Ed Belongia MD Profile picture
Mar 7, 2020 5 tweets 2 min read Read on X
1/n Extreme social distancing (SD) causes social and economic disruption. It is difficult to sustain and should be as brief as possible. In this preprint, #Seattleflustudy took a clever approach and modeled the effect of SD during an extreme weather event. medrxiv.org/content/10.110…
2/n They used data from pts tested for respiratory virus before and after heavy Seattle snowfall event Feb 2019. They estimated infections averted by simulating transmission of 9 viruses with/without reduced weather-related contact rates.
3/n They found that weather-related social distancing had the greatest impact for viruses that were near seasonal peak, with final attack rates reduced by about 7-9%. In contrast, there was little effect for viruses that peaked later in the season.
4/n Their analysis supports short-term use of social distancing for #COVID19 when implemented close to the peak of a local epidemic, rather than much earlier. However, this is one modeling study still in review, and it would be nice to have more supporting data.
5/n The analysis is still quite useful because state and local public health authorities will be making hard decisions on social distancing in the coming weeks. Maybe it's OK to wait until closer to the peak period before implementing disruptive measures.

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More from @EdBelongia

Nov 24, 2020
CDC ACIP met today on Covid-19 vaccines. They will not vote on a specific product recommendation until after FDA issues EUA. Here are a few takeaways from today's session on phased vaccine allocation when supply is limited. 1/
Phase 1 will include healthcare personnel (HCP), other essential workers, high risk adults, and adults over 65. Phase 1 has 3 tiers: 1a (highest priority), 1b and 1c.
2/
Workgroup proposed HCP and LTCF residents in phase 1a and essential workers in 1b. Members agreed w/ HCP as top priority, but differing views on LTCF res in 1a. Some concerned that vax efficacy/safety has not been studied in LTCF, but several others supported inclusion in 1a.
3/
Read 6 tweets
Oct 30, 2020
The CDC Advisory Committee on Immunization Practices (ACIP) met today on Covid-19 vaccines. Here are a few highlights. 1/
FDA summarized recent VRBPAC meeting. VRBPAC members agreed that current FDA guidance is the absolute minimum to issue EUA. Some members recommended longer safety follow-up, and continuation of trials with placebo group as long as feasible. 2/
Novavax reviewed clinical development for recombinant nanoparticle spike protein vaccine with adjuvant (same platform as flu vax). Robust antibody and T cell response in phase 1. Phase 2 is underway and phase 3 will launch soon in US and Mexico with 30K participants. 3/
Read 10 tweets
Sep 22, 2020
The CDC Advisory Committee on Immunization Practices (ACIP) met today on Covid-19 vaccines. The morning session focused on vaccine safety and implementation. The afternoon session addressed equity and prioritization. Here are a few highlights. 1/9
Process overview: the Covid-19 Work Group will review phase 3 efficacy/safety data and present policy options to ACIP. An emergency meeting will occur when FDA authorizes a vaccine, and ACIP will vote on recommendation. It could be more targeted than FDA indication. 2/9
WG recommends harmonization of safety monitoring methods across studies to facilitate comparisons. FDA has already published guidance on efficacy criteria, and they should do the same for safety criteria. 3/9
Read 9 tweets
Aug 26, 2020
CDC Advisory Committee on Immunization Practices (ACIP) met today on Covid-19 vaccines. Here are a few takeaways from 3 sessions:
➡️RNA vaccine development (Moderna, Pfizer/BioNTech)
➡️Post-approval safety monitoring
➡️Initial vaccine priority groups
1/6 Image
👉Moderna reviewed published phase 1 results. Their phase 3 has enrolled 13K (18% nonwhite).
👉Pfizer phase 1 trial: strong neutralizing Ab response after dose 2 of full spike (b2 candidate). Strong T cell response with Th1 bias--may reduce risk of vaccine enhanced disease.
2/6 Image
Pfizer b2 vaccine caused frequent fatigue, chills, muscle aches after dose 2. Graph below shows data for 18-55 yrs, but adverse effects were less common in older adults and mostly resolved in 1-2 days.
Multinational efficacy trial underway with 2 age groups: 18-55, 56-85.
3/6 Image
Read 6 tweets
Jun 24, 2020
1/5 The CDC Advisory Committee on Immunization Practices (ACIP) met today and had an excellent session on #COVID19 vax development and prioritization. ACIP makes evidence-based recommendations on vaccine policy. Here are a few highlights and screen shots from the presentations.
2/5 The normal clinical development path will be accelerated without compromising standards. Operation Warp Speed supports rapid development of a few products, early scale-up of manufacturing, and harmonizing phase 3 trials. OWS needs to work closely with ACIP in coming months. Image
3/5 The ultimate goal is sufficient vaccine for entire US population, but initial supply will be limited. Planning is needed now to identify priority groups despite incomplete information. This process must be transparent, fair, and maximize benefits while minimizing harms. Image
Read 5 tweets
Feb 27, 2020
1/Epi studies show striking age differences in #COVID19 cases. In China, only 2% are <20 yrs old (Wu, JAMA). Relative risk is much higher above 30 (Sun, LancetDigHealth). It's likely kids are infected but have mild or no symptoms. We need more data from outside China to confirm.
2/Why are #COVID cases detected more often in adults? Older adults have higher risk due to frailty and aging immune system. But this does not explain increased risk across all adult age groups vs children. One possible explanation might be antibody dependent enhancement (ADE).
3/Dengue #virus is a good example of ADE. There are 4 dengue serotypes, and infection generates protection only against the same serotype (no cross-protection). Later infection with a different serotype is a risk factor for more severe disease: dengue hemorrhagic fever.
Read 8 tweets

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