Today I read that the sheriff of Los Angeles County said that his department would not enforce the renewed county requirement to wear masks in indoor public places. “Forcing the vaccinated and those who already contracted Covid-19 to wear masks indoors is not backed by science,” he wrote according to the New York Times. Apparently, the sheriff thinks that those vaccinated and those who have had Covid-19 cannot spread the SARS-CoV-2 virus since the public health mandate is to prevent its spread. But the sheriff is wrong. That is not what science says.
There is a simple thing we all know that science tells us about vaccines. They work by kicking in the immune system. Those who are health food followers and believe in fostering their immune systems should understand that vaccines similarly energize the immune system. That means vaccines work when and only after you get infected by the virus, not before.
While the virus is in your body reproducing and circulating, the antibodies of your immune system go to work to eradicate the new viruses. This takes a little time. Science tells us it takes a day or two mostly, but it can drag on a few days more. The vaccine has pre-prepared the antibodies to work faster than normally; so, in a day or three your system will be cleared by the actions of your own antibodies.
But during that time, you are carrying viruses around, growing them and spewing them around as you talk and laugh and harrumph. You may never get any symptoms, or you may get only slight symptoms before your antibodies triumph, but for a while you will be a potential carrier and spreader of the deadly disease.
Clearly, being vaccinated does not prevent you from being dangerous. You are less of a risk because your window of virulent transmission is very much smaller, but vaccinated people who pick up the disease will be infectious. So, be careful of other people, and be careful for other people.
I don’t say this in disagreement over the wisdom of wearing masks indoors. However, I’d appreciate it if anyone offering medical or scientific information would cite the reliable sources—medical journal, medical school web site, etc.—from which they derived that information, allowing readers to double-check or learn more. Could this become a policy at the Sun?
Thanks, Patty, for the policy suggestion. In this column, I used no references because I thought most of it was based on a logical extension of what we as lay people generally understand about vaccines. But looking back, I see there are informational gaps that could be filled in.
For a generalized summary of how vaccines enlist antigens, antibodies, T-cells or memory cells, etc., to do what I called “pre-prepare” the immune system, one can look at the explanations by the World Health Organization or the U.S.’s Centers for Disease Control.
On the progression of COVID-19 in vaccinees who catch the disease (Covid Vaccine Breakthrough Infections), I relied mostly on a pre-publication (not peer reviewed) internet posting. This is an Israeli study of viral loads in vaccinees testing positive for SARS-CoV-2 viruses using the Cycle threshold number resulting from the nucleic acid test. The Ct number is inversely related to the quantity of viruses identified in the test: the larger the Ct, the smaller the viral load. This study was peer reviewed and revised and published in the journal Nature.
On viral loads and vaccination see “Single dose of a mRNA SARS-CoV-2 vaccine is associated with lower nasopharyngeal viral load among nursing home residents with asymptomatic COVID-19,” read this.
Estimates on the time element of transmission among non-vaccinated people comes from an earlier study out of China. Note that 44 percent of transmission occurred before the onset of symptoms.
On my assumption that vaccination reduces the severity, duration, and outcome in breakthrough cases, look at:
UCLA and UCSD data on infections among vaccinated health workers;
Arizona study of breakthrough cases;
UK study;
real-world data on effectiveness of two dose vaccines;
and source of my claim that the window of transmission is very small for vaccinated people.
For anyone willing to research scientific studies on the pandemic, the source is Google Scholar. All the medical journals in English are free and available on Google Scholar with the usual Google search engine. In addition, Google Scholar includes Medrxiv, which is where all pre-publication postings from all over the world are available, many dozens of new studies on Covid every day ranging from molecular chemistry to sociology.
I don’t believe Mr. Yeh answered Ms. Kearney’s question. The opinion piece addressed why the vaccinated should wear masks, and it specifically addressed the possibility of contagion by vaccinated people that were reinfected with the virus. There is guidance recently released by the CDC that the chance of a vaccinated person spreading the virus is basically zero.
A few days after I posted the opinion piece arguing that vaccinated people can transmit the COVID virus even as the vaccine protects that person, the CDC issued new guidelines recommending vaccinated people to wear masks indoors.
Part of the reason for that advice is that the studies I mentioned, and others, show that vaccinated people can and do get infected (not reinfected). That means that even if we vaguely say that transmission is “basically zero,” that basic zero is not zero but something. When you start thinking in very large numbers (600,000 dead from COVID), a tiny proportion so small that it might be “basically zero” turns out to be significant. If you can catch COVID, you can transmit it if the number of viruses you produce is sufficient. Many times it might not reach sufficiency (we don’t even know how many are needed), but sometimes it does.
I did not cite a study showing the statistics of transmission by the vaccinated. As far as I know, there has not been such a study, which would require detailed tracing of a lot of transmissions. That is why the piece is an opinion piece. It’s my opinion based on viral load considerations, that if we get infected, we can transmit.
A lot of the problems we have thinking about COVID come from the way we use and understand language. For example, we say that vaccination can make us “immune,” but what does that mean? It does not mean that vaccination keeps the spikes of the virus from latching onto cells in our bodies, which means that we are not immune from infection. After the infection, when the virus is multiplying inside us, our vaccinated system can kill the new virus off. But it takes time. And over time, our immune system can eradicate the viruses so that we ourselves do not get terribly sick from the infection. So immunity means immunity from serious illness. It does not mean immunity from infection itself. I was suggesting that if you get infected, you can be transmitting. But yes, I agree, the rates are very small. But then so is the ounce of prevention.
To me masking is not an intellectual, abstract issue. It is about a tiny gesture of concern for others. To put on a mask takes so little time, so little effort—less than the trouble of putting on your sock in the morning—basically zero effort and trouble. What’s the point of spending more energy arguing about it?
Yesterday (7/30), while I was writing my reply to Dave Willard, the CDC released a report called “Outbreak of SARS-CoV-2 Infections, Including COVID-19 Vaccine Breakthrough Infections, Associated with Large Public Gatherings—Barnstable County, Massachusetts, July 2021.” Since there seems to be a technical glitch in The Sun and none of my reference links in any of my replies is showing up, I have to sum up this report for you. [Editor’s Note: All of Yeh’s reference links are live in his replies and can be found by hovering the cursor as one reads over the text, which activates the link, which then shows up in light purple. But Yeh is right; a glitch in our software prevents the underlining of a link in our Comment section only. Links are underlined in all our posts.]
I was wrong to say that the trouble of tracking a lot of vaccinee transmissions would prevent a study of breakthrough transmissions. This study does exactly that, but for a small population: 469 COVID cases were traced back to a bunch of crowded indoor and outdoor July 4th events in one town in Barnstable County. Of these cases, 346 (74 percent) had been fully vaccinated. Vaccination rates in the county were at 69 percent of those eligible (so better than Sierra County); therefore, the transmissions were most likely happening not just because of the unvaccinated, but among the vaccinated. The county’s infection rate was 0 per 100,000 for 14 days prior to the 4th. Two weeks later, the infection rate jumped to 177 per 100,000. A large proportion of the virus identified in the patients was of the Delta variant. Viral loads (using Ct numbers, that is, not absolute counts but comparative amounts) were the same among vaccinated and unvaccinated patients. You can find this report on the CDC website in the Morbidity and Mortality Weekly Report. The report recommended the use of masks among the vaccinated, and CDC a few days ago issued that recommendation.
In case you erroneously think that this means the vaccine has no effect, there were only four hospitalizations and no deaths in Barnstable County. Just for perspective, in Sierra County we’ve had 6.5 deaths for every 100 cases with a much less powerful variant of the virus. Vaccination keeps people from serious illness and alive. Further, vaccination will reduce transmission, not by reducing viral load but by reducing the window when viral loads are high.
The study does not address, however, a problem that breakthrough infections create, one that we should all think about. Mother Nature does not make perfect duplicates (we are not identical humans). As viruses are reproduced in our infected cells, they invariably are creating different versions. Most of these will not survive their habitat. Only those that fit the habitat in our bodies well will survive and flourish. Among vaccinated individuals that habitat includes the vaccine. The variants that flourish in the vaccinated individuals will be those that by chance have some immunity to the vaccine. So breakthrough infections will be the source of more and more vaccine-resistant SARS-CoV-2 viruses. The only way for this natural process of variation not to produce these super-SARS is for the vaccinated to avoid getting infected, and that means masks and distance.
I believe the CDC appears to have come around to your view. That’s great. My initial concern was reading a piece by, as far as I could determine, an opinion piece by a non-expert with no medical background, that initially conflicted with what experts had been saying in the media. That’s not a good look in my opinion, and a bit arrogant.
You were fortunate your assesment was a good one. It may not work out that way next time, given what I have at least managed to discover about your expertise in the matter. Perhaps I missed some past training. Dr. Gupta is a pulmonologist with decades of work in the field. It wouldn’t hurt to run your next related piece by an expert in the field of airborne virus transmission.
The most recent numbers from Israel, which were updated this week, indicate your numbers are completely bogus and people are having just as high viral loads as the unvaxxed, months after taking both jabs. Forbes has covered this recently, as have other major publications. Is the Sun going to issue a retraction on this demonstrably false misinformation? Where’s the mention of Ivectosol, which started FDA approval 3/3? Does that fact that the advocacy from a newspaper like this would help to get doctor’s choice to our local VA nursing home do anything to motivate?
Thank you for pointing me to the Forbes article. Forbes does a thorough and careful job reviewing COVID literature. I read this article from last week, thinking it might be the one you mention. It is about a study that estimates the “effectiveness” of the Pfizer vaccine against the Delta variant to be lower than previous studies suggested. Nowhere does this article speak about viral loads, as you say (maybe it’s not the one you are talking about); so I don’t see why I should retract what I said about viral loads after vaccination, and I don’t know what “numbers” have to be changed because I don’t remember citing any numbers. I very much doubt that this article (or any of Forbes’s recent articles, which are all about this study) shows that I have to revise or apologize for my opinion because 1) this study measures “effectiveness” against one strain of the virus and not all strains of the SARS-CoV-2 and so is a little off-center; 2) the study has not been vetted thoroughly, as Forbes is very insistent on pointing out not only directly but indirectly by linking to other studies and reports of studies; so the study is still inconclusive until more is known about how the study was conducted; and 3) if the study’s conclusions are accurate, that the Pfizer vaccine is less effective against the Delta strain, then my suggestion that vaccinated people should wear masks (and also keep their distance) is given another argument, for which I thank you.
Since you seem to be a Forbes reader (I am not), perhaps you know this article from a few days ago. It does a much more thorough job than I had time to do in explaining how vaccines work (with pictures and diagrams) and the different meanings of the word “effective” in the COVID research world. That word is indeed slippery when it gets thrown around too much. When the media tells us that Pfizer is over 90 percent effective, readers often forget that this means effective at preventing severe cases and hospitalizations. In the Israeli study that Forbes pointed to in the earlier article I was just talking about, “effectiveness” is against infection, that is asymptomatic, mild, moderate, severe and hospitalized. That’s a whole different thing. When the new Israeli study says that Pfizer is 39 percent effective against Delta infections, that does not mean that Pfizer is no longer still over 90 percent effective against serious illness.
I also want to thank you for giving me an opportunity to share some useful information with everyone that I got from the National Institute of Health. The terms “mild,” “moderate” and “severe” used to describe cases are very strictly defined because their use allows home management of the disease and prevents, as much as possible, hospitals becoming over-stressed by people demanding attention when they don’t need it. If you test positive for the virus and have all those symptoms we are now familiar with, you have a mild case until your oxygen level in your blood drops and stays below 95 percent of saturation level. You can buy a oxygen meter at the drugstore. You might need oxygen tanks, but you can stay home. If then your breathing becomes really difficult or you have chest pains, you go from moderate to the severe category. You are in danger of having to be hospitalized so you need to be watched carefully.
If you are at risk because of health problems and/or age, you begin medications even while in the mild stage. That medication is intravenous infusions of monoclonal antibodies. If you reach the severe stage, cortisone injections will be added. Ivermectin is not mentioned in the NIH treatment guide.
Something really needs to be said about Ivermectin because what you say about it is entirely false. You write: “Where’s the mention of Ivectosol, which started FDA approval 3/3?” In fact, the honest truth, on 3/5 the FDA specifically posted on its site an article called “Why You Should Not Use Ivermectin to Treat or Prevent Covid-19.” The FDA did not start approval of Ivermectin on 3/3. In spite of what everyone clamors about on the internet, there have been no large-scale and methodologically sound study of Ivermectin’s effect on COVID patients. The NIH has compiled all the inconclusive studies, and you can find a link to that list in the Vaccine Alliance’s article on Ivermectin. It is simply untested; though, a large study started on it in February. At the present time, it’s really irresponsibly dangerous to suggest that one can pop roundworm pills for dogs and cattle to fight COVID, and that is why Ivermectin wasn’t mentioned in the article.
As for your last sentence, I don’t understand what you are saying. It sounds like it’s meant to be nasty and pointedly scandalous. Can you be a little more articulate? Or, as we say here in Sierra County, “huh?”
you make up arguments. Ivectosol is under approval, it’s a soluble version of ivermectin- the biotech that submitted it for approval is Mountain Valley MD< Forbes lol
The CDC published the numbers on breakthrough infections and viral loads before you wrote that article, you should look that up and then retract – lol i said ivectosol is in FDA approval and you told me ivermectin was not – lol ivermectin is already approved by the FDA just not to treat COVID- people have been using it for decades- and no nobody should take horse pills people need to talk to their doctor
max just put anitgens and antibodies in the same sentence as the same thing, then her handed off control and intel and authority of this to the CDC. embarassing
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