THE B.1.351 VARIANT CAN BREAK THROUGH VACCINE PROTECTION BY 5.4%

How well Covid-19 vaccines work 

Daily BriefingHOW WELL COVID-19 VACCINES WORK AGAINST VARIANTS, ACCORDING TO THE LATEST RESEARCH.

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The state of coronavirus variants

According to The Hill, experts are scrambling to determine how well authorized vaccines perform against coronavirus variants because, in several countries, the variants are becoming the dominant version of the virus in circulation.

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For example, CDC Director Rochelle Walensky last week said the B.1.1.7 variant, which was first identified in the United Kingdom, is now the United States' dominant coronavirus strain, The Hill reports.

The P.1 variant, which was first detected in Brazil, is now the second-most prevalent version of the virus in the United States, and the country also has reported increasing cases of the B.1.351 variant, which was first detected in South Africa.

How effective are Covid-19 vaccines against variants?

There is limited research available on how currently authorized vaccines perform against the variants. However, the research that is available—although generally preliminary—suggest that several vaccines are fairly effective at protecting against both the original version of the virus and the range of variants emerging around the globe.

For instance, one study of Johnson & Johnson's vaccine—the distribution of which U.S. officials have temporarily paused—found it was 85% effective at preventing severe Covid-19 from the B.1.351 variant, which was first discovered in South Africa. Similarly, a small study of Pfizer/BioNTech's vaccine found it was up to 100% effective at preventing even mild cases from the B.1.351 variant.

However, some preliminary research suggests not all vaccines are so effective against all variants. For example, one study of the vaccine developed by Novavax—which has not been authorized for use in the United States—found that, although it's about 89% effective at preventing mild Covid-19 from the original strain of the coronavirus, that efficacy drops to about 50% against B.1.351.

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And several lab experiments—in which blood samples from vaccinated people are exposed to variants or manufactured "pseudo-virus" variants—suggest that the antibodies produced by the Moderna vaccine are less effective against B.1.351 than against the original version of the virus. According to NPR's "Goats and Soda," these experiments suggest it takes about eight times as many of the antibodies produced by the Moderna vaccine to neutralize the B.1.351 variant as to neutralize the original version of the virus.

That said, Salim Abdool Karim, an infectious disease researcher and co-chair of the Covid-19 advisory committee for South Africa, said he was not deeply concerned about those findings. "[T]he Moderna vaccine produces pretty high levels of antibodies," he said, "so there is enough antibody still to neutralize the virus."

However, Abdool Karim expressed more concern about the efficacy of AstraZeneca's vaccine, which has not been authorized in the United States, against certain variants. One very small study suggested that that vaccine was almost entirely ineffective at preventing mild cases of Covid-19 against B.1.351, and a separate experiment found that it takes 86 times as many antibodies from the AstraZeneca vaccine to neutralize B.1.351 as it does to neutralize the original strain of the virus.

"I'm basically not confident about [AstraZeneca's] vaccine at all" in mitigating B.1.351 infections, Abdool Karim said.

What a real-world study revealed about the Pfizer/BioNTech vaccine's effectiveness against variants

Amid these laboratory findings, researchers in Israel recently conducted the first real-world study—although still in pre-print—assessing the efficacy of the Pfizer/BioNTech vaccine against the B.1.1.7 and B.1.351 variants, with largely positive results.

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For the study, researchers compared almost 400 people in Israel who had been infected with the coronavirus after receiving at least one dose of the Pfizer/BioNTech vaccine with a control group of unvaccinated people who had similarly contracted the virus. Of those in the vaccinated group, 149 participants were infected at least one week after their second dose; the rest were infected more than two weeks following their first dose, but less than one week after their second dose.

Overall, the researchers found that the vaccine performed well against all the variants circulating in Israel. However, because the vaccine doesn't have 100% efficacy, a few breakthrough infections occurred among vaccinated people—and those infections, while generally not severe, were most likely to be caused by the B.1.351 variant.

Specifically, the researchers found that "vaccine effectiveness remains high" against the B.1.1.7 variant. "We see evidence for reduced vaccine effectiveness against the [B.1.1.7] variant, but after two doses, extremely high effectiveness kicks in," Adi Stern, a researcher at Tel Aviv University and senior author on the study, said.

However, the researchers found that B.1.351 accounted for 5.4% of breakthrough infections among people who had received both doses and just 0.7% of the infections among unvaccinated people. "This means that the [B.1.351] variant is able, to some extent, to break through the vaccine's protection," Stern said.

Even so, Stern noted that while the study wasn't able to pinpoint precisely how much lower the vaccine's efficacy was against the B.1.351 variant, she pointed out that "even if the [B.1.351] variant does break through the vaccine's protection, it has not spread widely through the population."

Separately, Richard Lessells, an infectious disease expert focusing on the B.1.351 variant, said he doesn't believe the results of this study should "worry us unduly."

The study results "seem to provide support to what we currently understand—that while the neutralizing antibody response is still developing post-vaccination and has not yet reached peak, there is still a risk of infection."

"It is always important to keep in mind that vaccine protection is never 100%," Stern said. "As long as case counts are high, even fully vaccinated individuals should take precautions" (CIDRAP News, 4/12; Aizenman, "Goats and Soda," NPR, 4/9; Schumaker, ABC News, 4/12; Stein, "Shots," NPR, 4/15; Choi, The Hill, 4/11; Williams, The Hill, 4/09).

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Humans are Diurnal through evolution.

Barking Up The Wrong Tree April 28th, 2021 Before we commence with the festivities, I wanted to thank everyone for helping my first book become a Wall Street Journal bestseller! To check it out, click here. This Is The Best Time To Do Anything: 6 Powerful Secrets From Research (Click here to read on the blog)  In 2007 the World Health Organization declared shift work a probable carcinogen. Yeah, you read that right: working at the wrong time can kill you. And cancer isn't the only problem it causes. If horror movies don't give you nightmares, the list of health problems associated with shift work will. So what's the deal here? Shift work messes with your circadian rhythm. Now "circadian rhythm" might sound to some like iffy pseudoscience. Far from it. It has so much credibility that it has incredibility. Michael Rosbash won the Nobel Prize in medicine in 2017 for his work on it. There are no two ways about it: humans are diurnal. We're designed to be awake when it's light out and asleep when it's dark. Sure, we can be nocturnal but we weren't built for it and if you stay on that schedule too long, things get wonky. Well, anyway, good thing we're not shift workers, right? Problem is, these days all of us basically are. From The Circadian Code: Professor Till Roenneberg, a researcher in Munich, surveyed more than 50,000 people in Europe and the United States and found that the majority of people either go to bed after midnight or wake up early with insufficient sleep. Similarly, people also follow different bedtime schedules on weekdays and weekends. This, combined with our bright screen use at night, means we're all living like shift workers to some degree. And our bodies weren't built for this. As we discussed in my recent post on exercise, the way we live our modern lives has "some problems” in the same way the Pacific Ocean has “some water.” Timing matters in life, even more than you think. We're not talking about clever productivity hacks here; we're talking about much more important stuff like your health. And biology doesn't like to negotiate. For your body, "no" is a complete sentence. So what do we do? Luckily, experts have answers. I went down the research rabbit hole and patched together insights from a number of fancy-pants sources: Satchin Panda at the Salk Institute for Biological Studies, Daniel Liebermanat Harvard, and Andrew Huberman at Stanford. They're gonna tell us how to get our circadian rhythm back on track for increased health, happiness and productivity. Let’s get to it... The Rhythm Is Gonna Get You Every cell and every organ in your body has a clock. And, if things are going right, they're synced up with the master clock in your brain: the SCN or "suprachiasmatic nucleus." Think of it like an old school heist movie: "Synchronize watches!" Because if things aren't in sync, your body is like a bad symphony. But instead of the bassoon and viola coming in later than they should, it's your hormones that are out of whack, leading to problems with energy levels, hunger, stress and overall health. This is, as they say, "important." Brass tacks: what is the most important factor when it comes to your circadian rhythm? Light. Our ancestors didn't have a lot of control over light. When the sun rose and set was not a very democratic process. We, however, have unprecedented control over the amount and timing of the light we're exposed to, leading to unprecedented problems. And this is why we're all shift workers now. Okay, clearly not good. So what do you need to do tomorrow morning to fix this? Uh, back up, fella. Tomorrow is too late. Most of the work has to start the night before. From The Circadian Code: Your performance at any moment during the day is primarily determined by what you did the night before—when you ate and how much you slept—because that is what sets your clock, which then primes your body and brain. Sounds akin to: "All battles are won or lost before they are ever fought." I guess Sun Tzu was a circadian expert. (To learn more about how you can lead a successful life, check out my bestselling book here.) So what do we need to do tonight to get everything back on track? Well, you've probably heard some rumblings about the evils of blue light. Actually, that's only partially true... Blue Light Isn't The Problem. All Light Is The Problem. Blue light sends the most powerful signal to your SCN that it is daytime, making it your worst enemy at night -- but it's not the only enemy. After dark, you want to reduce all light as much as possible. Light at night means less melatonin which means poor sleep which results in a foggy brain the next day. (Researchers have spent many sleepless nights studying this stuff.) Optimally, you want as little light as possible after 8PM. Sound unrealistic? Oh, it is. Hold on, it gets worse. I regret to inform you that as the day goes on, your retina actually becomes more sensitive to light. Indoor lights and screens that aren't powerful enough to wake you up and set your clock in the morning are more than enough to screw your clock up at night. From The Circadian Code: A mere 8 lux—a level of brightness exceeded by most table lamps and about twice that of a night-light—has an effect, notes Steven Lockley, a sleep researcher at Harvard. No, I'm not saying you need to sit around during the evening with your home as dark as a Nietzchean abyss, skulking about like a swampgoblin. I am well aware that nothing short of an EMP blast is going to stop us from watching TV and doing internet ablutions on smartphones. We just need to limit light as much as we reasonably can, and there are tricks we can leverage to help. The cells in your eyes most relevant to timing are primarily at the bottom of your retina -- so you want to reduce overhead lighting. Dim lights set low in a room are a good idea. (And candlelight does not trigger these cells much at all.) Use the "Nightshift" feature on Apple devices (or the equivalent) to reduce blue light. And if you want to go for the nuclear option, check out Drift TV, which gradually removes blue light from your television screen at night. I know what some people are thinking: "Oh, that won't work for me. I'm a night owl." Ummm, maybe not. I've been a card-carrying night owl my entire life. Everybody talks about the early bird, but I have always lived in fear of being the early worm. Telling me I should go to bed early makes me want to reach for something sharp. I thought it was just how I was wired. Guess what? I was wrong. Researcher Ken Wright Jr. at the University of Colorado, Boulder, did a study where he took night owls camping. No artificial light. Guess what happened? Yup. In a matter of days they stopped being night owls and were all in bed by 10PM. Maybe you're an exception, but to my chagrin, I'm not. Keeping the house dark at night, through some sort of Blakean alchemy, has transformed this night owl into an early riser. You might want to give it a shot. (To learn how to make emotionally intelligent friendships, click here.) Okay, light is the number one thing when it comes to getting our clocks right. But it's not the only thing... Your Stomach Is Not An All-Night Diner Eating is another signal that tells your body it's daytime. Also, there's plenty of research on how healthy “time-restricted eating” is and, yes, it looks like those intermittent fasting folks are on to something. Satchin Panda found that people who got all their calories in an 8-11 hour window and stopped eating 3 hours before bed were notably healthier. I know, I know -- late night snacks are one of the things that makes life worth living. I agree. But if we sacrifice the unmitigated glory of munching after dark, what benefit do we get? Super productivity and focus. From The Circadian Code: Studies have shown that both modest fasting and exercise have a similar brain-boosting effect. Each of them can increase a chemical called brain-derived neurotropic factor (BDNF) that improves the connection between brain cells and improves brain function. When you have plenty of BDNF combined with a good night’s sleep, your brain is better prepared for performing complex tasks, staying focused, and being productive, so you can complete the same amount of work in less time. Eating a late-night meal negatively affects your ability to pay attention the next day. (To learn the two-word morning ritual that will make you happy all day, click here.) Okay, everybody says getting enough sleep is important. Definitely true. But when it comes to your circadian rhythm, it's not just about the amount... Be Consistent You need around seven hours of sleep. More for kids, less for older folks. Sleeping notably less -- or more -- than seven hours is associated with a shorter lifespan. From Exercised: ...numerous studies using better data and sophisticated methods to correct for factors like age, illness, and income have confirmed that people who sleep about seven hours tend to live longer than those who sleep more or less. In no study is eight hours optimal, and in most of the studies people who got more than seven hours had shorter life spans than those who got less than seven hours (an unresolved issue, however, is whether it would be beneficial for long sleepers to reduce their sleep time). But the thing that very rarely gets talked about is consistency. It's huge. Studies show kids that sleep a consistent amount every night get better grades. Timing and consistency is a good idea across the board. Having a regular schedule for when you wake up, when you have your first and last meal, when you dim the lights, and when you go to sleep is a powerful combo. Satchin Panda says if any of these factors shift by two hours over the course of a week, it's an issue. If they all do, that's a big issue. (To learn how to live a long awesome life, click here.) Okay, we have our evenings down. But what's important when you wake up in the morning? Well, turns out what you do then is the most important factor of them all... The Most Important Event Of The Day Satchin Panda's words, not mine: “When (and how) you wake up is the most important event of the day.” And the key event here is getting bright light in your eyes early to set your master clock. If your only outdoor activity is collecting Amazon packages from your doorstep and you tend to get as much morning light as a mole rat, take note. Live like a Morlock and you're going to be less chipper, less energetic and the word "metastatic" may be in your future. From The Circadian Code: In modern times, an average person spends more than 87 percent of their time indoors; we average only 2½ hours outdoors, half of which is often after sunset. Our indoor light environment may be disrupting our circadian rhythm and compromising our mood. So if you forget everything else I have written here, remember this: Right after you wake up, go outside and get sunlight into your eyeballs.  Yes, you need to go outside. Remember, your retinas are more sensitive at night, meaning they are less sensitive in the morning. You need ~100,000 lux before 9AM. Don't worry, that only takes about 2-10 minutes depending on how bright it is outside. But digital screens are only 500-1000 lux and that just ain't enough photons. It's important to get this as early as possible to set your clock properly. The relevant cells in your eyes are awfully particular. They respond best to light at "low solar angle." So once the sun is overhead, it's not the same. Blue light in the morning is a good thing, so appreciate that morning sky. No, do not stare directly into the sun. The negative effects of this are obvious: you will be blind and unable to read my future blog posts. (To learn the 4 harsh truths that will make you a better person, click here.) So your clock is set. Once you're firing on all chronological cylinders, when will you be sharpest and most productive during the day? Best Time For Brain Work You'll be sharpest between 10AM and 3PM. This is when you want to do your thinky work. From The Circadian Code: Your optimal brain function is highest between 10:00 a.m. and 3:00 p.m.; that’s when you should notice that your best work or learning is done. Studies have shown that this is the window during which we are in the right frame of mind for making good decisions, solving multifaceted problems, and navigating complicated social situations. Still not feeling awake? Kinda cranky? You may need even more early sunlight. Indoor light isn't enough to get your brain up to top speed during the day (but it sure is enough to screw you up at night.) From The Circadian Code: You need at least 1 hour of daylight exposure—being outside, driving in your car, sitting by a window where you can soak up at least 1,000 lux of light—to reduce sleepiness, synchronize your clock, perk up your mood, and stay happy and productive throughout the day. (To learn how to stop being lazy and get more done, click here.) What about when sunlight isn't enough? Still tired throughout the day? Well, there's another powerful influence on your circadian rhythm that can help... Exercising Keeps The Rhythm Exercise has a huge effect on how well you sleep at night and how energetic you feel the next day. From Exercised: One survey of more than twenty-six hundred Americans of all ages that controlled for factors like weight, age, health status, smoking, and depression found that those who regularly engaged in at least 150 minutes of moderate to vigorous activity a week not only reported a 65 percent improvement in sleep quality but also were less likely to feel overly sleepy during the day. The most important thing about exercise is just to do it at all. That said, timing still helps. Doing it early in the day improves energy levels and mood but the optimal time is between 3PM and dinner. So, if you can swing it, try to work out between finishing work and eating your final meal. An intense workout later at night can spike cortisol and mess with sleep, but if you can't hit the gym earlier, there's a hack that can help. Eating and exercising primarily alter circadian rhythm by increasing body temperature, so if you do either one late but still want a good night's sleep, the trick is to take a shower before hitting the sack. This will help your body cool down and get ready for beddy-bye. (For more on how to motivate yourself to exercise, click here.) Okay, we've covered a lot. No longer can anyone say you don't have rhythm. Let's round everything up and learn the secret to how you can enjoy (a little) extra light and screen time at night without wreaking havoc... Sum Up Timing matters. Here's what to do: It's not just blue light, it's all light: Biology says when the sun goes down, you should too. Do the next best thing: kill overhead lights and dim everything else. Your stomach is not an all-night diner: You want to be eating all your calories in less than half the day and none 3 hours before bed. Apparently, starving in the dark is good for you. Be consistent: Sleeping in on the weekend means you're doing it wrong during the week. Your physiology does not like an unpredictable schedule and it will seek vengeance. The most important event of the day: Wake up, go outside, and get many many photons into your eyeballs. Best time for brain work: 10AM to 3PM. And this reformed-night-owl writer now finds that's when I really have a "way with words." After 3PM, well, uh... not have way. Exercise keeps the rhythm: Best time is after work but before dinner. If you have to work out late, use the shower trick. Yes, you really should do this every day. I don't make the rules. The only part of life where you get time off for good behavior is prison. That said, there is a trick for sneaking in a little extra screen time in the evening without causing problems. Stanford University professor Andrew Huberman says getting outside for 2-10 minutes around sunset can help keep your internal clock calibrated. A little more of that low solar angle magic light tells your SCN "must be nighttime" and can help defend against the negatives of evening light. Yes, medical science insists you enjoy more sunsets. No doubt, in the modern world, keeping your circadian rhythm humming properly can be challenging. But it's worth it to feel more energized and happy during the day, to sleep better at night and give yourself a much better shot at long term health. We're often our own worst enemy, and that also means we're our own worst victim. Timing is everything in life but we're often too focused on the timing of external things when the really important stuff is internal. So synchronize watches. This heist is an inside job. ***And if you want a daily insight, quote or laugh, you should follow me on Instagram here.***  Email Extras Findings from around the internet...  + Want to learn the workplace skill that can actually make your entire life much happier? Click here.  + Want to know what makes a mentor great? Click here. (Many thanks to the excellent Dan Pink.)  + Want to know how to be a better writer -- from one of the greats? Click here.  + Miss last week's post? Here you go: This Is How To Have A Long Awesome Life: 5 Secrets From Research.  + Want a lot of great info on how to be happier? Click here.  + You read to the end of the email. I feel that our clocks are in sync -- and that warms my heart. Thank you. Okay, Crackerjack Time: Last week I received a barrage of messages via email, Twitter, Facebook, LinkedIn and even a few via smoke signal and semaphore. What happened? One of the most flattering things ever: my book was a question on "Jeopardy." I cannot express in words how good that felt. And it would not have been possible without all the wonderful people who have supported my work -- that means you. So thanks again. You are amazing. (And if you're curious to see the question, I've posted it here.) Thanks for reading! Eric  PS: If a friend forwarded this to you, you can sign up to get the weekly email yourself here.

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Robert M. Wachter is chair of the department of medicine at the University of California at San Francisco and host of the podcast “In the Bubble.”

If covid-19 has taught us anything, it’s that nothing is straightforward. We know that people who are fully vaccinated are greatly protected against infection and serious illness and are far less likely to transmit covid-19 to others. The vaccines truly are a miracle.

But here’s the bad news: Life has become even riskier for unvaccinated people, particularly those who have never had covid-19. (People with prior infections fall into a middle category, since they are at least partly protected but still require vaccination to increase the level and durability of immunity.)

The reasons that the unvaccinated are at higher risk are biological, behavioral and political.

   Let’s start with the biological. The human body has not evolved to be any better at fighting the novel coronavirus, so unless our immune system is primed to fight the virus, our vulnerability remains unchanged. While treatments for covid-19 have improved somewhat since early 2020, the chances of hospitalization and death after a covid infection have not gone down much.

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But while humans haven’t evolved, the virus surely has. The B.1.1.7 variant, first reported in Britain, is now the most prevalent form of the virus in the United States. This variant is far better at its job than the original coronavirus in two crucial ways: It’s about 50 percent more transmissible and, for someone who catches it, up to 60 percent more likely to be serious. 

Then there’s the matter of human behavior: As more of the population is vaccinated, case rates, hospitalizations and deaths are likely to fall (although the current surges in Michigan and a few Northeast states — largely driven by infections in unvaccinated younger individuals — illustrate that improvement is not invariable). Seeing these numbers, unvaccinated people might well conclude that things have become safer and let down their guard.

 The problem is that the aggregate numbers — even if they show down-trending test positivity rates, hospitalizations and deaths — may be masking an important duality. The situation may be getting enormously better in the growing vaccinated population, while at the same time growing somewhat worse in the unvaccinated group. Taken together, the overall curve shows moderate improvement. It would be like looking at a graph of lung cancer cases in a population whose rate of nonsmokers is growing. The overall curve looks good, but the risk to an individual smoker hasn’t budged. And if smokers saw the falling case rates, concluded that smoking had become safer and decided to add a pack a day, their risk would go up.

The inclination to act on sunny but partly misleading news will also influence political leaders. These officials are under tremendous pressure to open up their economies and may well see the overall improvements as reason enough to return to normalcy. Their optimistic messaging, along with the practical impact of opening settings such as bars, restaurants and gyms, will further promote virus exposure and cases in unprotected people.

The situation may not be as dire as it sounds. First, every day more unvaccinated people move into the vaccinated category. Second, as the vaccinated group grows larger, the overall impact on cases (not quite herd immunity but the same idea) makes life safer for unvaccinated people. Why? If case rates fall in a community due to more people being vaccinated, eventually unvaccinated people will be exposed to less virus, a downward pressure that may ultimately compensate for the variants’ superpowers and any uptick in risky behaviors. Finally, because the first groups to be vaccinated were those at highest risk of exposure and death, those being exposed today tend to be younger and healthier, individuals whose risk of severe disease and death is relatively low — though far from zero.

ROBERT M WACHTER IS CONTINUED ON THE FOLLOWING BLOG...

                                                                                                                      

 

FROM THE WASHINGTON POST: 

 Robert M. Wachter is chair of the department of medicine at the University of California at San Francisco and host of the podcast “In the Bubble.

CONTINUED:

 ”The problem is that the aggregate numbers — even if they show down-trending test positivity rates, hospitalizations and deaths — may be masking an important duality. The situation may be getting enormously better in the growing vaccinated population, while at the same time growing somewhat worse in the unvaccinated group. Taken together, the overall curve shows moderate improvement. It would be like looking at a graph of lung cancer cases in a population whose rate of nonsmokers is growing. The overall curve looks good, but the risk to an individual smoker hasn’t budged. And if smokers saw the falling case rates, concluded that smoking had become safer and decided to add a pack a day, their risk would go up.

The inclination to act on sunny but partly misleading news will also influence political leaders. These officials are under tremendous pressure to open up their economies and may well see the overall improvements as reason enough to return to normalcy. Their optimistic messaging, along with the practical impact of opening settings such as bars, restaurants and gyms, will further promote virus exposure and cases in unprotected people.

The situation may not be as dire as it sounds. First, every day more unvaccinated people move into the vaccinated category. Second, as the vaccinated group grows larger, the overall impact on cases (not quite herd immunity but the same idea) makes life safer for unvaccinated people. Why? If case rates fall in a community due to more people being vaccinated, eventually unvaccinated people will be exposed to less virus, a downward pressure that may ultimately compensate for the variants’ superpowers and any uptick in risky behaviors. Finally, because the first groups to be vaccinated were those at highest risk of exposure and death, those being exposed today tend to be younger and healthier, individuals whose risk of severe disease and death is relatively low — though far from zero.

The solutions to the problem of heightened risk among unvaccinated people range from very difficult to extremely easy. Very difficult: Convince unvaccinated people that — notwithstanding the general optimism — they may, in fact, be at higher risk than before. Particularly if they’re planning to be vaccinated, now is the worst possible time to let down their guard. They should continue to wear their masks, keep their distance and avoid risky situations — even as they see their vaccinated brethren enjoying their newfound freedom. Equally challenging: Require proof of vaccination (so-called immunity passports) to access places that don’t require masks and social distancing.

Easy: Everyone gets vaccinated when their number comes up. Problem solved.