丞相起風了，
華盛頓郵報報導變種病毒來自疫苗
不要一直罵主流媒體，他們的記者其實蠻優秀的。這一篇，他用三明治的方式，頭尾維持主流媒體的立場“疫苗要打好打滿”；但中間的部分告訴你，疫苗是Delta變種病毒的助燃物。
這是很大的發現，因為他們取得CDC疾病管制局內部開會的投影片資料。
但官方拒絕評論。
===
以下(文長)
戰局已改變：
CDC 內部文件發布緊急新訊息，
警告delta變種病毒感染可能更嚴重。
CDC對於日益增加的爆發感染，
掙扎於怎樣溝通疫苗的有效性。
Delta 變種病毒比早先的變種病毒造成更嚴重的症狀，會像水痘一樣容易傳播，
根據聯邦衛生機構的文件，直指官方必須確認戰局已經改變。
這份CDC內部開會的投影文件被華盛頓郵報取得。
直指這個國家最高健康機構，在感染確診案例激增之際，絞盡腦汁勸服大眾打疫苗，戴好口罩等預防措施。
新的研究報告顯示打過疫苗的人會傳播病毒。(註：跟CNN報導的一樣)
這樣的報告觸發緊急警示，#顯示CDC知道它必須修改過去強調接種疫苗是對抗傳染力強的變種病毒之最佳方法的說法。這幾乎像是不同的新型病毒，從一個感染對象跳到另一個對象，速度比伊波拉或普通流感還快。
有些人打完疫苗仍然感染到新冠病毒。
文件中多方引用尚未對外公開的資料，顯示打過疫苗的人感染到delta病毒，跟沒打過疫苗的人一樣可能輕易傳染給別人，
打完疫苗感染到 delta變種病毒的人，身上帶有可衡量的病毒載量，類似於未打過疫苗感染到的人。
「我讀完後比還沒讀更擔心。」加州大學舊金山分校醫學系主任Robert Wachter在email寫道。
其中一張投影片指出，不管打不打疫苗，老人族群相較年輕族群較易重症或死亡。
另一項推估是1億6千萬打過疫苗的美國人當中每周會有35000個人感染確診。
該文件指出會有溝通上的挑戰，因為在打過疫苗的人身上爆發感染，
包括地方衛生機關
(✓)懷疑新冠疫苗是否仍然有效，
(✓)大眾信服的新冠疫苗不再有效
(✓)是否需打加強版的第三劑
內部文件也提出CDC 面臨的如影隨形的艱難任務：
(✓)它得繼續強調疫苗預防重症與死亡的有效性。
(✓)最終會有不少輕微的感染，
(✓)打過疫苗的人會具有傳染性
CDC必須成功轉移大家既有的認知。
要求匿名的官員透露：「雖然罕見，但我們認為在個人層次，#打過疫苗的人可能會傳播病毒，所以我們必須更新我們的建議。」
5 月 13 日，本來說打過疫苗的人在室內或室外就不需再戴口罩。新的指導方針顯示面對delta變種病毒必須採取撤退的戰略。
CDC說，即使打了疫苗的人在病毒大量傳播的熱區或所在地方有容易感染與生病的人都要戴口罩。
這份文件提出新的科學，也提出需要一套新的溝通策略，指出如果大眾經歷到或聽說有病毒突圍的案例，會對疫苗的信心產生動搖，特別是當公共衛生的官員說是罕見的時候。
風險溝通專家Matthew Seeger表示，對於突圍感染的溝通已經證明是有問題的。
因為公共衛生官員強調疫苗有巨大功效，當民眾發現不是這樣的時候會感到一種背叛。
「我們在告訴大眾新冠疫苗是奇蹟疫苗這部分的工作做得很好。但我們可能掉進一個過度保證的陷阱，這是任何危機溝通情境最大的挑戰之一。」
該文件指出，疫苗接種提供對病毒實質的保護。但CDC要修飾如何在接種過疫苗的人的溝通，有關其個別的風險，那個風險取決於很多因素，包括年紀，免疫功能等等。
也包括對一些免疫功能低下的患者以及安養院的老人，打疫苗效果不佳，需要額外再接種一劑的可能性。
CDC內部報告文件也指出，
病毒突圍確診是意料中的事，
而且可能躍升為所有確診中一定的比例，
因為現在有太多人接種過疫苗了。
這也可以從別國的資料得到呼應，
包括疫苗施打涵蓋率高的新加坡，
新進感染案例中有75%的人已打過一劑或兩劑。
CDC 也把大眾對疫苗的疑慮視為挑戰之一，公眾相信疫苗不再有效，報告的第一張投影片就講了。
埃默里疫苗中心的副主任說，他看到資料說明打過疫苗的人，跟沒打過的人一樣會感染脫落蠻多的delta 變種病毒，感到非常吃驚。
有一張投影片引用麻州某縣的疫情爆發，打過疫苗跟沒打過疫苗，脫落的病毒量幾乎是一樣的。
「我認為這對改變事情的看法非常重要。」
一位與 CDC 合作調查 delta 變種病毒的人士匿名表示說，來自 7 月 4 日在麻州某縣爆發的資料。基因分析顯示接種疫苗的人將病毒傳染給其他接種過疫苗的人。這資料讓人深感不安。是礦坑裏的金絲雀散發出示警訊息。
如果戰局改變，如CDC所言，對於疫情掌握的推估也要改變。delta變種病毒的極度感染性讓群體免疫成了更具挑戰的目標。
我認為核心問題在於
接種過疫苗的人很大的程度參與了delta變種病毒的傳播，
哥倫比亞大學流行病學家Jeffrey Shaman看了CDC的這套投影片報告在email裡頭說的。
某種意義，
疫苗接種是要保護個人
保護個人免於重症。
群體免疫不是重點，
我們看到大量重複與突破性感染的證據。
這份內部投影文件強調科學家專家幾個月來一直在說的話：是時候該改變人們對這場疫情的看法。ckw
疫苗專家 Kathleen Neuzil 表示，讓更多人接種疫苗仍是當務之急，但在可預見的未來，大眾或許必須改變與病毒(和平共存)的一種關係。
我們真的需要轉向預防重症、殘疾和醫療後果的目標，不要太擔心在人們鼻子捅到的每一種病毒，很難做到，但我想我們得適應新冠病毒不會消失(的現況)。
2021 年 6 月 23 日更新
https://www.washingtonpost.com/health/2021/07/29/cdc-mask-guidance/
‘The war has changed’: Internal CDC document urges new messaging, warns delta infections likely more severe
The internal presentation shows that the agency thinks it is struggling to communicate on vaccine efficacy amid increased breakthrough infections
The delta variant of the coronavirus appears to cause more severe illness than earlier variants and spreads as easily as chickenpox, according to an internal federal health document that argues officials must “acknowledge the war has changed.”
The document is an internal Centers for Disease Control and Prevention slide presentation, shared within the CDC and obtained by The Washington Post. It captures the struggle of the nation’s top public health agency to persuade the public to embrace vaccination and prevention measures, including mask-wearing, as cases surge across the United States and new research suggests vaccinated people can spread the virus.
The document strikes an urgent note, revealing the agency knows it must revamp its public messaging to emphasize vaccination as the best defense against a variant so contagious that it acts almost like a different novel virus, leaping from target to target more swiftly than Ebola or the common cold.
Some people are catching coronavirus after being vaccinated. Johns Hopkins University infectious disease expert Lisa Maragakis gives advice on how to stay safe. (John Farrell/The Washington Post)
It cites a combination of recently obtained, still-unpublished data from outbreak investigations and outside studies showing that vaccinated individuals infected with delta may be able to transmit the virus as easily as those who are unvaccinated. Vaccinated people infected with delta have measurable viral loads similar to those who are unvaccinated and infected with the variant.
“I finished reading it significantly more concerned than when I began,” Robert Wachter, chairman of the Department of Medicine at the University of California at San Francisco, wrote in an email.
CDC scientists were so alarmed by the new research that the agency earlier this week significantly changed guidance for vaccinated people even before making new data public.
The data and studies cited in the document played a key role in revamped recommendations that call for everyone — vaccinated or not — to wear masks indoors in public settings in certain circumstances, a federal health official said.
That official told The Post that the data will be published in full on Friday. CDC Director Rochelle Walensky privately briefed members of Congress on Thursday, drawing on much of the material in the document.
One of the slides states that there is a higher risk among older age groups for hospitalization and death relative to younger people, regardless of vaccination status.
Another estimates that there are 35,000 symptomatic infections per week among 162 million vaccinated Americans.
The document outlines “communication challenges” fueled by cases in vaccinated people, including concerns from local health departments about whether coronavirus vaccines remain effective and a “public convinced vaccines no longer work/booster doses needed.”
The presentation highlights the daunting task the CDC faces. It must continue to emphasize the proven efficacy of the vaccines at preventing severe illness and death while acknowledging milder breakthrough infections may not be so rare after all, and that vaccinated individuals are transmitting the virus. The agency must move the goal posts of success in full public view.
The CDC declined to comment.
“Although it’s rare, we believe that at an individual level, vaccinated people may spread the virus, which is why we updated our recommendation,” according to the federal health official, who spoke on the condition of anonymity because they were not authorized to speak publicly. “Waiting even days to publish the data could result in needless suffering and as public health professionals we cannot accept that.”
The presentation came two days after Walensky announced the reversal in guidance on masking among people who are vaccinated.
On May 13, people were told they no longer needed to wear masks indoors or outdoors if they had been vaccinated. The new guidance reflects a strategic retreat in the face of the delta variant. Even people who are vaccinated should wear masks indoors in communities with substantial viral spread or when in the presence of people who are particularly vulnerable to infection and illness, the CDC said.
The document presents new science but also suggests a new strategy is needed on communication, noting that public trust in vaccines may be undermined when people experience or hear about breakthrough cases, especially after public health officials have described them as rare.
Matthew Seeger, a risk communication expert at Wayne State University in Detroit, said a lack of communication about breakthrough infections has proved problematic. Because public health officials had emphasized the great efficacy of the vaccines, the realization that they aren’t perfect may feel like a betrayal.
“We’ve done a great job of telling the public these are miracle vaccines,” Seeger said. “We have probably fallen a little into the trap of over-reassurance, which is one of the challenges of any crisis communication circumstance.”
The CDC’s revised mask guidance stops short of what the internal document calls for. “Given higher transmissibility and current vaccine coverage, universal masking is essential to reduce transmission of the Delta variant,” it states.
The document makes clear that vaccination provides substantial protection against the virus. But it also states that the CDC must “improve communications around individual risk among [the] vaccinated” because that risk depends on a host of factors, including age and whether someone has a compromised immune system.
The document includes CDC data from studies showing that the vaccines are not as effective in immunocompromised patients and nursing home residents, raising the possibility that some at-risk individuals will need an additional vaccine dose.
The presentation includes a note that the findings and conclusions are those of the authors and do not necessarily represent the CDC’s official position.
The internal document contains some of the scientific information that influenced the CDC to change its mask guidance. The agency faced criticism from outside experts this week when it changed the mask guidance without releasing the data, a move that violated scientific norms, said Kathleen Hall Jamieson, director of the Annenberg Public Policy Center at the University of Pennsylvania.
“You don’t, when you’re a public health official, want to be saying, ‘Trust us, we know, we can’t tell you how,’” Jamieson said. “The scientific norm suggests that when you make a statement based on science, you show the science. … And the second mistake is they do not appear to be candid about the extent to which breakthroughs are yielding hospitalizations.”
The breakthrough cases are to be expected, the CDC briefing states, and will probably rise as a proportion of all cases because there are so many more people vaccinated now. This echoes data seen from studies in other countries, including highly vaccinated Singapore, where 75 percent of new infections reportedly occur in people who are partially and fully vaccinated.
The CDC document cites public skepticism about vaccines as one of the challenges: “Public convinced vaccines no longer work,” one of the first slides in the presentation states.
Walter A. Orenstein, associate director of the Emory Vaccine Center, said he was struck by data showing that vaccinated people who became infected with delta shed just as much virus as those who were not vaccinated. The slide references an outbreak in Barnstable County, Mass., where vaccinated and unvaccinated people shed nearly identical amounts of virus.
“I think this is very important in changing things,” Orenstein said.
A person working in partnership with the CDC on investigations of the delta variant, who spoke on the condition of anonymity because they were not authorized to speak, said the data came from a July 4 outbreak in Provincetown, Mass. Genetic analysis of the outbreak showed that people who were vaccinated were transmitting the virus to other vaccinated people. The person said the data was “deeply disconcerting” and a “canary in the coal mine” for scientists who had seen the data.
If the war has changed, as the CDC states, so has the calculus of success and failure. The extreme contagiousness of delta makes herd immunity a more challenging target, infectious-disease experts said.
“I think the central issue is that vaccinated people are probably involved to a substantial extent in the transmission of delta,” Jeffrey Shaman, a Columbia University epidemiologist, wrote in an email after reviewing the CDC slides. “In some sense, vaccination is now about personal protection — protecting oneself against severe disease. Herd immunity is not relevant as we are seeing plenty of evidence of repeat and breakthrough infections.”
The document underscores what scientists and experts have been saying for months: It is time to shift how people think about the pandemic.
Kathleen Neuzil, a vaccine expert at the University of Maryland School of Medicine, said getting more people vaccinated remains the priority, but the public may also have to change its relationship to a virus almost certain to be with humanity for the foreseeable future.
“We really need to shift toward a goal of preventing serious disease and disability and medical consequences, and not worry about every virus detected in somebody’s nose,” Neuzil said. “It’s hard to do, but I think we have to become comfortable with coronavirus not going away.”
Updated June 23, 2021
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