Eric Topol Profile picture
Jul 18, 2020 13 tweets 6 min read
Our conversation with Tony Fauci was highly informative, and inspirational. A summary of key points of the podcast and commentary w/ @cuttingforstone @Medscape medscape.com/viewarticle/93…
1. The #SARSCoV2 virus in unique
2. That's 20-40% of people who get infected and never show symptoms. More likely in young. Who don't understand they are propagating the pandemic
"Usually a virus that is good enough to kill you would make almost everybody at least a little bit sick."
3. The chronic "long covid" post-viral symptoms of #COVID19 are common, understudied to date.
"And it's extraordinary how many people have a postviral syndrome that's very strikingly similar to myalgic encephalomyelitis/chronic fatigue syndrome."
4. We don't have a #COVID19 czar with decision-making authority, like @RonaldKlain for Ebola (who Fauci loves) but @VP has taken on a lead role, is receptive, and "deeply involved." Fauci is very respectful to the Administration despite all the efforts of @POTUS to undermine him
5. What about the @HHSgov hijacking the @CDCgov covid data?
Fauci only learned about it by watching television
6. What about the hyperimmune response to #COVID19 and that being implicated as the basis for most fatalities?
7. It took 5 days from the sequence of #SARSCoV2 to Fauci's team to get the start on a vaccine, 62 days to get Phase 1 clinical trial started (That is simply incredible)
8. What about short-lived antibodies to the virus and the role of T cells?
#SARSCoV2 is like SARS with a significant and enduring T cell response. We shouldn't be worried about the IgG antibody waning report that got a lot of buzz this week.
9. What about reinfection, does it occur?
There are anecdotes, but no proof of replication competent virus. So if it really exists it's rare (considering millions of infections). Hard to prove since you need a BSL-3 lab to correlate PCR results of RNA nucleotides w/ live virus
10. On the mask pushback, Fauci attributes this to the "disturbing anti-science trend" My worry is that will extend to implementing the vaccine, but we didn't get to that issue
11. Monoclonal (neutralizing) antibodies were developed for Ebola and highly successful They are now in clinical trials for SARSCoV2, very potent, and will likely be used in early and late stages of treatment. Mabs don't get the attention of vaccines but very important & imminent
12. Rapid diagnostic kits for home or point of care are in the works, NIH has invested $500 million, results in < 30 mins. These will be transformative when they are available this fall
13. Favorite part: his comments to the frontline heroes and how science will prevail.

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More from @EricTopol

Feb 13
We've learned a lot about Prior Covid ("Natural Immunity") over the past year, but the US/CDC continues to negate the abundant evidence for it providing any protection
erictopol.substack.com/p/ground-truth… w/links
And there's substantial new data, I'll review🧵here /1
Last week, the large J&J 1- shot, placebo-controlled trial w/ >2,000 participants who had Prior Covid published @NEJM
Vaccine effectiveness vs moderate/severe disease
Prior Covid 90%
J&J Vaccine 56%
Yet 1-shot J&J vaccine = "fully vaccinated" @CDCgov
Nothing for Prior Covid /2
Neutralizing antibodies after Prior Covid are present out to 16 months in 214 people (graph)
And another study showing persistence of memory B cells at 15 months /3
Read 13 tweets
Feb 9
Today >3,400 Covid deaths reported in the United States, a 7-day average exceeding 2,600 lost lives.
This likely represents the current wave peak; 80% of the US pandemic peak when there were no vaccines. Compared to 20% in countries with high % vaccination and booster rates Image
OTOH at least we're seeing a rapid descent of hospitalizations to the 100,000 level Image
Read 4 tweets
Feb 7
🆕 Omicron [O] and Delta [D] outcomes for hospitalizations, deaths and by vaccines in > 1 million O and ~450,000 D cases in England
papers.ssrn.com/sol3/papers.cf…
—75% reduced hospitalization risk for O vs D
—For O, Booster >70% protection vs hospitalizations and deaths across all ages
2 and 3 dose vaccine effects vs hospitalization (both AZ and mRNA)
and
Prior Covid, without vaccination, had moderate protection (HR 0.53) vs hospitalization for Omicron, and high protection vs death.
Children age < 10 had infrequent hospital admissions and the incidence did not differ significantly between Delta and Omicron
Read 4 tweets
Feb 4
New: Assessment of an Omicron-specific booster vs Moderna original (vs ancestral) booster in macaques: no difference
"An Omicron boost may not provide greater immunity or protection compared to a boost with the current mRNA-1273 vaccine"
biorxiv.org/content/10.110… Image
Interesting to note that the same was seen for the Beta variant with the Pfizer vaccine, original vaccine booster vs Beta-specific booster, which led to abandoning that strategy.
3rd shots of the original vaccines are performing far better than expected 👍
A very good thread on the new Omicron-specific booster study and the overarching issue by @erlichya
Read 4 tweets
Feb 4
New @CDCgov
Reduction of death by vaccination and booster by age, per 100,00 people, vs unvaccinated, relative, with absolute data below
covid.cdc.gov/covid-data-tra…
Age 65+
2 shot 92% reduced
3 shot 99% reduced
Age 50-64
2 shot 95% reduced
3 shot 99% reduced
By age: cases and vaccination/booster status
As cases were rising steeply in December with emergence of Omicron, booster vs 2-shot was associated with 50% or more reduction of cases across the 3 age groups
And much higher % drop for vaccination vs unvaccinated
Which goes along with this new data posted showing booster had vaccine effectiveness of >60% vs Omicron infections
covid.cdc.gov/covid-data-tra…
Read 5 tweets
Jan 31
New @FT
"Almost half of the US Covid hospitalisations this winter could have been averted if the country had matched the vaccination coverage of leading European countries"
ft.com/content/03aa46… by @mroliverbarnes @jburnmurdoch @JamieSmythF
US lagging European peers by vaccine doses and boosters, especially notable in age 60+
"On December 20, 30% of people in the US over-65 had gone six months since receiving a second dose, compared with just 2% in Portugal; 5 per cent in England; and 7% in Denmark."
Graphic that shows differences in vaccination waning for US vs England, Denmark and Portugal, age 60+
Read 5 tweets

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