Thread by @EricTopol

To better understand the #COVID19 immune response, we just did a podcast w/ @VirusesImmunity, an extraordinary immunobiologist @YaleMed @YaleIBIO @HHMINEWS
link here:
medscape.com/viewarticle/93…
w/ @cuttingforstone @Medscape
We covered a lot of ground, here's a thread summary👇

1. Interferon, part of our innate immunity 1st line of defense, is deficient in some people. Giving recombinant type I IFN early and the right dose may turn out to be preventive, and there are some clinical trial data to support

2. The antibody response waning in the first 2-3 months is expected, not a concern. Memory B cells and a T-cell immune response are on standby.

3. In severe, critical covid cases there is a chaotic, confused, markedly dysregulated immune response. To exemplify that, part of the cytokine storm can even include the responses one would expect vs a fungus or parasitic helminth (worm) infection

4. What is the explanation for #LongCovid?
There aren't immunologic studies yet.
Akiko has 3 hypotheses:
—a reservoir of virus, hiding, activating, reactivating
—virus particles retained activating an immune response
—infection generates an autoimmune disease

5. To understand whether autoimmunity is taking place, a culprit autoantigen has to be identified. Many groups are working on this. It may also apply, to some extent, to the multisystem inflammatory syndrome in children and adolescents (MIS-C)

6. Mucosal immunity. There hasn't been that much work on an intranasal vaccine to rev up the IgA response , with nearly all of the ~200 vaccine program being shots to achieve neutralizing (IgG) antibodies. They could wind up being complementary approaches

7. Herd immunity in regions where people show a positive antibody response ~20%?
"It's premature and dangerous to depend on those numbers without a vaccine"

8. What is the optimal immune response to a vaccine?
A robust T cell (CD8) response may ultimately be considered icing on the cake
Not too concerned about antibody-dependent enhancement (ADE) or immune complex disease from vaccines

9. Why do men do poorly compared with women?
There's an age-dependent decline in T-cell activation in men, not women

10. What about kids with infections and their ability to transmit?
(Her kids will be going to school, in-person, soon)

11. The rest of our discussion was about Akiko's lab at Yale, her background as an immigrant from Japan, the influence of her parents on her career.
It has been a silver lining of the pandemic to get to know Akiko and learn from her. A veritable phenom!

12a. Learning. That brings in the master educator dimension of @VirusesImmunity's contributions. Like this recent "Immunology 101" tweetorial

https://twitter.com/VirusesImmunity/status/1285944893085491204

12b. and the accompanying 8 minute video

https://twitter.com/VirusesImmunity/status/1285944893085491204

This isn't just about facilitating learning about the covid immune response; it's a model for educating life science thru @YouTube and @twitter channels

13. Yet another example of @VirusesImmunity's standout talent as an educator, explaining and contextualizing this new case of reinfection today

https://twitter.com/VirusesImmunity/status/1297890418168860674