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Severity of COVID influences how much neutralizing antibody (NAb) is produced: in 59 recovered patients there was a positive correlation between NAb and disease severity. Highest NAb was from patients w/severe disease, but asymptomatic patients failed to mount competent NAbs 1/4
80% w/severe symptoms & 47% w/moderate symptoms had antibodies capable of completely neutralizing infection (in cultured cells), while only 25% of samples w/mild symptoms blocked infection. Sera from asymptomatic patients had no neutralizing activity 2/4
"Given the critical role of NAbs in protecting viral infection in airways, the recovered asymptomatic patients may suffer from SARS-CoV-2 re-infection. In this circumstance, these patients need to be vaccinated whenever the effective vaccines are available" 3/4
Given lack of neutralizing antibodies, it's unclear why asymptomatic patients don't progress to more severe disease. "Probably, these patients can mount robust T cell responses...However, this hypothesis needs to be confirmed in future investigations" 4/4
nature.com/articles/s4139…
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Dr. Ali Nouri
@AliNouriPhD
JAMA: asymptomatic super-spreader on bus infected 23 passengers. Exhaled airborne aerosols that float & travel far likely contributed to outbreak since many of those infected sat far away from index patient. The central air conditioner was set to "recirculation mode" ...1/3
"Airborne spread of SARS-CoV-2 seems likely to have contributed to the high attack rate in the exposed bus. Future efforts at prevention and control must consider the potential for airborne spread of the virus"

Unfortunately CDC isn't listening...2/3
jamanetwork.com/journals/jamai…
Despite much evidence pointing to aerosols as a culprit in this pandemic, @CDCgov's main message continues to be to stay apart 6ft. But we know that in poorly ventilated spaces, there is no safe distance. 3/3
cdc.gov/coronavirus/20…
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Dr. Ali Nouri
@AliNouriPhD
NEW REPORT on evolution of SARS-COV-2: The virus variant that's now widespread, D614G, replicates more efficiently in lab-grown human lung and airway cells. And when hamsters are infected with both versions, the new one has enhanced fitness & replicates better in upper airway 1/6
The mutation is in the spike protein of the virus (the part that helps the virus grab onto, and infect cells.) Prior research took the spike protein and stuck it into other viruses that are easy to work with. And they showed the new spike mutation enhanced infection of cells 2/6
This study takes it a step farther. Researchers took the early SARS-CoV-2 strain and introduced the mutation right into the virus. So the two viruses are identical, except for a single amino acid change. So they confirmed that single mutation enhances the virus' capabilities 3/6
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Dr. Ali Nouri
@AliNouriPhD
NIH/CDC asked the National Academies: HOW SHOULD WE ALLOCATE A VACCINE? Draft response:

Phase I: limited initial supply should go to high-risk workers in health care & 1st responders. Then, those w/underlying conditions at higher risk & older adults in overcrowded settings..1/3
Phase II: workers in essential industries & w/high risk of exposure; teachers/school staff; people all ages w/underlying conditions; all older adults not included in Phase 1; homeless shelters, group homes for disabled; prisons/jails

Note: consider equity across all phases. 2/3
Phase III: young adults; children; workers in essential industries and at increased risk of exposure that were not included in Phases 1 or 2

Phase IV: everyone in US who didn't get it in prior phases.

This is open for public comment until Sep. 4th. 3/3
nationalacademies.org/our-work/a-fra…
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