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There's a really dangerous misinformed claim going around relating to COVID-19 vaccines.
A while ago there was a trendy idea that part of the hypercoagulability from COVID-19 was because of endothelialitis caused by direct infection of endothelial cells by SARS-2.
A while ago there was a trendy idea that part of the hypercoagulability from COVID-19 was because of endothelialitis caused by direct infection of endothelial cells by SARS-2.
The major paper advancing this claim is here:
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30937-5/fulltext
It purports to demonstrate viral inclusions within endothelial cells consistent with SARS-CoV-2 infection, and notes ACE2 expression on the endothelial cells. Except...
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30937-5/fulltext
It purports to demonstrate viral inclusions within endothelial cells consistent with SARS-CoV-2 infection, and notes ACE2 expression on the endothelial cells. Except...
there are huge problems here. For one thing the citation for the claim that endothelial cells express ACE2 is this paper:
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.104.510461
There is no such claim in the paper. It's examining ACE2 expression within rat ventricles, which aren't endothelial tissue.
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.104.510461
There is no such claim in the paper. It's examining ACE2 expression within rat ventricles, which aren't endothelial tissue.
The arguably even bigger issue here is that questions have been raised about whether the purported viral inclusions noted in this study even represent SARS-CoV-2 virions (rather they are perhaps more consistent with ER vesicles and associated ribosomes): https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31188-0/fulltext#back-bib1
This is not the only paper to make comments about failures interpreting electron micrographs with respect to COVID-19:
https://jasn.asnjournals.org/content/31/9/2223#ref-2
The virions may easily be confused for clathrin-coated vesicles.
https://jasn.asnjournals.org/content/31/9/2223#ref-2
The virions may easily be confused for clathrin-coated vesicles.
Further, this paper notes that infection of human primary endothelial cells by SARS-CoV-2 did not occur until they were induced to express ACE2, which was not detected within them by profiling RNA or protein: https://mbio.asm.org/content/11/6/e03185-20
Basically, it doesn't look too great for this hypothesis.
That brings us to the vaccine claim.
One individual has argued that it would be dangerous for individuals who had previously recovered from COVID-19 to receive these vaccines due to purported viral endothelialitis.
That brings us to the vaccine claim.
One individual has argued that it would be dangerous for individuals who had previously recovered from COVID-19 to receive these vaccines due to purported viral endothelialitis.
The claim is that the immune response provoked by the vaccine against viral antigens will result in destruction of the vascular endothelium that will trigger adverse thromboembolic events, particularly in the elderly and medically frail.
Hopefully at this point we have established that the underlying basis of this concern is charitably called as "unfounded." But further we do have data on the question of whether or not we're seeing more thromboembolic events by vaccinees, in fact in such medically frail patients.
At the most recent ACIP meeting a great deal of safety data has been reviewed: https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2021-01/06-COVID-Shimabukuro.pdf
There are no safety signals. Note that various thromboembolic events have been examined and occur at rates well below background incidence among the vaccinated.
There are no safety signals. Note that various thromboembolic events have been examined and occur at rates well below background incidence among the vaccinated.
Regarding the question of whether or not recovered patients would need to be vaccinated in the first place, the answer is: yes. I think for a time we had a bit of wiggle room with waiting but with the emergence of variants of concern, I think the question is answered.
Some patients who recovered had 200-fold reductions in the ability of their antibodies to neutralize B.1.351 (commonly called the South African variant). That's a concerning number (though of course, in vitro evidence and not considering T cells). https://www.medrxiv.org/content/10.1101/2021.01.26.21250224v1
We also have the situation in Manaus to guide us:
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00183-5/fulltext
Right now, everyone who can get this vaccine needs this vaccine until compelling evidence emerges to suggest otherwise.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00183-5/fulltext
Right now, everyone who can get this vaccine needs this vaccine until compelling evidence emerges to suggest otherwise.
