Eric Topol Profile picture
Sep 15, 2020 14 tweets 6 min read Read on X
Our informative and refreshing podcast w/ @nataliexdean, a guiding light in the pandemic
medscape.com/viewarticle/93… @Medscape w/ @cuttingforstone
A🧵summary
1. "We're struggling right now in the United States....there's a lot of uncertainty"
2. We need a coordinated response of "all these public health things that people don't always appreciate, they add up." Some places in the US are doing it well.
Explains forward and backward contact tracing.
3. On herd immunity confusion, a term that is usually in the context of vaccines. See below.
We need to focus on "proactive strategies to protect people"
4. What about Sweden's strategy?
Nice explanation here; not a simple herd immunity model as many have characterized
5. What should be the criteria for efficacy of a #SARSCoV2 vaccine?
WHO and FDA have agreed on 50%, but that is a point estimate with 95% lower confidence intervals that can't/shouldn't be too low (like only 15 or 20% effective)
6. There's a prodigious challenge here vaccinating billions of people, mostly healthy, and remarkably diverse--the aged, children, different ancestries. The vaccine trials are not adequately representative and subgroups so not provide adequate power, uncertainties in dosing, etc
7. Getting acceptance of the vaccine relies on public trust. Key thoughts on what is needed here
8. Efficacy is not a simple yes/no.
"It's possible that a vaccine to make people less symptomatic but they could still be infectious to others"
(which means using masks for awhile)
and many other nuances.
It will take time to get to 80% coverage
9. Excited about the prospects of rapid testing
10. What about vaccine safety?
Short term
"We need at least 1-2 months of follow-upon enough people after they receive their second dose"
Then there's the long term safety issues for which there are less concerns but needs to be defined (the dengue vaccine took 2-3 years)
11. Other uncertainties include the duration of protection from the various vaccines which will require extended follow-up and the issue that some trials have very low seropositive (1%) participants but currently ~15% of Americans are estimated to be seropositive
12. Would you take the vaccine right now?
13. We discussed the WHO, the COVAX efforts that the US pulled out from (beyond the WHO, as well), their efforts on #LongCovid, daily press conferences and the @COVID19Tracking project that both Dr. Dean and I are advisors
14. We wrapped up with her experience using social media. If you don't already, follow @nataliexdean. You'll learn a lot .

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More from @EricTopol

Jan 20
Physical activity and the reduction of all-cause mortality, from 2 very large prospective cohorts
1. The relationship is non-linear, suggesting a threshold effect for many types of exercise as seen below Image
2. Engaging in > 1 type of physical activity was generally correlated with better outcomes compared with 1 type (T1,2,3) Image
The @BMJMedicine was supposed to post this paper 2 hours ago but has failed to do. It is being covered by other means medicalxpress.com/news/2026-01-p…
Someday the link will be active!
dx.doi.org/10.1136/bmjmed… Image
Read 5 tweets
Jan 1
People age 70+ should not be taking aspirin at any dose for prevention. Results of randomized trials show higher risk of all-cause mortality, major bleeding events and deaths from cancer. p 153, SUPER AGERS bookImage
President Trump takes 325 mg aspirin/day. The randomized trials tested 75-81 mg/day. His doctors recommended low-dose aspirin for heart event prevention. That recommendation is ill-founded based upon best evidence in older individuals.
nejm.org/doi/full/10.10…
academic.oup.com/eurheartj/arti…Image
Aspirin dosing information
wsj.com/us-news/as-sig…
Read 4 tweets
Aug 14, 2025
As I wrote in SUPER AGERS, the immune system is the key to modulating our aging process and the opportunity to extend healthspan. Today @NatureAging 7 new articles, summarized here, that reinforce its central role
nature.com/articles/s4358…Image
Inflammaging: with aging comes untoward inflammation, a summary graphic
nature.com/articles/s4358…Image
The potential consequences of too youthful immune system in an older person —> autoimmunity
nature.com/articles/s4358…Image
Read 5 tweets
Aug 7, 2025
The new special issue @ScienceMagazine features Immunity with 4 outstanding review papers, 5★
Our immune system over the lifespan, sex differences, influence on physiology, and host antiviral defenses science.org/toc/science/cu…Image
Our immune system as we age: the path to immunosenesence and inflammaging
science.org/doi/10.1126/sc…Image
Read 5 tweets
Jun 8, 2025
We've learned a lot more about the principal drivers of age-related diseases in the past few weeks. And that leads to a unified model to pull it all together. (open-access) Image
I review 4 new reports, summarized here:
1. The proteins from senescent cells predict age-related clinical outcomes
2. A new epigenetic age clock connects the dots between aging, the immune system, inflammation and lifestyle factors
3. People with a fast pace of aging had an increased risk of cognitive impairment, age-related diseases, disability, and mortality
4. The Importance of “Immune Resilience” for Healthspan
And present a unified I/I model for what we now know Image
Read 4 tweets
Apr 13, 2025
Most people haven’t heard of this test, which is available in the US. It accurately predicts Alzheimer’s (not just if there’s a risk, but when). It is favorably affected by exercise and likely many other lifestyle factors.
Here’s (almost) everything we know about it. In Ground Truths (link in my profile d/t X-suppression)Image
Here's the response to exercise Image
The most sensitive and accurate biomarker to date Image
Read 5 tweets

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