diego)
· Vaccine Efficacy
· COVAX Vaccines Delivered by Drone
· Beijing Wantai Rapid Test
∘ Sterilizing Immunity — Jennie Lavine et al., 2021
∘ India Serology Tests
UC San Diego Data
Here’s the COVID data collected from the end of Autumn (Social Psych sample & Health Psych/Pre-Med sample) through Winter Quarter (Intro Psych sample). All the extra fluff is down in the sidenotes section, per usual.
1. Masks As Long Term Behavior Change
- Most students (by a margin of 271 to 21) indicated that they plan to continue wearing masks in the years after COVID19 has ended whenever they go to work sick, have to work around sick colleagues, and/or sit next to a sick person on public transportation.
- In addition, 115 students indicated that they plan to continue wearing their mask after they’re vaccinated. This makes sense given that the vaccine does not confer sterilization immunity. It’s why I’ve continued to #WearAMask even though I’m fully vaccinated.
According to Dr. Syra Madad, Sterilization Immunity means that you’re prevented from ever being infected in the future (e.g., Measles vaccine). That’s not what the COVID19 vaccine does, though it provides excellent protection & everyone should get vaccinated ASAP because I haven’t been to boba since September & I’m having boba withdrawal symptoms.
2. Introverts Want to Continue Social Distancing After COVID Ends
- Introverts should be given accommodations to allow them to return to social life at their own pace. From a mental health standpoint, it’d be healthier to wean introverts off their me-time gradually rather than expecting them to part with such a significant amount of me-time overnight.
3. Students Are MultiMasking (and Fashion Masks Don’t Seem to Make a Difference)
- Like myself & Dr. Fauci, most students indicated that they’re multimasking
v- Interestingly, Fashion masks had no significant influence on mask adherence. I honestly thought masks with logos & brand names may increase adherence. This may be worth reassessing with different samples. I mean I have like 2 dozen masks now from all kinds of brand names — even Louis Vuitton. And I’m proud of that.
4. Course Modality Preference When We Return
- Most students want to return to in-person/ indoor… a finding that surprises no one. However…
Most students indicated that they want some form of online course option to continue to exist as an (at-will/ any given day) option for any class they may be taking.
Others indicated they’d prefer an online option…
A. For unvaccinated students so they won’t have to risk potentially becoming infected from a vaccinated carrier.
B. During exams so people aren’t forced to in a crowded classroom, with someone sneezing next to them, while trying to concentrate on making a 92 on their final so they can maintain their 4.0 for Med School.
Finally, women & extroverts expressed greater interest in continuing to utilize Zoom after COVID ends. This is consistent with data showing that introverts are most likely to have their cameras off during Zoominars, regardless of what anyone else is doing.
Given that introverts already have their cameras off more, it makes sense they’d be less interested in using Zoom in the future.
5. You Can’t Sit With Us Without a Vaccine Passport (Vaccine ≠ Sterilizing Immunity)
A minority of students suggest that vaccination status may become a relevant social category for the next year or 2 & that people may use vaccination status (or lack thereof) as a way to escape bad dates.
- Many students who didn’t wear glasses began wearing them to avoid the risk of ocular infection. This includes students who switched from contacts to glasses, those who purchased non-prescription fashion glasses to wear over their contacts, & those with absolutely no medical need for glasses but purchased fashion glasses simply for protection. (Note: Glasses don’t provide the same protection as goggles, and the risk of ocular infection is substantially lower than the risk of infection via the nose. Nose > Mouth > Eyes)
7. Human Space Avoidance (Recognizing Implied Social Environments)
- Students indicated avoiding walking on sidewalks (even if it’s empty, you know someone walked there at some point)
- Reparking their car if someone inexplicably parked next to them when there are other wide open spaces more than 6 feet away,
- Getting in front of a group that was talking as opposed to remaining downwind of them.
- In addition, some mentioned getting groceries as early in the day as possible to avoid the cumulative aerosols that may buildup over the course of the day.
UCSD Mask Adherence Project File
- If you’re interested in any of the data from the observational non-remote study from 2020 — which was presented for this year’s virtual SPSP Conference — the OSF project file can be found here: https://osf.io/u2qzc/
- Of note, women wear masks more in the evening (think back to cumulative aerosol buildup) whereas men wore their masks more in the morning.
Vaccine Passports: Protection, Not Preference
I’m fully vaccinated now (1st Pfizer on Feb 21; 2nd dose March 14; efficacy should be complete by March 28th) & started wearing the new free faculty mask to commemorate my vaccination against this monster. Masks are still required given that the vaccine does not confer sterilization immunity.
As such, businesses that only allow vaccinated patrons inside (and some that are even offering discounts to vaccinated customers to incentivize those who aren’t vaccinated), and high schools that only let vaccinated students return in-person, aren’t doing so out of animosity towards unvaccinated customers/students. Rather, they’re trying to protect unvaccinated customers/students because they’re at risk of becoming infected from someone who is vaccinated.
Unless someone is wearing their CDC card around their neck like I am (with 2 stickers showing to indicate 2 shots), there’s no way to know if someone is safe or not. Thus, wearing my Vaccination Card during lecture this fall will let students know it’s safe to come ask me questions at the podium after class.
Moreover, there’s the possibility that vaccinated individuals could be ‘carriers’ of the virus to others even if they are no longer at risk of severe (or even noticeable infection) themselves.UCSD Health — COVID Spring Update
Updates from UCSD Health on Post-Vaccination Life can be found here: https://ucsdnews.ucsd.edu/feature/qa-are-covid-19-vaccines-safe-and-effective
Fall 2021 Exam Grades
Students first exam this Fall will be their first in-person, crowded room, paper/scantron/blue book, pen/pencil, closed notes/ closed Siri, exam they’ve had in 18–19 months.
— There may be some interesting handwriting in blue books given that we’ve typed more & written less this year than ever before.
— A few bubbles may be missed on scantrons as we haven’t bubbled anything in for over a year.
National Institute for Health Research March 16th, 2021
Long Covid is a group of four possible syndromes affecting patients differently.
In an NIHR survey of 3,286 patients, 71% said the symptoms were affecting their family life while 80% said it impacted on their ability to work.
- 10% of those infected reported at least one symptom after 12 weeks with some patients experiencing symptoms beyond 6 months.
The report said: “Long Covid appears to be more frequent in women and in young people (including children) than might have been expected,” adding other sufferers could be experiencing an active disease, impacting on their organs and causing debilitating symptoms that would need ongoing treatment. In some patients, the effects included neurological changes in their brains while others showed signs of blood clotting and inflammation. Other patients reported anxiety, fatigue and damage to their lungs and heart.
It also warned there was evidence some long Covid patients could actually be getting worse, underlining the need to invest in services that will be needed to cope with what could be a long term problem.
Syra Madad et al. (NYC Health Hospitals)
- Vaccines help the immune system create immune cells
and antibodies in order to prevent illness.
- After vaccination, the body is left with a supply of “memory” cells & antibodies that will recognize and remember how to fight specific germs in the future
- Like many other vaccines, the COVID-19 mRNA vaccines require two doses to build protection.
- The Johnson & Johnson (Janssen) COVID-19 adenovirus vaccine requires one dose to build protection.
Indeed, there is no obvious mechanism by which they could. “To generate sterilizing immunity in a mucosal space using a vaccine that’s injected into your muscle is extremely difficult,” Angela Rasmussen, a virologist at Georgetown University, told me. She said that early evidence in rhesus macaques has suggested that the AstraZeneca vaccine could provide sterilizing protection, but only when administered as a nasal spray. Other researchers have begun to work on nasally delivered vaccines that could theoretically serve to coat our mucous membranes with antiviral armor, though there is no certainty that this approach would be effective at preventing severe disease.
Immunological Memory For Up to 8 Months After Infection
Jennifer Dan et al. (February 5th, 2021)
Shane Crotty (UC San Diego)
The best vaccine is one that elicits high concentrations of neutralizing antibodies and maintains those high amounts forever. For any antibody neutralization sensitive pathogen.
B1351 has mutations creating a high degree of antibody escape. Unfortunately, no direct measurements there of T cells and neutralizing antibodies against B1351. But 1-dose J&J elicits a substantial T cell response (CD4 & CD8) and an ok antibody response against regular SARS2.
But the AZ vaccine ChadOx South Africa trial results appear to tell an opposite story. That vaccine has ~75% efficacy against mild cases with ‘regular’ SARS2 but ~10% against B1351. If the AZ vaccine T cells were highly protective against mild cases, that shouldn’t have happened.
“…our data on immune memory in people after COVID-19 shows a huge amount of heterogeneity from person to person. Most people have a substantial about of immune memory, but not everyone, which results in more uncertainty.
…You have to get a CD4 T cell response to generate good neutralizing antibodies, which is a major focus of my lab. Vaccines have to elicit those T cells to get good antibodies.”
“People with chronic diseases and who are immunosuppressed mount less efficacious vaccine response.”
Viruses can change through mutations. These mutated forms of a virus are called variants.
+ Multiple variants of the virus that causes COVID-19 are circulating globally. The new variants may make the virus easier to spread, and may cause worse infections.
+ The best way to prevent more variants from spreading is to get vaccinated and follow the recommended safe practices. Preventing infections prevents the virus from being able to mutate and spread.
+ Current COVID-19 vaccines from Moderna, Pfizer BioNTech, and Janssen still offer protection against variants.
COVAX Vaccines Delivered by Drone
Beijing Wantai Rapid Test
“…survivors of SARS have functional T cells 17 years (and counting) after their infection, and this virus might be the same. …The vast majority of people in the new study have robust levels of B cells (which can make antibodies as needed), as well as the types of T cells needed to fight the virus, and they show extremely slow rates of decline — consistent with many years of protection.”
Sterilizing Immunity — Jennie Lavine et al., 2021
“Building on ideas from the vaccine modeling literature, we suggest that immunity may provide protection in three ways (Halloran et al., 2010). In its most robust form, sterilizing immunity can prevent a pathogen from replicating, thereby rendering the host refractory to reinfection. We term this property immune efficacy with respect to susceptibility (IES). If immunity does not prevent reinfection, it may still attenuate pathology due to reinfection (IEP) and/or reduce transmissibility or infectiousness (IEI). Indeed, experimental reexposure studies on endemic HCoVs provide evidence that the three immune efficacies do not wane at the same rate (Callow et al., 1990; Bradburne et al., 1967). Callow et al.’s experimental study shows that reinfection is possible within one year (relatively short IES); however, upon reinfection, symptoms are mild (high IEP) and the virus is cleared more quickly (moderate IEI).”
Huffpost UK — 3.12.2021
“The study assessed the records of people who live with both vaccinated and unvaccinated healthcare workers, and found the rate of Covid-19 among them was at least 30% lower when the health worker had had a single dose.
Given that people living with healthcare workers could also catch the virus from other sources, researchers said the 30% figure is a low estimate.
For those living with workers who had both doses of either vaccine, their risk of Covid was found to be at least 54% lower.
India Serology Tests
The survey of more than 35,700 people above 10, conducted in the last two months, gave a much lower estimate for the average number of people to have contracted COVID-19 than other research.
Separate tests done on more than 700,000 people across India by diagnostics company Thyrocare Technologies showed 55% of the country’s 1.35 billion people may have already been infected, its chief told Reuters last week.
India has officially reported 10.8 million infections, the world’s highest after the United States, though its cases have come down sharply since a mid-September peak of nearly 100,000.
The national survey, however, suggests that more than 290 million people may have already been infected in the country.
“The first few days I couldn’t get out of bed or eat anything but I was kind of expecting that. These acute symptoms lasted a couple of days but my breathing continued to be affected and my chest felt really tight. I tried to seek medical help but would just be on hold to 111 for hours. Then if you did get through they would ask what felt like silly questions like: “Can you concentrate on watching TV?” And if you said yes then they would say you weren’t ill enough to be hospitalised. It was pretty traumatic.” — Amy Durant
(Given that we may not know everything about sterilization immunity & risk of infection post-vaccination, this is just my personal storage of additional pieces of info. Posting in this area DOES NOT MEAN AGREEMENT — it just means I’m storing it so it’s easier to revisit. It also means things will be deleted once their scientific and/or public health utility has eroded in the wake of better information)
Seems like after 2 doses the fraction reporting developing *any* COVID19 symptom in the test group drops sharply vs control. Transmission lacks solid data, but there’s strong hints of reduced spread. After 2 doses many people seems to reach “sterilizing immunity” (can’t infect).
NHS Scotland has just released study covering 300,000 NHS staff who got the first vaccines (AZ or Pfizer) in December. Their families were 30% less likely to get Covid after NHS member had 1st dose & 54% less likely after 2nd. So promising results so far.
”The glory of the disposition that stops to consider stimuli rather than rushing to engage with them is its long association with intellectual and artistic achievement. Neither E=mc2 nor ‘Paradise Lost’ was dashed off by a party animal.”
- science journalist Winifred Gallagher
“…men with dispositionally higher perceived infectability (PI) demonstrated reduced preferences for extraverted female faces, whereas higher PI in women predicted a reduced preference for extraverted male faces.
This relationship between higher PI and reduced preferences for extraverted faces provides partial support for the hypothesis that pathogen concerns facilitate stronger preferences for [introverted] individuals, an adaptive response to mitigate contact with disease vectors” (Brown & Sacco, 2016).”
While the clinical trials for the vaccines were not designed to assess whether vaccines reduced asymptomatic infection (and, thereby, transmission), there is biological plausibility that the antibodies and T-cell responses blocking symptomatic disease will also block asymptomatic infection in the nasal passages. IgG immunoglobulins (generated and measured by the vaccine trials) enter the nasal mucosa and systemic vaccinations generate IgA antibodies at mucosal surfaces (SARS-CoV-2 vaccines also generate IgA). Monoclonal antibodies given to outpatients with COVID-19 hasten viral clearance from the airways.
Accumulating data from the real-world roll-out has also been very hopeful that vaccines reduce transmission. A recent article showed that health-care workers in the United Kingdom who were swabbed every two weeks after vaccination demonstrated an 86 percent reduction in asymptomatic infection compared with unvaccinated individuals. Other data, from health-care workers based in Israel (published in the Lancet) and across the Mayo Clinic system, show a similar result: a massive reduction in both symptomatic disease and asymptomatic infection after vaccination. A study from Israel with Ministry of Health data showed that asymptomatic infection was reduced by 94% after two doses of the Pfizer vaccine. In clinical trials, the Johnson & Johnson vaccine was 74.2 percent effective in preventing asymptomatic infection . Finally a large study from vaccinated patients presenting for pre-surgical care at Mayo Clinics compared to unvaccinated showed an 80% reduction in asymptomatic infection following mRNA vaccines. Another study from vaccinated HCWs in the UK show a four-fold reduction in asymptomatic infection with routine swabbing compared to unvaccinated HCWs after just 1 dose of the mRNA vaccine.
Moreover, even if someone exposed after vaccination gets SARS-CoV-2 replication in their nose, what is the chance that this viral load is infectious? Nasal viral loads from post-vaccination exposures are low and likely noninfectious per CT values.
Given that low nasal viral loads are the most important predictor of ability to transmit infection, these lower nasal SARS-CoV-2 RNA levels in those vaccinated versus those unvaccinated portends well that forward transmission after vaccination will be rare.
Visits between fully vaccinated people and unvaccinated people
Indoor visits between fully vaccinated people and unvaccinated people who do not wear masks or physically distance from one another are likely low risk for the vaccinated people.
Therefore, the level of precautions taken should be determined by the characteristics of the unvaccinated people, who remain unprotected against COVID-19.
Though the risk of disease may be minimal to the fully vaccinated person themselves, they should be mindful of their potential risk of transmitting the virus to others if they become infected, especially if they are visiting with unvaccinated people.