Israel sees 70% spike in number of seriously ill COVID patients within a week

‘It’s an unpredictable and unstable situation,’ says immune system expert Prof. Cyrille Cohen, urging lawmakers to ‘actively encourage herd immunity among the vulnerable’

Authors:  Times of Israel June 2022

The number of coronavirus patients in serious condition in Israel reached 140 on Friday, marking a near 70% rise since last week, with health experts warning that the current situation was “unstable.”

While Israel has seen rising infection numbers for a few weeks, a rise in seriously ill patients marks a real concern as the country deals with the spread of the new variant BA.5, with experts warning that hospitals may need to reopen COVID wards. The number was up from 85 seriously ill patients on Friday last week.

Some 7,313 Israelis tested positive for the virus on Friday, the Health Ministry said. The reproduction number (R) stood at 1.31 as of Friday. The figure measures how many people each coronavirus carrier infects on average, with any number above 1 meaning the spread of COVID-19 is increasing. It first began to rise above 1 in mid-May, having stayed below that threshold for nearly two months.

The death toll stood at 10,882, including six fatalities over the past week.

“The data definitely indicates that the disease is active in the community,” immune system expert Prof. Cyrille Cohen of Bar Ilan University told the Ynet news site.

“The real indication is the number of patients in serious condition because we know much of the morbidity is not detected as people don’t go and get tested, and that should also be taken into account,” he said.

“The thing that determines the policy is not necessarily the number of confirmed patients but the condition of seriously ill patients. We need to understand whether they are experiencing the disease in a more severe way — and whether we will need to get ready to reopen COVID wards this summer,” he added.

Despite the warning, Cohen said it’s too early to know the severity of the variant that mutated from Omicron, known as BA.5, and whether or not it will develop into a new wave.

“We don’t know exactly what this wave will look like and whether we can call it a wave at all,” he said. “We are following the events in Portugal because variant BA.5 is the dominant one there and because its population is similar to Israel in size with many people vaccinated, even more so than in Israel.”

Cohen noted that morbidity and mortality rates rose in Portugal at the same time the BA5 variant started spreading.

“We need to realize that’s going to happen here as well,” he said, urging lawmakers to take action. “It’s an unpredictable and unstable situation regarding COVID. It will take months and even years before there is a significant decrease and we reach a more predictable scenario. But one must also be careful with making estimations,” he added.

Cohen said the effort should be concentrated on “actively encouraging herd immunity among the vulnerable and older population” by “calling people who haven’t received the vaccine and encouraging them to get it.”

He also advised wearing masks in crowded places like on buses and at shopping centers.

On Wednesday, coronavirus czar Prof. Salman Zarka said the new variant BA.5 is quickly gaining traction and is more resistant to vaccines than previous strains.

“The BA.5 strain currently accounts for about 50 percent of patients,” he said. “The strain caused relatively mild illness among young people, but we can see a rise in hospitalizations.”

He said BA.5 was replacing Omicron as the dominant variant, and that it will continue to gain ground.

Israel scrapped its indoor mask requirement in April as infection numbers dropped off sharply. Outdoor masks have not been required since April of last year.

Salman Zarka also said Israelis may soon be able to be officially recognized as COVID-19 patients based solely on a home test, under certain conditions, while at the same time the Health Ministry was working to expand test facilities.

New Study Finds mRNA Vaccines Actually Hurt Long-Term Immunity to Covid Compared to the Unvaccinated

Authors:  Jim Hoft Published May 19, 2022  The Gateway Pundit

A new study conducted by scientists from the National Institutes of Health (NIH) and Moderna Inc. showed that mRNA vaccines hurt the long-term immunity to Covid-19 after contracting infection compared to unvaccinated people.

Researchers performed a placebo-controlled vaccine efficacy trial published at medRxiv last month, to evaluate anti-nucleocapsid antibody (anti-N Ab) seropositivity in Moderna vaccine efficacy after Covid-19 infection.

“To evaluate for evidence of prior infection in a person with a history of COVID-19 vaccination, a test that specifically evaluates anti-N should be used. Past infection is best determined by serologic testing that indicates the presence of anti-N antibody,” according to the CDC.

The study analyzed data from 1,789 participants (1,298 placebo recipients and 491 vaccine recipients) with Covid-19 infection at 99 sites in the US during the blinded phase (through March 2021).

The study concludes that anti-nucleocapsid antibody (anti-N Abs) may have lower sensitivity in patients vaccinated with Moderna who become infected. The study also mentioned that the anti-N Ab response in unvaccinated persons has been reported to be durable, with half-life estimates ranging from 68 to 283 days.

Among the participants with confirmed Covid-19 illness, only 21 out of 52 (40%) of people who received the Moderna shots had antibodies compared to the placebo recipients, 605 out 648 (93%).

Unvaccinated people are much more likely to develop broad antibody immunity after Covid infections than people who have received mRNA shots, a new study shows.

Researchers already knew that many vaccinated people do not gain antibodies to the entire coronavirus after they are infected with Covid.

Unvaccinated people nearly always gain antibodies to the nucleocapsid protein, which covers the virus’s core of RNA, as well as its spike protein, which allows the virus to attack our cells. Vaccinated people often lack those anti-nucleocapsid antibodies and only have spike protein antibodies.

The researchers examined the development of anti-nucleocapsid antibodies in people who had been part of Moderna’s clinical trial and were infected with Covid. As they expected, the scientists found that the vaccinated people were far less likely to develop the anti-nucleocapsid antibodies. Only 40 percent of people who received the shots had antibodies, compared to 93 percent of those who did not.

But they then went a step further. Because the infected people had been in the trial, their viral loads had been precisely measured when they were found to have Covid. So the researchers were able to compare vaccinated and unvaccinated people who had the same amounts of virus in their blood.

Once again, they found that unvaccinated people were far more likely to develop anti-nucleocapsid antibodies than the jabbed. An unvaccinated person with a mild infection had a 71 percent chance of mounting an immune response that included those antibodies. A vaccinated person had about a 15 percent chance.

The chart that should worry the vaccinated: the yellow line shows the odds that an unvaccinated person will develop anti-nucleocapsid antibodies to Sars-Cov-2, stratified by viral load. The blue line shows the same odds for a person who received an mRNA shot.

An unvaccinated person has an almost 60 percent chance of developing antibodies even with an extremely mild infection; a vaccinated person needs almost 100,000 times as much virus in his blood to have the same chance.

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As the Gateway Pundit previously reported, a new report released earlier this year by the Centers for Disease Control and Prevention (CDC) revealed that unvaccinated people who recovered from COVID-19 were better protected than those who were vaccinated and not previously infected during the recent delta surge.

The researchers evaluated the data from 1.1 million Covid-19 cases among adults in California and New York (which account for 18% of the U.S. population) from May 30 to Nov. 20, 2021.

“When looking at the summer and fall of 2021, when Delta became predominant in this country, however, surviving a previous infection now provided greater protection,” CDC epidemiologist Benjamin Silk said.

The study confirmed something that we’ve known for a long time that “natural immunity” acquired through previous infection of COVID is more potent than experimental vaccines.

COVID-19 Cases and Hospitalizations by COVID-19 Vaccination Status and Previous COVID-19 Diagnosis — California and New York, May–November 2021

Weekly / January 28, 2022 / 71(4);125–131 January 19, 2022, this report was posted online as an MMWR Early Release.

Authors: Tomás M. León, PhD1; Vajeera Dorabawila, PhD2; Lauren Nelson, MPH1; Emily Lutterloh, MD2,3; Ursula E. Bauer, PhD2; Bryon Backenson, MPH2,3; Mary T. Bassett, MD2; Hannah Henry, MPH1; Brooke Bregman, MPH1; Claire M. Midgley, PhD4; Jennifer F. Myers, MPH1; Ian D. Plumb, MBBS4; Heather E. Reese, PhD4; Rui Zhao, MPH1; Melissa Briggs-Hagen, MD4; Dina Hoefer, PhD2; James P. Watt, MD1; Benjamin J. Silk, PhD4; Seema Jain, MD1; Eli S. Rosenberg, PhD2,3

Summary

What is already known about this topic?

Data are limited regarding the risks for SARS-CoV-2 infection and hospitalization after COVID-19 vaccination and previous infection.

What is added by this report?

During May–November 2021, case and hospitalization rates were highest among persons who were unvaccinated without a previous diagnosis. Before Delta became the predominant variant in June, case rates were higher among persons who survived a previous infection than persons who were vaccinated alone. By early October, persons who survived a previous infection had lower case rates than persons who were vaccinated alone.

What are the implications for public health practice?

Although the epidemiology of COVID-19 might change as new variants emerge, vaccination remains the safest strategy for averting future SARS-CoV-2 infections, hospitalizations, long-term sequelae, and death. Primary vaccination, additional doses, and booster doses are recommended for all eligible persons. Additional future recommendations for vaccine doses might be warranted as the virus and immunity levels change.

By November 30, 2021, approximately 130,781 COVID-19–associated deaths, one in six of all U.S. deaths from COVID-19, had occurred in California and New York.* COVID-19 vaccination protects against infection with SARS-CoV-2 (the virus that causes COVID-19), associated severe illness, and death (1,2); among those who survive, previous SARS-CoV-2 infection also confers protection against severe outcomes in the event of reinfection (3,4). The relative magnitude and duration of infection- and vaccine-derived protection, alone and together, can guide public health planning and epidemic forecasting. To examine the impact of primary COVID-19 vaccination and previous SARS-CoV-2 infection on COVID-19 incidence and hospitalization rates, statewide testing, surveillance, and COVID-19 immunization data from California and New York (which account for 18% of the U.S. population) were analyzed. Four cohorts of adults aged ≥18 years were considered: persons who were 1) unvaccinated with no previous laboratory-confirmed COVID-19 diagnosis, 2) vaccinated (14 days after completion of a primary COVID-19 vaccination series) with no previous COVID-19 diagnosis, 3) unvaccinated with a previous COVID-19 diagnosis, and 4) vaccinated with a previous COVID-19 diagnosis. Age-adjusted hazard rates of incident laboratory-confirmed COVID-19 cases in both states were compared among cohorts, and in California, hospitalizations during May 30–November 20, 2021, were also compared. During the study period, COVID-19 incidence in both states was highest among unvaccinated persons without a previous COVID-19 diagnosis compared with that among the other three groups. During the week beginning May 30, 2021, compared with COVID-19 case rates among unvaccinated persons without a previous COVID-19 diagnosis, COVID-19 case rates were 19.9-fold (California) and 18.4-fold (New York) lower among vaccinated persons without a previous diagnosis; 7.2-fold (California) and 9.9-fold lower (New York) among unvaccinated persons with a previous COVID-19 diagnosis; and 9.6-fold (California) and 8.5-fold lower (New York) among vaccinated persons with a previous COVID-19 diagnosis. During the same period, compared with hospitalization rates among unvaccinated persons without a previous COVID-19 diagnosis, hospitalization rates in California followed a similar pattern. These relationships changed after the SARS-CoV-2 Delta variant became predominant (i.e., accounted for >50% of sequenced isolates) in late June and July. By the week beginning October 3, compared with COVID-19 cases rates among unvaccinated persons without a previous COVID-19 diagnosis, case rates among vaccinated persons without a previous COVID-19 diagnosis were 6.2-fold (California) and 4.5-fold (New York) lower; rates were substantially lower among both groups with previous COVID-19 diagnoses, including 29.0-fold (California) and 14.7-fold lower (New York) among unvaccinated persons with a previous diagnosis, and 32.5-fold (California) and 19.8-fold lower (New York) among vaccinated persons with a previous diagnosis of COVID-19. During the same period, compared with hospitalization rates among unvaccinated persons without a previous COVID-19 diagnosis, hospitalization rates in California followed a similar pattern. These results demonstrate that vaccination protects against COVID-19 and related hospitalization, and that surviving a previous infection protects against a reinfection and related hospitalization. Importantly, infection-derived protection was higher after the Delta variant became predominant, a time when vaccine-induced immunity for many persons declined because of immune evasion and immunologic waning (2,5,6). Similar cohort data accounting for booster doses needs to be assessed, as new variants, including Omicron, circulate. Although the epidemiology of COVID-19 might change with the emergence of new variants, vaccination remains the safest strategy to prevent SARS-CoV-2 infections and associated complications; all eligible persons should be up to date with COVID-19 vaccination. Additional recommendations for vaccine doses might be warranted in the future as the virus and immunity levels change.

Four cohorts of persons aged ≥18 years were assembled via linkages of records from electronic laboratory reporting databases and state-specific immunization information systems. Persons were classified based on whether they had had a laboratory-confirmed SARS-CoV-2 infection by March 1, 2021 (i.e., previous COVID-19 diagnosis)§; had received at least the primary COVID-19 vaccination series by May 16, 2021; had a previous COVID-19 diagnosis and were fully vaccinated**; or had neither received a previous COVID-19 diagnosis by March 1 nor received a first COVID-19 vaccine dose by the end of the analysis period. The size of the unvaccinated group without a previous diagnosis was derived by subtracting the observed groups from U.S. Census estimates.†† To maintain each defined cohort, persons who received a COVID-19 diagnosis during March 1–May 30, 2021, or who died before May 30, 2021, were excluded (to maintain eligibility for incident cases for all cohorts on May 30, 2021),§§ as were persons who received a first vaccine dose during May 30–November 20, 2021. During May 30–November 20, 2021, incident cases were defined using a positive nucleic acid amplification test (NAAT) result from the California COVID-19 Reporting System (CCRS) or a positive NAAT or antigen test result from the New York Electronic Clinical Laboratory Reporting System. In California, person-level hospitalization data from CCRS and supplementary hospitalization reports were used to identify COVID-19–associated hospitalizations. A lifetable method was used to calculate hazard rates (average daily cases during a 7-day interval or hospitalizations over a 14-day interval), hazard ratios, and 95% CIs for each cohort. Rates were age-adjusted to 2000 U.S. Census data using direct standardization.¶¶ Supplementary analyses stratified case rates by timing of previous diagnoses and primary series vaccine product. SAS (version 9.4; SAS Institute) and R (version 4.0.4; The R Foundation) were used to conduct all analyses. Institutional review boards (IRBs) in both states determined this surveillance activity to be necessary for public health work, and therefore, it did not require IRB review.

Approximately three quarters of adults from California (71.2%) and New York (72.2%) included in this analysis were vaccinated and did not have a previous COVID-19 diagnosis; however, 18.0% of California residents and 18.4% of New York residents were unvaccinated with no previous COVID-19 diagnosis (Table 1). In both states, 4.5% of persons were vaccinated and had a previous COVID-19 diagnosis; 6.3% in California and 4.9% in New York were unvaccinated with a previous diagnosis. Among 1,108,600 incident COVID-19 cases in these cohorts (752,781 in California and 355,819 in New York), the median intervals from vaccination or previous COVID-19 diagnosis to incident diagnosis were slightly shorter in California (138–150 days) than in New York (162–171 days).

Before the Delta variant became predominant in each state’s U.S. Department of Health and Human Services region (June 26 in Region 9 [California] and July 3 in Region 2 [New York]),*** the highest incidence was among unvaccinated persons without a previous COVID-19 diagnosis; during this time, case rates were relatively low among the three groups with either previous infection or vaccination and were lowest among vaccinated persons without a previous COVID-19 diagnosis (Supplementary Figure 1, https://stacks.cdc.gov/view/cdc/113253) (Supplementary Figure 2, https://stacks.cdc.gov/view/cdc/113253). During the week beginning May 30, 2021, compared with COVID-19 case rates among unvaccinated persons without a previous COVID-19 diagnosis, COVID-19 case rates were 19.9-fold (California) and 18.4-fold (New York) lower among vaccinated persons without a previous diagnosis; rates were 7.2-fold (California) and 9.9-fold (New York) lower among unvaccinated persons with a previous COVID-19 diagnosis and 9.6-fold (California) and 8.5-fold (New York) lower among vaccinated persons with a previous COVID-19 diagnosis (Table 2).

As the Delta variant prevalence increased to >95% (97% in Region 9 and 98% in Region 2 on August 1), rates increased more rapidly among the vaccinated group with no previous COVID-19 diagnosis than among both the vaccinated and unvaccinated groups with a previous COVID-19 diagnosis (Supplementary Figure 1, https://stacks.cdc.gov/view/cdc/113253) (Supplementary Figure 2, https://stacks.cdc.gov/view/cdc/113253). For example, during the week of October 3, compared with rates among unvaccinated persons without a previous COVID-19 diagnosis, rates among vaccinated persons without a previous diagnosis were 6.2-fold lower (95% CI = 6.0–6.4) in California and 4.5-fold lower (95% CI = 4.3–4.7) in New York (Table 2). Further, rates among unvaccinated persons with a previous COVID-19 diagnosis were 29-fold lower (95% CI = 25.0–33.1) than rates among unvaccinated persons without a previous COVID-19 diagnosis in California and 14.7-fold lower (95% CI = 12.6–16.9) in New York. Rates among vaccinated persons who had had COVID-19 were 32.5-fold lower (95% CI = 27.5–37.6) than rates among unvaccinated persons without a previous COVID-19 diagnosis in California and 19.8-fold lower (95% CI = 16.2–23.5) in New York. Rates among vaccinated persons without a previous COVID-19 diagnosis were consistently higher than rates among unvaccinated persons with a history of COVID-19 (3.1-fold higher [95% CI = 2.6–3.7] in California and 1.9-fold higher [95% CI = 1.5–2.3] in New York) and rates among vaccinated persons with a history of COVID-19 (3.6-fold higher [95% CI = 2.9–4.3] in California and 2.8-fold higher [95% CI = 2.1–3.4] in New York).

COVID-19 hospitalization rates in California were always highest among unvaccinated persons without a previous COVID-19 diagnosis (Table 2) (Figure). In the pre-Delta period during June 13–June 26, for example, compared with hospitalization rates among unvaccinated persons without a previous COVID-19 diagnosis, hospitalization rates were 27.7-fold lower (95% CI = 22.4–33.0) among vaccinated persons without a previous COVID-19 diagnosis, 6.0-fold lower (95% CI = 3.3–8.7) among unvaccinated persons with a previous COVID-19 diagnosis, and 7.1-fold lower (95% CI = 4.0–10.3) among vaccinated persons with a previous COVID-19 diagnosis. However, this pattern also shifted as the Delta variant became predominant. During October 3–16, compared with hospitalization rates among unvaccinated persons without a previous COVID-19 diagnosis, hospitalization rates were 19.8-fold lower (95% CI = 18.2–21.4) among vaccinated persons without a previous COVID-19 diagnosis, 55.3-fold lower (95% CI = 27.3–83.3) among unvaccinated persons with a previous COVID-19 diagnosis, and 57.5-fold lower (95% CI = 29.2–85.8) among vaccinated persons with a previous COVID-19 diagnosis.

Among the two cohorts with a previous COVID-19 diagnosis, no consistent incidence gradient by time since the previous diagnosis was observed (Supplementary Figure 3, https://stacks.cdc.gov/view/cdc/113253). When the vaccinated cohorts were stratified by the vaccine product received, among vaccinated persons without a previous COVID-19 diagnosis, the highest incidences were observed among persons receiving the Janssen (Johnson & Johnson), followed by Pfizer-BioNTech, then Moderna vaccines (Supplementary Figure 4, https://stacks.cdc.gov/view/cdc/113253). No pattern by product was observed among vaccinated persons with a previous COVID-19 diagnosis.

Discussion

This analysis integrated laboratory testing, hospitalization surveillance, and immunization registry data in two large states during May–November 2021, before widespread circulation of the SARS-CoV-2 Omicron variant and before most persons had received additional or booster COVID-19 vaccine doses to protect against waning immunity. Rate estimates from the analysis describe different experiences stratified by COVID-19 vaccination status and previous COVID-19 diagnosis and during times when different SARS-CoV-2 variants predominated. Case rates were initially lowest among vaccinated persons without a previous COVID-19 diagnosis; however, after emergence of the Delta variant and over the course of time, incidence increased sharply in this group, but only slightly among both vaccinated and unvaccinated persons with previously diagnosed COVID-19 (6). Across the entire study period, persons with vaccine- and infection-derived immunity had much lower rates of hospitalization compared with those in unvaccinated persons. These results suggest that vaccination protects against COVID-19 and related hospitalization and that surviving a previous infection protects against a reinfection. Importantly, infection-derived protection was greater after the highly transmissible Delta variant became predominant, coinciding with early declining of vaccine-induced immunity in many persons (5). Similar data accounting for booster doses and as new variants, including Omicron, circulate will need to be assessed.

The understanding and epidemiology of COVID-19 has shifted substantially over time with the emergence and circulation of new SARS-CoV-2 variants, introduction of vaccines, and changing immunity as a result. Similar to the early period of this study, two previous U.S. studies found more protection from vaccination than from previous infection during periods before Delta predominance (3,7). As was observed in the present study after July, recent international studies have also demonstrated increased protection in persons with previous infection, with or without vaccination, relative to vaccination alone†††, §§§ (4). This might be due to differential stimulation of the immune response by either exposure type.¶¶¶ Whereas French and Israeli population-based studies noted waning protection from previous infection, this was not apparent in the results from this or other large U.K. and U.S. studies**** (4,8). Further studies are needed to establish duration of protection from previous infection by variant type, severity, and symptomatology, including for the Omicron variant.

The findings in this report are subject to at least seven limitations. First, analyses were not stratified by time since vaccine receipt, but only by time since previous diagnosis, although earlier studies have examined waning of vaccine-induced immunity (Supplementary Figure 3, https://stacks.cdc.gov/view/cdc/113253) (2). Second, persons with undiagnosed infection are misclassified as having no previous COVID-19 diagnosis; however, this misclassification likely results in a conservative bias (i.e., the magnitude of difference in rates would be even larger if misclassified persons were not included among unvaccinated persons without a previous COVID-19 diagnosis). California seroprevalence data during this period indicate that the ratio of actual (presumptive) infections to diagnosed cases among adults was 2.6 (95% CI = 2.2–2.9).†††† Further, California only included NAAT results, whereas New York included both NAAT and antigen test results. However, antigen testing made up a smaller percentage of overall testing volume reported in California (7% of cases) compared with New York (25% of cases) during the study period. Neither state included self-tests, which are not easily reportable to public health. State-specific hazard ratios were generally comparable, although differences in rates among unvaccinated persons with a previous COVID-19 diagnosis were noteworthy. Third, potential exists for bias related to unmeasured confounding (e.g., behavioral or geographic differences in exposure risk) and uncertainty in the population size of the unvaccinated group without a previous COVID-19 diagnosis. Persons might be more or less likely to receive testing based on previous diagnosis or vaccination status; however, different trajectories between vaccinated persons with and without a previous COVID-19 diagnosis, and similar findings for cases and hospitalizations, suggest that these biases were minimal. Fourth, this analysis did not include information on the severity of initial infection and does not account for the full range of morbidity and mortality represented by the groups with previous infections. Fifth, this analysis did not ascertain receipt of additional or booster COVID-19 vaccine doses and was conducted before many persons were eligible or had received additional or booster vaccine doses, which have been shown to confer additional protection.§§§§ Sixth, some estimates lacked precision because of sample size limitations. Finally, this analysis was conducted before the emergence of the Omicron variant, for which vaccine or infection-derived immunity might be diminished.¶¶¶¶ This study offers a surveillance data framework to help evaluate both infections in vaccinated persons and reinfections as new variants continue to emerge.

Vaccination protected against COVID-19 and related hospitalization, and surviving a previous infection protected against a reinfection and related hospitalization during periods of predominantly Alpha and Delta variant transmission, before the emergence of Omicron; evidence suggests decreased protection from both vaccine- and infection-induced immunity against Omicron infections, although additional protection with widespread receipt of booster COVID-19 vaccine doses is expected. Initial infection among unvaccinated persons increases risk for serious illness, hospitalization, long-term sequelae, and death; by November 30, 2021, approximately 130,781 residents of California and New York had died from COVID-19. Thus, vaccination remains the safest and primary strategy to prevent SARS-CoV-2 infections, associated complications, and onward transmission. Primary COVID-19 vaccination, additional doses, and booster doses are recommended by CDC’s Advisory Committee on Immunization Practices to ensure that all eligible persons are up to date with COVID-19 vaccination, which provides the most robust protection against initial infection, severe illness, hospitalization, long-term sequelae, and death.***** Additional recommendations for vaccine doses might be warranted in the future as the virus and immunity levels change.

Acknowledgments

Dana Jaffe, California Department of Public Health; Rebecca Hoen, Meng Wu, New York State Department of Health; Citywide Immunization Registry Program, New York City Department of Health and Mental Hygiene.

Corresponding author: Tomás M. León, tomas.leon@cdph.ca.gov.


1California Department of Public Health; 2New York State Department of Health; 3University at Albany School of Public Health, SUNY, Rensselaer, New York; 4CDC.

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

 https://covid.cdc.gov/covid-data-tracker/#cases_deathsper100klast7days

 Statewide immunization databases in California are the California Immunization Registry, Regional Immunization Data Exchange, and San Diego Immunization Registry; the laboratory system is the California COVID Reporting System (CCRS). In New York, immunization information systems include Citywide Immunization Registry and the New York State Immunization Information System; the laboratory system is the Electronic Clinical Laboratory Reporting System (ECLRS). California data were matched between the immunization and case registries using a probabilistic algorithm with exact match for zip code and date of birth and fuzzy match on first name and last name. New York data were matched to the ECLRS with the use of a deterministic algorithm based on first name, last name, and date of birth. In California, person-level hospitalization data from CCRS and supplementary hospitalization reports were used to identify COVID-19–associated hospitalizations.

§ For both classification into cohorts of persons with previous COVID-19 diagnoses and for measuring incident cases, laboratory-confirmed infection was defined as the receipt of a new positive SARS-CoV-2 nucleic acid amplification test (NAAT) or antigen test (both for New York and NAAT only for California) result, but not within 90 days of a previous positive result.

 Fully vaccinated with the primary vaccination series is defined as receipt of a second dose of an mRNA COVID-19 vaccine (Pfizer-BioNTech or Moderna) or 1 dose of the Janssen (Johnson & Johnson) vaccine ≥14 days before May 30, 2021.

** Because of the timing of full vaccination, the cohort definitions, and analysis timeframe, this cohort consisted nearly exclusively of persons who had previously received a laboratory-confirmed diagnosis of COVID-19 and later were fully vaccinated (California: 99.9%, New York: 99.7%), as opposed to the reverse order.

†† Whereas vaccinated cohorts were directly observed in the immunization information system databases, unvaccinated persons without a previous COVID-19 diagnosis were defined using U.S. Census population estimates minus the number of persons partially or fully vaccinated by December 11, 2021, and unvaccinated persons with a previous laboratory-confirmed infection before May 30, 2021. In California, the California Department of Finance population estimates were used for 2020, and the 2018 CDC National Center for Health Statistics Bridged Race file for U.S. Census population estimates were used in New York, consistent with other COVID-19 surveillance reporting.

§§ In California, a person-level match was performed to exclude deaths in each cohort before May 30, 2021. In New York, COVID-19 deaths were removed in aggregate from the starting number of unvaccinated persons with a previous COVID-19 diagnosis on May 30, 2021.

¶¶ https://www.cdc.gov/nchs/data/statnt/statnt20.pdfpdf icon

*** https://covid.cdc.gov/covid-data-tracker/#variant-proportions

††† https://www.medrxiv.org/content/10.1101/2021.09.12.21263461v1external icon

§§§ https://www.medrxiv.org/content/10.1101/2021.11.29.21267006v1external icon

¶¶¶ https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/vaccine-induced-immunity.html#anchor_1635540449320

**** https://www.medrxiv.org/content/10.1101/2021.12.04.21267114v1external icon

†††† https://www.medrxiv.org/content/10.1101/2021.12.09.21267565v1external icon

§§§§ https://covid.cdc.gov/covid-data-tracker/#rates-by-vaccine-status

¶¶¶¶ https://www.medrxiv.org/content/10.1101/2021.12.30.21268565v1external iconhttps://www.medrxiv.org/content/10.1101/2022.01.07.22268919v1external icon

***** https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html

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  8. Kim P, Gordon SM, Sheehan MM, Rothberg MB. Duration of SARS-CoV-2 natural immunity and protection against the Delta variant: a retrospective cohort study. Clin Infect Dis 2021. Epub December 3, 2021. https://doi.org/10.1093/cid/ciab999external icon PMID:34864907external icon

Increases in COVID-19 are unrelated to levels of vaccination across 68 countries and 2947 counties in the United States

Authors: S. V. Subramanian & Akhil Kumar  European Journal of Epidemiology (2021)

Vaccines currently are the primary mitigation strategy to combat COVID-19 around the world. For instance, the narrative related to the ongoing surge of new cases in the United States (US) is argued to be driven by areas with low vaccination rates [1]. A similar narrative also has been observed in countries, such as Germany and the United Kingdom [2]. At the same time, Israel that was hailed for its swift and high rates of vaccination has also seen a substantial resurgence in COVID-19 cases [3]. We investigate the relationship between the percentage of population  fully vaccinated and new COVID-19 cases across 68 countries and across 2947 counties in the US.

Methods

We used COVID-19 data provided by the Our World in Data for cross-country analysis, available as of September 3, 2021 (Supplementary Table 1) [4]. We included 68 countries that met the following criteria: had second dose vaccine data available; had COVID-19 case data available; had population data available; and the last update of data was within 3 days prior to or on September 3, 2021. For the 7 days preceding September 3, 2021 we computed the COVID-19 cases per 1 million people for each country as well as the percentage of population that is fully vaccinated.

For the county-level analysis in the US, we utilized the White House COVID-19 Team data [5], available as of September 2, 2021 (Supplementary Table 2). We excluded counties that did not report fully vaccinated population percentage data yielding 2947 counties for the analysis. We computed the number and percentages of counties that experienced an increase in COVID-19 cases by levels of the percentage of people fully vaccinated in each county. The percentage increase in COVID-19 cases was calculated based on the difference in cases from the last 7 days and the 7 days preceding them. For example, Los Angeles county in California had 18,171 cases in the last 7 days (August 26 to September 1) and 31,616 cases in the previous 7 days (August 19–25), so this county did not experience an increase of cases in our dataset. We provide a dashboard of the metrics used in this analysis that is updated automatically as new data is made available by the White House COVID-19 Team (https://tiny.cc/USDashboard).

Findings

At the country-level, there appears to be no discernable relationship between percentage of population fully vaccinated and new COVID-19 cases in the last 7 days (Fig. 1). In fact, the trend line suggests a marginally positive association such that countries with higher percentage of population fully vaccinated have higher COVID-19 cases per 1 million people. Notably, Israel with over 60% of their population fully vaccinated had the highest COVID-19 cases per 1 million people in the last 7 days. The lack of a meaningful association between percentage population fully vaccinated and new COVID-19 cases is further exemplified, for instance, by comparison of Iceland and Portugal. Both countries have over 75% of their population fully vaccinated and have more COVID-19 cases per 1 million people than countries such as Vietnam and South Africa that have around 10% of their population fully vaccinated.

figure1

Across the US counties too, the median new COVID-19 cases per 100,000 people in the last 7 days is largely similar across the categories of percent population fully vaccinated (Fig. 2). Notably there is also substantial county variation in new COVID-19 cases within categories of percentage population fully vaccinated. There also appears to be no significant signaling of COVID-19 cases decreasing with higher percentages of population fully vaccinated (Fig. 3).

Fig. 2

figure2

Median, interquartile range and variation in cases per 100,000 people in the last 7 days across percentage of population fully vaccinated as of September 2, 2021Full size image

figure3

Of the top 5 counties that have the highest percentage of population fully vaccinated (99.9–84.3%), the US Centers for Disease Control and Prevention (CDC) identifies 4 of them as “High” Transmission counties. Chattahoochee (Georgia), McKinley (New Mexico), and Arecibo (Puerto Rico) counties have above 90% of their population fully vaccinated with all three being classified as “High” transmission. Conversely, of the 57 counties that have been classified as “low” transmission counties by the CDC, 26.3% (15) have percentage of population fully vaccinated below 20%.

Since full immunity from the vaccine is believed to take about 2 weeks after the second dose, we conducted sensitivity analyses by using a 1-month lag on the percentage population fully vaccinated for countries and US counties. The above findings of no discernable association between COVID-19 cases and levels of fully vaccinated was also observed when we considered a 1-month lag on the levels of fully vaccinated (Supplementary Figure 1, Supplementary Figure 2).

We should note that the COVID-19 case data is of confirmed cases, which is a function of both supply (e.g., variation in testing capacities or reporting practices) and demand-side (e.g., variation in people’s decision on when to get tested) factors.

Interpretation

The sole reliance on vaccination as a primary strategy to mitigate COVID-19 and its adverse consequences needs to be re-examined, especially considering the Delta (B.1.617.2) variant and the likelihood of future variants. Other pharmacological and non-pharmacological interventions may need to be put in place alongside increasing vaccination rates. Such course correction, especially with regards to the policy narrative, becomes paramount with emerging scientific evidence on real world effectiveness of the vaccines.

For instance, in a report released from the Ministry of Health in Israel, the effectiveness of 2 doses of the BNT162b2 (Pfizer-BioNTech) vaccine against preventing COVID-19 infection was reported to be 39% [6], substantially lower than the trial efficacy of 96% [7]. It is also emerging that immunity derived from the Pfizer-BioNTech vaccine may not be as strong as immunity acquired through recovery from the COVID-19 virus [8]. A substantial decline in immunity from mRNA vaccines 6-months post immunization has also been reported [9]. Even though vaccinations offers protection to individuals against severe hospitalization and death, the CDC reported an increase from 0.01 to 9% and 0 to 15.1% (between January to May 2021) in the rates of hospitalizations and deaths, respectively, amongst the fully vaccinated [10].

In summary, even as efforts should be made to encourage populations to get vaccinated it should be done so with humility and respect. Stigmatizing populations can do more harm than good. Importantly, other non-pharmacological prevention efforts (e.g., the importance of basic public health hygiene with regards to maintaining safe distance or handwashing, promoting better frequent and cheaper forms of testing) needs to be renewed in order to strike the balance of learning to live with COVID-19 in the same manner we continue to live a 100 years later with various seasonal alterations of the 1918 Influenza virus.

References

  1. 1.Vaccinations CDC. CDC COVID data tracker. Centers for Disease Control and Prevention. 2021. https://covid.cdc.gov/covid-data-tracker/#vaccinations.
  2. 2.Nicolas E. Germany mulls restrictions for unvaccinated as cases soar. EUobserver; 2021. https://euobserver.com/coronavirus/152534.
  3. 3.Estrin D. Highly vaccinated Israel is seeing a dramatic surge in New COVID cases. Here’s why. NPR; 2021. https://www.npr.org/sections/goatsandsoda/2021/08/20/1029628471/highly-vaccinated-israel-is-seeing-a-dramatic-surge-in-new-covid-cases-heres-why.
  4. 4.Ritchie H, Ortiz-Ospina E, Beltekian D, Mathieu E, Hasell J, Macdonald B, Giattino C, Appel C, Rodés-Guirao L, Roser M. Coronavirus pandemic (COVID-19). 2020. Published online at OurWorldInData.org. Retrieved from: https://ourworldindata.org/coronavirus.
  5. 5.White House COVID-19 Team. COVID-19 community profile report. 2020. HealthData.gov. https://healthdata.gov/Health/COVID-19-Community-Profile-Report/gqxm-d9w9.
  6. 6.Ministry of Health Israel. Two-dose vaccination data. Government of Israel; 2021. https://www.gov.il/BlobFolder/reports/vaccine-efficacy-safety-follow-up-committee/he/files_publications_corona_two-dose-vaccination-data.pdf.
  7. 7.Thomas SJ, Moreira ED, Kitchin N, Absalon J, Gurtman A, Lockhart S, Perez JL, et al. Six Month safety and efficacy of the BNT162b2 Mrna Covid-19 vaccine. MedRxiv. 2021. https://doi.org/10.1101/2021.07.28.21261159.Article PubMed PubMed Central Google Scholar 
  8. 8.Gazit S, Shlezinger R, Perez G, Lotan R, Peretz A, Ben-Tov A, Cohen D, Muhsen K, Chodick G, Patalon T. Comparing sars-cov-2 natural immunity to vaccine-induced immunity: reinfections versus breakthrough infections. MedRxiv. 2021. https://doi.org/10.1101/2021.08.24.21262415.Article Google Scholar 
  9. 9.Canaday DH, Oyebanji OA, Keresztesy D, Payne M, Wilk D, Carias L, Aung H, Denis KS, Lam EC, Rowley CF, Berry SD, Cameron CM, Cameron MJ, Wilson B, Balazs AB, King CL, Gravenstein S. Significant reduction in humoral Immunity among healthcare workers and nursing home residents 6 months AFTER COVID-19 BNT162b2 mRNA vaccination. MedRxiv. 2021. https://doi.org/10.1101/2021.08.15.21262067.Article PubMed PubMed Central Google Scholar 
  10. 10.McMorrow M. (rep.). Improving communications around vaccine breakthrough and vaccine effectiveness. 2021. Retrieved from https://context-cdn.washingtonpost.com/notes/prod/default/documents/8a726408-07bd-46bd-a945-3af0ae2f3c37/note/57c98604-3b54-44f0-8b44-b148d8f75165.

US Covid-19 Breakthrough Infections-are-Uncommon Rising Considerably and D-19 Breakthrough Infections are Uncommon, Rising Considerably, and Sort of Okay

Authors: PETER WEBER 5:20 AM

The Biden administration is advising eight-month booster shots for Americans vaccinated with the Pfizer and Moderna COVID-19 vaccines because the Delta variant, which now accounts for about 98.8 percent of new U.S. infections, is a lot more contagious and the effectiveness of the vaccines appears to wane with time. 

“Fortunately,” the COVID-19 vaccines are “still holding at a high level” of protection from hospitalization and death, Surgeon General Vivek Murthy said Wednesday. “But our anticipation is that if the trajectory that we are seeing continues … we will likely see in the future an increase in breakthrough hospitalizations and breakthrough deaths” without boosters.

Even as the Delta variant surges, “COVID-19 breakthrough cases remain uncommon,” The Wall Street Journal reports, citing its own analysis of data from health departments in 44 states and Washington, D.C. In those states, about 0.1 percent of vaccinated residents got COVID between Jan. 1 and early August, the Journal found.

“This continues to be ‘a pandemic of the unvaccinated,'” but “breakthrough infections accounted for 12 percent to 24 percent of COVID-related hospitalizations” in seven states keeping detailed records, The New York Times reports, citing its analysis. Those breakthrough cases are mostly among older or immunocompromised adults — in Oregon, for example, the median age for a breakthrough-associated death is 83, and 74 percent of breakthrough cases nationwide are among people 65 and older, federal data show. 

The overall numbers remain small, but it’s pretty clear “the chances of a breakthrough infection have gone up considerably,” U.C. San Francisco’s Dr. Robert Wachter tells the Times. “Remember when the early vaccine studies came out, it was like nobody gets hospitalized, nobody dies,” he added. “That clearly is not true.”

“Let’s be real, here: Breakthrough infections are sort of okay,” Larry Corey, a virologist at Seattle’s Fred Hutchinson Cancer Research Center, tells the Journal. “You get infected and you have a cold, maybe an achy fever for 24 hours. But you don’t end up in the hospital, and you don’t end up with that 2.5 percent chance of dying once you are hospitalized.”

“All we’re really seeing, with vaccine breakthrough cases that come into the hospital, are people who are over 80 or have a compromised immune system,” adds Jorge Bernett, an infectious disease specialist with John Muir Health in Walnut Creek, California. “Basically everyone who is on a ventilator is unvaccinated.”

Resolving “Long-Haul COVID” and Vaccine Toxicity: Neutralizing the Spike Protein

Authors: Dr. Thomas E. Levy, MD, JD July 1, 2021

Although the mainstream media outlets might have you believe otherwise, the vaccines that continue to be administered for the COVID pandemic are emerging as substantial sources of morbidity and mortality themselves. While the degree to which these negative outcomes of the COVID vaccines can be debated, there is no question that enough disease and death have already occurred to warrant cessation of the administration of these vaccines until additional scientifically-based research can examine the balance between its now clear-cut side effects versus its potential (and still not yet clearly proven) ability to prevent new COVID infections.

Nevertheless, enough vaccinations have already been administered to warrant concern that a new “pandemic” of illness and death may well be emerging from the side effects that continue to be documented in steadily increasing numbers. The vaccine-induced “culprit” that is now receiving most of the attention and is the focus of much new research is the COVID virus fragment known as the spike protein. Its physiological impact appears to be doing far more harm than good (COVID antibody induction), and its manner of introduction appears to be fueling its ongoing replication with a continuing presence inside the body for an indefinite length of time.

The physical appearance of the COVID virus can been depicted as a central sphere of viral protein surrounded completely by spear-like appendages. Known as spike proteins, they are very analogous to the quills surrounding a porcupine. And just as the porcupine stabs its victim, these spike proteins penetrate into cell membranes throughout the body. After this penetration, protein-dissolving enzymes are activated, the cell membrane breaks down, the viral sphere enters the cytoplasm through this membrane breach, and the metabolism of the cell is subsequently “hijacked” to manufacture more viral particles. These spike proteins are the focus of a great deal of ongoing research examining vaccine side effects (Belouzard et al., 2012; Shang et al., 2020).The Spike Protein’s Toxic Effects in the Body The spike protein first attaches to ACE2 (angiotensin converting enzyme 2) receptors in the cell membranes (Pillay, 2020). This initial binding step is vital to triggering the subsequent sequence of events that brings the virus inside the cell. When this binding is blocked by competition or prompt enough displacement with an appropriate therapeutic agent, the virus cannot enter the cell, the infectious process is effectively stopped, and the immune defenses of the body are freed to mop up, metabolize, and eliminate the viral pathogens, or just the spike protein alone if free and no longer attached to a viral particle.Although ACE2 is found in many different cells throughout the body, it is especially noteworthy to realize that it is the initial target bound by coronavirus on the epithelial cells lining the airways after pathogen inhalation (Hoffmann et al., 2020). ACE2 expression (concentration) is also especially high on lung alveolar epithelial cells (Alifano et al., 2020). This cell membrane-bound virus can then begin the process that eventually results in the severe acute respiratory syndrome (SARS) seen in clinically-advanced COVID infections (Perrotta et al., 2020; Saponaro et al., 2020). The SARS presentation manifests most clearly when the degree of oxidative stress in the lungs is very elevated. This stage of COVID infection-related extreme oxidative stress is often referred to in the literature as a cytokine storm, and left unchecked this invariably leads to death (Hu et al., 2021).Increasing concern has focused on the continued presence of the spike protein in the blood by itself, unattached to a virion, following COVID vaccination. Supposedly intended to initiate an immune response to the entire virus particle, the spike protein injections are disseminating throughout the body rather than staying put in the upper arm at the vaccine site while the immune response to it evolves. Furthermore, it also appears that these circulating spike proteins can enter cells on their own and replicate themselves without attached virus particles. This not only wreaks havoc inside those cells, it helps to assure the indefinite presence of the spike protein throughout the body.It has also been suggested that large amounts of spike protein are just binding ACE2 receptors and not proceeding any further into the cell, effectively blocking or disabling normal ACE2 function in a given tissue. Additionally, when the spike protein binds a cell wall and “stops” there, the spike protein serves as a hapten (antigen) which can then initiate an autoimmune (antibody or antibody-like) response to the cell itself, rather than to the virus particle to which it is usually attached. Depending on the cell types to which such spike proteins bind, a wide variety of diseases with autoimmune qualities can result.Finally, another worrisome property of the spike protein which alone would be of great concern is that the spike protein itself appears to be highly toxic. This intrinsic toxicity, along with the apparent ability of the spike protein to replicate itself indefinitely within the cells it enters, probably represents the way in which the vaccine can inflict its worst long-term damage, as the production of this toxin can continue indefinitely without other external factors at play.In fact, the long-haul COVID syndrome likely represents a low-grade unresolved smoldering COVID infection with the same kind of spike protein persistence and clinical impact as is seen in many individuals after their COVID vaccinations (Mendelson et al., 2020; Aucott and Rebman, 2021; Raveendran, 2021).

For More Information: https://vitalitymagazine.com/article/resolving-long-haul-covid-and-vaccine-toxicity-neutralizing-the-spike-protein/

New Covid-19 Hospitalizations for 30- to 39-Year-Olds at Record Rate

Group largely avoided hospitals earlier in pandemic, but highly contagious Delta variant and lagging vaccination rates have changed health outcomes

Authors: By Melanie Evans and Taylor Umlauf

Hospitalizations of Covid-19 patients in their 30s have hit a new record, U.S. government data show, a sign of the toll that the highly contagious Delta variant is taking among the unvaccinated.

Thirty-somethings, who are in prime ages for work and parenting, had largely avoided hospital stays for Covid-19 during earlier phases of the pandemic because of their relative good health.

Yet the age group is seeing new Covid-19 hospital admissions increase during the recent Delta-driven surge, which doctors and epidemiologists attribute to the failure of large numbers of Americans to get vaccinated and their highly active lives.

The rate at which adults ages 30 to 39 are entering hospitals with Covid-19 reached about 2.5 per 100,000 people as of last Wednesday, according to the latest data from the U.S. Centers for Disease Control and Prevention and Department of Health and Human Services, up from the previous peak of roughly 2 per 100,000 people in early January.

For More Information: https://www.wsj.com/articles/new-covid-19-hospitalizations-for-30-to-39-year-olds-at-record-rate-11628938800