#61

The virus has evolved to become much more contagious, but are you saying it also has become less virulent? If so, I haven’t seen anything about that. My understanding is that short-term hospitalizations and deaths are so much lower now thanks to the fact that nearly everyone has had at least one past infection and/or one or more vaccines. Since I’ve never had the infection (as far as I know), I’m relying on the vacc (and the portable HEPA filters that I keep in my patient exam rooms). I do have a stash of metformin ready to go, just in case.

My main concern is potential long-term effects of the virus on cardiovascular and neurological health, even in the absence of “long COVID” symptoms. Just too many unknowns there.

2 Likes
#62

Have you seen a single case of an unvaccinated person getting myocarditis?

@DrFraser this question is for you too

#63

Are you saying that there is no difference between an “asymptomatic infection” vs someone who is exposed but the virus is fully neutralized by antibodies? I’m not sure that’s true, but even if it is, the boosters help protect against “symptomatic infection” and isn’t that all anyone cares about? In addition to lowering risk of long COVID, hospitalization, death, and possibly CVD events, subclinical neurological damage, etc.

We’ll know next year how well (or not) this round of boosters does for those of us who get them. I’m getting Pfizer just to minimize any small cardiomyopathy risk.

1 Like
#64

Pardon the interruption … Can I get some advice on the interaction between the vaccine and Rapamycin, please.

I took Rapamycin on Sat. I’m scheduled for my vax on Wed, is that fine?

And should I skip my next dose of rapamycin that is due on Sat?

Thank you!!!

3 Likes
#65

I just booked an appointment for this Wednesday, August 28, for myself and my wife, the new covid vacc and the flu vacc. Regarding the flu vacc, I am highly sceptical, as it seems to work for some and not for others depending on what year and strain it is and so on. But I continue to be intrigued by the possibility (however remote) that the flu vaccine might provide some protection against dementia. For many years I didn’t take it, as I regarded it as such a poor vaccine, but ever since the steady drumbeat of the dementia connection, I decided to start doing it. My reasoning is that even if the odds are slim to none that there’s any connection to dementia, the risk is similarly tiny. Every time I’ve taken the covid flu combo vacc, it resulted in zero side effects - unlike my wife who is wiped out for a couple of days after this combo.

I’ve never had covid, insofar as I know, and I think I may have had the flu in 2000, right after I came back from London where I went to celebrate the 1999/2000 millenium New Year - it felt like I caught something on the airplane coming back. I was decently sick for a couple of days. No flu since, that I know of, and only like maybe two colds in the last 25 years. But I’m 66, so I figure, why not grab a shot just in case. I have my yearly physical at the end of October, so I figure why not have some protection, however minor, when I present at the doctor’s office, walking through a building full of sick people (yes, I’ll wear a mask). I continue not wanting to catch covid - my idea is that if I postpone the (inevitable?) date when I finally come down with covid, by then hopefully the virus will evolve to be as mild as possible (and the FLirT variant apparently is pretty mild)… although that apparently is not happening with the flu which we’ve had for over a century and after the initial drop off in virulence after all that dying, I don’t think it’s become less virulent in the last, say, 20 years or so, and people die from the flu every year, so my plan may be seriously flawed - maybe covid too will plateau in virulence and not get any milder after some point.

I’ll report if I have any side effects from the vacc.

On the politics of it - I think live and let live is best, I’m not bent on convincing anyone of anything either way. Just reporting my reasoning and choices for comparison purposes. YMMV, and I respect your choice, whatever it may be.

3 Likes
#66

This is also for me the most interesting point. People so far in this thread have argued about the risk/reward ratio of the vaccine for each age group. I think we all agree that: 1/ Covid is becoming like a cold and 2/ the protection offered by vaccines is modest. For some this modest protection is enough because the vaccines are safe (especially for old people with commorbidities taking Pfizer?). For others this modest protection is not worth the potential risk (especially for healthy young men with Moderna?).

But what about the potential long-term neuroprotection @DrFraser?

There’s a growing body of evidence that some vaccines might protect from NDDs:

So far none of the above has been proven to be causal (except maybe EBV for MS) and even if the infection is causal we don’t know if vaccination can prevent. That’s why the 2024 Lancet Commission on Dementia Prevention did not include vaccination as a modifiable risk factor (see dedicated thread: Dementia Prevention - 2024 report of the Lancet standing Commission - #4 by AnUser ). However the 2024 report did not include the latest evidence published in 2023 and 2024 and preprints being reviewed. I would be willing to be that the upcoming edition will include some vaccines as modifiable risk factors (even if just for 1% overall dementia prevention). It’s also possible that these vaccines protect from dementia by other pathways, irrespective of infection prevention.

This for me is the best reason to get all safe vaccines. Then we go back to what is safe…

4 Likes
#67

That we’ll do.

image

Not sure I understand, the last wave was about a year ago, it’s usually in the autumn and spring, why wouldn’t the literature be based on how things were when infections were at its peak? The FDA approval is based on the observed effect of the previous updated vaccine, etc.

#68

Myocarditis is pretty rare, in the last 4 years, I’ve seen one case vaccine related (probably) and one not. Thinking back 20 years, it’s probably only every 2-3 years I diagnose a case.
My vaccine related issue was a pericarditis, not a myocarditis. Incidentally, that didn’t have me not get more vaccines, just not moderna.

@AnUser The experience on the ground as we see cases, especially those of us working in high volume urban centers in areas where covid is high gives one a good sense of how things are going. I used to admit multiple patients per shift … now just like @KarlT no such cases. The anecdote of Dr. Seheult … well let’s have the details … possibly an 80 year old with COPD, heart disease, obesity, on home oxygen, still smoking? It certainly is not likely to be a fit person in their 50’s or 60’s.

People on this board are presumably taking care of themselves, and as such, the risks, even from the early days were markedly less.

Again, stacks of cases being seen - I don’t test unless I’d offer the patient antivirals - which is a tiny segment of cases - only in age 65+ some guidelines (AU) 70+ years. Some patients with age and multiple comorbidities I’ll consider antivirals who are less than age 65. Most people I tell don’t bother testing, it’s a cold, treat symptomatically.

@adssx I’ve not seen convincing evidence of these vaccines causing neuroprotection. I absolutely agree on the points with some other vaccines.

@Beth I’d anticipate 2 days out from standard dose rapamycin, you’d have little active drug remaining - certainly by 4 days … so I doubt there would be an issue.

2 Likes
#69

Here’s a paper on that and an explanation (hypothesis?):

“we find that the SARS-CoV-2 variants selected for as the virus evolved from the pre-Alpha to the Delta variant had earlier and higher peak in viral load dynamics but a shorter duration of infection. Selection for increased transmissibility shapes the viral load dynamics, and the isolation measure is likely to be a driver of these evolutionary transitions. In addition, we show that a decreased incubation period and an increased proportion of asymptomatic infection are also positively selected for as SARS-CoV-2 mutated to adapt to human behavior (i.e., Omicron variants).”

https://www.nature.com/articles/s41467-023-43043-2

1 Like
#70

We could only see neuroprotection in a few years, looking at longitudinal data. But we have some signals:

We know that for people >60yo who got infected with the first Wuhan strain (so probably “stronger” than the most recent ones and people had zero exposure back then), even nonsevere infections led to worse cognition after 2.5y: Tracking cognitive trajectories in older survivors of COVID-19 up to 2.5 years post-infection 2024

image
image1624×1252 180 KB

For more recent strains, hospitalization led to “cognitive deficits…equivalent in magnitude to 20 years of aging”: Post-COVID cognitive deficits at one year are global and associated with elevated brain injury markers and grey matter volume reduction: national prospective study 2024 :warning: Preprint :warning: (Interesting: “There is growing biochemical evidence that neurological complications in COVID-19, including cognitive impairment, are immune-mediated, which is corroborated here by clinical demonstration of the protective effect of acute treatment with corticosteroids.”)

Only half of people recover from post-Covid cognitive deficits after 2 years: Predictors of non-recovery from fatigue and cognitive deficits after COVID-19: a prospective, longitudinal, population-based study 2024 (noteworthy: “Significant risk factors for cognitive non-recovery were male sex, older age and <12 years of school education.”)

We also know that many NDDs are associated with olfactory or gustatory dysfunction and it turns out that even 3y after a mild Covid infection, people still have a higher rate of both vs controls: Olfactory and Gustatory Function 3 Years After Mild COVID-19—A Cohort Psychophysical Study 2023

image
image1872×1006 123 KB

(but these are also people who got the first strains, and new variants are less likely to cause loss of smell)

And we know that vaccination is associated with a lower risk of long-term neuropsychiatric symptoms: “Factors such as mild severity of COVID-19, increased vaccination against COVID-19 and heterologous vaccination were associated with reduced long-term risk of adverse neuropsychiatric outcomes.” Short- and long-term neuropsychiatric outcomes in long COVID in South Korea and Japan 2024 (however they don’t give the OR…)

According to Cognition and Memory after Covid-19 in a Large Community Sample 2024, mild Covid with resolved symptoms is equivalent to losing 3 points of IQ. However, there was only “a small cognitive advantage among participants who had received two or more vaccinations”.

In terms of safety, this paper was published yesterday: Long-Term Prognosis of Patients With Myocarditis Attributed to COVID-19 mRNA Vaccination, SARS-CoV-2 Infection, or Conventional Etiologies 2024

In total, 4635 individuals were hospitalized for myocarditis: 558 with postvaccine myocarditis, 298 with post–COVID-19 myocarditis, and 3779 with conventional myocarditis. Patients with postvaccine myocarditis were younger than those with post–COVID-19 and conventional myocarditis (mean [SD] age of 25.9 [8.6], 31.0 [10.9], and 28.3 [9.4] years, respectively) and were more frequently men (84%, 67%, and 79%). Patients with postvaccine myocarditis had a lower standardized incidence of the composite clinical outcome than those with conventional myocarditis (32/558 vs 497/3779 events; weighted hazard ratio, 0.55 [95% CI, 0.36-0.86]), whereas individuals with post–COVID-19 myocarditis had similar results (36/298 events; weighted hazard ratio, 1.04 [95% CI, 0.70-1.52]).
So, post-vaccine myocarditis is mostly limited to “healthy young men”.

Based on all the above, for people other than “healthy young men” vaccination seems to have a good risk-reward ratio. For “healthy young men”, it’s less clear…

3 Likes
#71

The issue is, currently, does the vaccine decrease the risk of these outcomes? Given these outcomes are rare now, NNT is going to be growing, and the benefit of vaccination now in preventing significant disease is less clear. I certainly give antivirals to high risk individuals, but even these are looking less effective with time.
Open minded, but not at all convinced of benefit in this space for neurocognitive protection based on vaccination with current vaccines and current variants. The data will be interesting.
I’ll continue to recommend people keep up with their vaccines, just not doing so myself on this one as my alternate strategy seems highly effective at this point.

2 Likes
#72

@DrFraser @adssx
You both mention not getting moderna. Is that just a male thing. Basically, I’m asking, if you were me, 58yo, would you opt for Pfizer? Aside from one shot, I’ve always had moderna, and back in the day, I read it was slightly more effective.

Thank you!

#73

I only said this because the myocarditis risk was higher with Moderna (at least at the beginning). But this mostly applied to healthy young men. I don’t know if the recent Moderna vaccines still suffer from this problem.

2 Likes
#74

Apparently boosters have much less risk of myocarditis compared to the primary series. This is from a CDC analysis in 2023:

Screenshot_20240827_074056_Drive
Screenshot_20240827_074056_Drive1440×3120 391 KB

Link to full presentation: https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2023-02/slides-02-24/COVID-09-Wallace-508.pdf

3 Likes
#75

At this point, I am not comfortable with any mRNA vaccines that f*ck with my genes.
There are no long-term safety studies. I think I will wait another decade or so before I get
another one because of the side effects of the first one I received.

5 Likes
#76

If you are in the northern hemisphere, it may be too soon for vaccination. Keep in mind the shot gives you antibodies for 2-4 months. If you get your shot in August, how many antibodies do you have to protect you in January and February?

1 Like
#77

Current WHO recommendations:
(I would consider having Covid equivalent to receiving a shot.)

2 Likes
#78

I doubt a vaccine has ever been scrutinized as extensively as the Covid-19 vaccines. How many people have spent their life doing zero research and getting various vaccines at their health providers recommendation? Wonder where all the concern and biases came from? My guess, not from data.
Covid severity has decreased for most people to perhaps the level of a seasonal flu. Funny, how I do not recall the vocal pushback against seasonal flu shots.

4 Likes
#80

I’d say that as with any medical intervention, proof of efficacy from RCT’s is a basic requirement.
There are none for boosters (with meaningful clinical endpoints). In an environment where nearly everyone on the planet has COVID (at least once), this should be a basic expectation.
We have RCT’s for influenza vaccines (in everything from healthy kids, healthy adults, to adults with COPD) and it is only because of these that I can make an informed decision regarding their use.
It’s long past being acceptable for these vaccines to get by on the basis of belief.
COVID will continue to kill people… but there remains zero credible evidence that the boosters will change anything but the bottom line of Pfizer and others.

1 Like
#81

You might wish to check what Cochrane says about the flu shots.
In that case there are RCT’s for them… COVID boosters… zero!

1 Like