Vaccination with natural immunity
post by sudoLife · 2021-08-18T05:47:21.870Z · LW · GW · 2 commentsThis is a question post.
Contents
Answers 14 korin43 5 Maxwell Peterson None 2 comments
Why it's important to me: I have had Covid, alas unofficially, which means the healthcare system doesn't recognize me eligible for just one shot of Pfizer.
The same healthcare system also supposedly issued a statement early this summer about how recovered patients must receive one mRNA shot only and not a viral-vector jab.
This makes me worried.
Have any of you gone through this? It seems I should not subject my immune system to unnecessary work (second jab) that doesn't produce results.
P.S. Jannsen has only one shot, but it's viral-vector. I've read through some of the papers, and it seems it has about the same / lower efficacy and more side effects. This one, maybe?
UPD. A valid request for a more clearly stated question has been raised.
My main question is which vaccine seem to render a better outcome given the situation. While I have read through a study, I still lack insight from others.
Answers
It seems I should not subject my immune system to unnecessary work (second jab) that doesn't produce results.
What risk are you worried about here? The paper says a second dose produces "muted responses" but the second dose not doing as much as the first is expected (the same thing happens for people who haven't had COVID). Why do you want to avoid making your immune system do work?
But if you really don't want the second shot for whatever reason, you can just sign up for both and then cancel the second appointment after you get your first shot.
↑ comment by sudoLife · 2021-08-18T17:34:41.524Z · LW(p) · GW(p)
Why do you want to avoid making your immune system do work?
Because a few immunologists suggested it is not a good thing to subject one's immune system to unnecessary work.
There are other threats it might have to deal with, so I would like to avoid useless / distracting labor.
I have heard anecdotally that Pfizer and Moderna are more associated with side effects than Janssen. There was a lot of hubub about blood clots regarding Janssen but that turned out to be nothing. I’m surprised to hear you think J&J has more side effects. I could be wrong? It does have lower efficicacy than the two-dose course of mRNA, though, yeah, but with you having been infected already, I think 1 J&J is a good compromise between avoiding side effects and getting more protection.
If you want a single Pfizer, though, you can just get one. There’s no way to force you back in for the second dose. And when I got a second dose at Walgreens, different from where I’d got my first dose (ie they had no records of me), they didn’t even ask about my vaccination or infection history.
↑ comment by cistrane · 2021-08-23T17:07:08.135Z · LW(p) · GW(p)
There is nothing anecdotal about CDC warning on heart inflammation and pericarditis risk following mRNA vaccination. For a population of 16-28 year old men in which the cases mostly are clinically observed, the chance of getting it is close to 1 in 15,000
Replies from: sudoLife, maxwell-peterson↑ comment by sudoLife · 2021-08-23T18:52:12.791Z · LW(p) · GW(p)
Thanks for the info. I already have some minor heart issues, so this info worries me quite significantly. Could you please provide the source of those particular numbers?
Also, please share if you've done any related calculations / comparisons. I'd be very interested.
Replies from: cistrane↑ comment by cistrane · 2021-08-23T19:36:49.479Z · LW(p) · GW(p)
https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/myocarditis.html
The link goes to the CDC warning itself.
https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/adverse-events.html
This link lists the number of confirmed cases as of August 11. There were 762 confirmed cases most clustering in men 16-29 or as the CDC says "particularly in male adolescents and young adults."
As of August 11 there were approximately 10 million fully vaccinated men in this age group.
Divide 700 into 10 million to arrive at the chance of getting it conditional on belonging to this population.
Replies from: sudoLife↑ comment by Maxwell Peterson (maxwell-peterson) · 2021-08-23T18:01:39.414Z · LW(p) · GW(p)
Thanks for the additional information. I haven’t read that stuff, so all I had was anecdotal. I’m quite willing to believe there are side effects with decent rates and studies attached.
↑ comment by Maxwell Peterson (maxwell-peterson) · 2021-08-18T16:26:06.857Z · LW(p) · GW(p)
Ah, I should mention that I’m in America.
↑ comment by sudoLife · 2021-08-18T17:44:39.749Z · LW(p) · GW(p)
There was a lot of hubub about blood clots regarding Janssen but that turned out to be nothing.
Hmm, source? I have found this, it's rather new. I agree that the numbers are somewhat low. However the law of big numbers still applies. Maybe you happen to have more recent statistics with mentioned risk groups?
If you want a single Pfizer, though, you can just get one. There’s no way to force you back in for the second dose.
Ah, I should mention that I’m in America.
Regrettably, it works differently in Europe (and Lithuania in particular).
There's a thing called "Opportunity passport" that works inside the country and EU Digital Covid-19 Certificate that works in the whole Union. They grant you certain rights over others, such as unrestricted travel.
In Lithuania, a bill has recently been passed that denies the non-vaccinated access to:
- non-essential stores
- stores, whose area is over 1500 sqm
- beauty salons
- library
- small repair services > 15 mins of time
- any indoors cultural / sports / celebration events
- outdoors events > 500 people
As you see, those docs are pretty essential, and you won't get them unless you comply.
Replies from: maxwell-peterson↑ comment by Maxwell Peterson (maxwell-peterson) · 2021-08-18T18:54:36.535Z · LW(p) · GW(p)
The article mentioned that there was a specific type of blood clot of concern called CVST. This was new to me. It says there were 6 incidents reported to VAERS, with 9 million doses administered. That's a rate of 0.067 cases per 100,000 vaccine recipients. I found this paper https://iovs.arvojournals.org/article.aspx?articleid=2690377 that surveys the US population and finds an adjusted rate per year of 1.16/100K for men and 1.78/100K for women. (They control for age - I'm not sure if this helps or hurts the comparison to the rate of J&J clots). The mean afflicted person was 40 years old, so this rate isn't being pumped up by elderly people. Let's shoddily combine those gendered rates by eye and say it's 1.4/100K CVST cases per year. The J&J had only been being administered for a little bit when the 6 cases were reported, so let's call the 0.067/100K rate the CVST rate for one month. Multiplying by 12 to match the yearly rate gives a rate of 0.8/100K.
So if we assume the cases reported to VAERS are all the cases, then the rate for J&J recipients is lower than the base population rate. VAERS is under-reported, however, and I'm not sure by how much. If assuming only half of people with this fairly serious clot report, we get a rate of 1.6/100K for J&J receivers - about the same as the population rate. But maybe VAERS is more under-reported than that, and a factor of 10 is more fair? Then it's 8/100K CVSTs per person-year for J&J recipients, which is higher than the base rate. I'm not sure about the right factor here.
A different useful cost-benefit analysis would compare the rate of blood clots in people who get COVID to the rate of blood clots with people who get J&J. Blood clots (not just CVST though) in hospitalized COVID patients is something like 1 in 5 (!): https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(20)30383-7/fulltext. Most people who catch COVID, especially those who have been infected before, will not be hospitalized, so this factor as it applies to your case is much much lower than 1 in 5, but is it as low as the 8/100K number above? I'd guess not, but I haven't done the calculations to back it up.
Sorry Lithuania has those wacky combination of rules! Sounds like a difficult situation.
Replies from: sudoLife↑ comment by sudoLife · 2021-08-19T07:23:39.175Z · LW(p) · GW(p)
Hm,
But maybe VAERS is more under-reported than that, and a factor of 10 is more fair?
It may be a negative slope: the more serious a side effect is, the more it gets reported. Going by that, a factor of two or three for blood clots sounds pessimistic enough. Then we'd still be somewhere around the base rate.
This study estimates the risk of cerebral venous thrombosis (CVT) and portal vein thrombosis (PVT) following Covid-19 diagnosis vs vaccination (mRNA).
Excluding those with prior history of CVT or PVT, we get 3.53/100K and 17.5/100K cases, respectively. This includes both hospitalized and non-hospitalized patients.
Also, for CVT
Among the 23 events, 7 were observed in patients under the age of 30, 4 between 30 and 39, 2 between 40 and 49, 3 between 50 and 59, 2 between 60 and 69, and 5 between 70 and 79.
I am afraid if we only look at the relevant group (e.g. under 30, hon-hospitalized), we will end up with too small a sample to draw any conclusions, so I'm not going to do so. But excluding those with prior history seems to be a good choice.
Supposing nobody gets both CVT and PVT, we end up with a total of 21.03/100K cases. This is still 2.6 times more than your worst-case scenario. Of course, the probabilities are not adjusted for those recovered from Covid-19 and having natural immunity, in which case the risk probably goes down drastically.
The study itself concludes you're about 10 times more likely to get thrombosis from Covid-19 than from Pfizer/Moderna. I wonder how Jannsen compares to that.
Side note: my mother had a contact with an infected individual. Coincidentally, she tested for antibodies soon after that, and found out they shot up quite drastically (about 7-fold) from almost not existing to a decent level. This gets me thinking just how pointless it is to race after constantly high levels. Haven't we known for a good deal of time that the immune system produces what's necessary at the moment?
Replies from: maxwell-peterson↑ comment by Maxwell Peterson (maxwell-peterson) · 2021-08-19T18:50:38.102Z · LW(p) · GW(p)
A lower ratio than I expected! Thanks for doing the analysis. Cheers
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comment by Randomized, Controlled (BossSleepy) · 2021-08-18T16:18:18.350Z · LW(p) · GW(p)
A meta point: korin43 has done pretty well below trying to offer up a helpful reply, but in general you might get better responses by asking one or more specific questions; all you've done here is enumerate some facts: you've had covid; you don't have a diagnosis; there are some recommendations that may be relevant to you; you're worried; therefore... should I do...? Are there things I should research...? etc.
Replies from: sudoLife