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

May 16
The connection between #SARSCoV2 and neurodegeneration
@TheLancetNeuro
Quotes below:
1. SARS-CoV-2 infection should be considered as a risk factor for Alzheimer’s disease, even though the distinction between causation versus disease acceleration is not clear.thelancet.com/journals/laneu…Image
2. Inflammation in patients with COVID-19, and controlled experiments show prolonged neuro-inflammation after mild SARS-CoV-2 infection
in macaques.
3. A direct correlation has been reported
between prior SARS-CoV-2 infection and increased risk
of Alzheimer’s disease (figure).

4. So far, the estimated lifetime cumulative risk of dementia due to hospitalisation for any viral infection is 1·48 (95% CI 1·15–1·91).
Read 4 tweets
Apr 26
The FLiRT variant KP.2 begins its takeover for Covid cases in the US, now accounting for 1 in 4 cases
covid.cdc.gov/covid-data-tra…
Image
I've reviewed the FLiRT variants and their implications in a Ground Truths (link in profile) Image
The 2 mutations in the spike that account for KP.2's rise to dominance, compared with the JN.1 variant which has prevailed for months Image
Read 5 tweets
Jan 22
Breaking down the risks and benefit for lecanemab, the amyloid beta-directed antibody vs Alzheimer's drug approved @US_FDA last year. It doesn't look good.

@AnnalsofIM acpjournals.org/doi/10.7326/M2…
Image
A new systematic review of these antibodies looks even worse @AnnFamMed doi.org/10.1370/afm.30…



Image
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Fixed link for this important paper
annfammed.org/content/22/1/5…
Read 4 tweets
Jan 4
My oped on the JN.1 variant and the 2nd biggest US wave of infections (after Omicron) since the pandemic began
@latimes @latimesopinion #LongCovid latimes.com/opinion/story/…
Image
Recent @CDCgov #SARSCoV2 wastewater data for current wave (vs Omicron Jan 2022 and subsequent waves), graph by @luckytran Image
Sorry, @washingtonpost, but this is not "another Covid-19 uptick" as you put it in your Health Alert. You ignore the best metric for infections that we have at present—wastewater—focusing only on hospitalizations
washingtonpost.com/health/2024/01…
Image
Read 4 tweets
Nov 23, 2023
3 New #LongCovid reports
1. Vaccination protection—1 dose 21%, 2 doses 59%, 3 doses 73% among ~590,000 people in Sweden (strong association)
bmj.com/content/383/bm…
Image
2. 3-year prospective follow up of a cohort of ~1350 participants, hospitalized in China
—Lung function restored back to baseline in most
—Higher risk of reinfection that people w/o Long Covid
—Half w/ persistent symptoms
thelancet.com/journals/lanre…
3. At @RSNA annual meeting, brain MRI with microstructure imaging (DMI), participants with #LongCovid vs controls had microstructure changes associated with impaired cognition, sense of smell and fatigue
eurekalert.org/news-releases/…
Image
Read 6 tweets
Aug 25, 2023
Big news #ESC2023 and @NEJM
In a placebo-controlled randomized trial of people with obesity + heart failure (with preserved ejection fraction). semaglutide (Wegovy) markedly improved symptoms, exercise time, reduced inflammatory markers (and weight loss)
nejm.org/doi/full/10.10…

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This also tells us something about the underlying mechanism of heart failure with preserved EF—metabolic dysfunction and attendant systemic inflammation—not previously acknowledged or confirmed
The accompanying editorial lays this finding out well. Prior studies of weight loss didn't help HFpEF
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Read 4 tweets

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