POSITIVE news

Monoclonals antibodies (mAbs) have been quietly built and tested for months now. IMO mAbs have some of the best chances of offering powerful treatments for #COVID19

Lilly is now posting positive results from a relatively small trial

1/

statnews.com/2020/09/16/lil…
Monoclonal antibodies are manufactured antibodies that are built, in part, based on looking at recovered people’s cells and asking “What antibodies naturally formed in these people” and then recreating the “successful” or protective antibodies as a treatment.

2/
Many different antibodies are tried in the lab and in animal studies and the most potent are eventually manufactured - and in the case of Lilly and Regeneron are now being trialed, with early but positive looking results

Why do I think monoclonal antibodies are promising?...

3/
mAbs are promising because we are literally taking proteins (antibodies) that our bodies normally make to defend us from pathogens, we are choosing the best ones, producing them and simply giving them as treatments...

4/
So biologically, our bodies are built to be OK with these types of molecules.

Also, we have a tremendous amount of experience with mAbs. Different mAbs are produced for all different conditions. Some to defeat viruses like RSV and some to help defeat cancers...

5/
Point is, we know how to build them, know they can be given to people safely (caveat that each needs to be assessed on its own), we have examples where they work for similar-ish viruses, and we know that the body can break them down safely.

Also, a great aspect of mAbs...

6/
Is that they could even be given prophylactically. mAbs can even potentially be produced and given to people as a preventative measure - almost like a temporary vaccine - but instead of your body developing immune memory, you give the immune products and they last temporarily

7/
Some mAbs can be produced to stick around in the blood for months. So there is a potential, particularly for elderly people who may not take to a vaccine very well, to provide a shot of mAbs each winter, for example...

8/
But mAbs aren’t here quite yet. But I’ve been banking on them (metaphorically - I have no investments) as one of the most promising class of drugs to help us out of this mess. Perhaps moreso even then vaccines - at least for the short term...

9/
If mAbs (plus other therapies and medical innovations) can help people stay alive and out of the hospital, it can change the overall risk equation and perhaps increase our tolerance for outbreaks, helping the economy to stay open more safely.

But we aren’t there yet.

10/
mAbs may come to market at very high price points and very limited distribution

Like vaccines, they’re unlikely to be widely available soon. But maybe for ex for compassionate use in hospitalized patients.

So, I’m not holding my breath, but I will remain optimistic.

11/11

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More from @michaelmina_lab

29 Aug
Are we quarantining millions of people unnecessarily?

Article by @apoorva_nyc on pitfalls of #COVID19 PCR for quarantine / public heatlth action / policy.

*Disclaimer* the article is based on my discussions with her.

I want to clarify here:

1/17

nytimes.com/2020/08/29/hea…
The basic gist is that PCR is an exceedingly powerful useful tool to detect infections. So powerful that it can remain positive for much longer than people are infectious

More in this thread:

2/17
So PCR is great for diagnosing sick ppl. But if testing non-sick people, many get their first +ve test weeks after being contagious.

I wrote about it in this thread here:

But There is a simple solution...

3/17
Read 17 tweets
29 Aug
THREAD: Maybe you’ve heard about Ct values in the qPCR test and viral loads.

So what’s a Ct value, why is higher Ct a lower viral load, what’s it have to do with #COVID19 , and why do we care?

1/11
Ct stands for 'Cycle Threshold'

In qPCR tests, when the virus RNA enters the test, to detect whether virus RNA exists, it has to get amplified to be seen by the machine, like a ‘zoom’ feature.

2/11
The qPCR machine has detectors that detect fluorescent light.

Importantly, in qPCR, fluorescent molecules bind RNA (actually DNA, but for clarity, I’ll keep calling it RNA since it’s RNA in the virus and people know RNA now - but really the RNA becomes DNA in the test).

3/11
Read 11 tweets
27 Aug
Some Great news!!

Terrific news from ⁦@AbbottNews⁩ and a MASSIVE step forward towards widescale cheap, simple, rapid tests. This is the type of test that not only will diagnose ppl - but can stop transmission chains.

What makes this different?
1/ abbott.mediaroom.com/2020-08-26-Abb…
This is a simple $5 #COVID19 test that requires no instrument. That means it can be produced in the millions and can actually be used - without being limited or bottlenecked by the availability of the instrument.

2/...
Because this is an antigen test - this test will detect people when they are most likely to be infectious but without remaining positive for long periods of time after infection. This can be a major benefit to prioritize containing the virus.

3/...
Read 14 tweets
25 Aug
Terrific balanced reporting here by @apoorva_nyc

It’s very important to make some points clear - the article discusses these...

As I and other immunologists have been saying for months, #COVID19 reinfection is likely but what it means is not what many people might think...
1/
Immunity to viruses is not binary. It’s not 0% or 100%.

We have immune memory and like regular memory, immune memory must learn.

Just as repetition is beneficial to learning or to building muscle memory, repetition helps build immune memory...

2/
In the case of reinfections with #COVID19, or rather, the SARS-CoV-2 virus, it’s likely that reexposures will occur. The important thing is what happens upon reexposure...

3/
Read 9 tweets
25 Aug
Why do we need frequent testing over very sensitive testing? It’s easy

The average person is PCR+ for ~30+ days but infectious for ~7.

Most people are asymptomatic. So, infrequent PCR based surveillance will detect + people but ~75% will no longer be transmitting virus

1/...
We know this. The CDC recommends that after someone recovers from infection and quarantines for ten days, they do not test again bc they are likely to be positive but no longer infectious

2/
So we know that testing someone more than ten days or so days after they are infected doesn’t make a lot of sense.

If performing random testing on asymptomatics, most who are Found to be positive will be discovered only after the first week or so of infection...

3/
Read 7 tweets
22 Aug
Shhh... don’t tell anyone, the actual cost of a #COVID19 test is nowhere near what is charged. Many companies/labs in US are making millions, limiting access to tests. Amid a global emergency & tragedy, costs driven by excessive medical reimbursements are a national embarrassment
We all know medical reimbursements are out of control and bankrupting the US economy. But that it has bled into the pandemic response is terrible. The average markup in a pathology lab is something around ~20x (with a large distribution around it)
As far as limiting access - I’m referring to disparate access. There are many tests that require fees. A $110 fee quite precludes whole segments of population from obtaining equal access to tests. Frequently these segments are the hardest hit with this virus too.
Read 5 tweets

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