Michael Mina Profile picture
Oct 7, 2020 11 tweets 3 min read Read on X
Winter is coming!

If we do not get this virus under control now, we are in for a perfect and terrible storm

We are not taking the expected seasonality of this SEASONAL virus seriously!

Instead, we've assumed our efforts are responsible for decreased cases this summer...

1/x Image
I worry very much that people are confusing the fact that this virus has transmitted in the summer for it not being very seasonal.

This is a grave mistake and misinterpretation...

2/x
The 'force of infection' of this virus is massive! Think of it like the momentum that the virus has to transmit

The huge number of susceptible people is what is allowing the virus to maintain transmission through the summer months - when other coronaviruses go to near zero.

3/x
Mistaking ongoing transmission in the summer for a "less seasonal virus" is not smart. All evidence points in the other direction

Instead, continued transmission reflects force of infection 'going uphill'... which means that as winter sets in, we may see massive increases.

4/x
This virus got out of control because of a handful of imports.

We now have literally 10,000's of cases in the US daily... all potentially ready to explode into massive outbreaks once the weather / other natural or social biology becomes optimal for spread.

5/x
Meanwhile we're not acting now to stop it. We're barely acting to improve any semblance of surveillance. At same time we're saying - we must open back up.

Yes! But, one must come before the other - ideally it would be control first, open fully second, once we're ready.

6/x
We could have been much more ready now. But instead we are just giving the virus a major headstart at the very time when it has its guard down. that we are not taking advantage of it is going to be reflected in many more infections and deaths moving forward I fear.

End
7/7
Here is a review of what’s known about seasonality of coronaviruses.

doi.org/10.1093/infdis…
People say we don’t have evidence of seasonality for this virus - and suggest seasonality may not even be a thing for a pandemic virus. That’s just wrong.

True we don’t have a lot of evidence for THIS virus - but we do it’s closest neighbors. That gets us far...

15/x
But while we don’t have evidence of seasonality in the northern hemisphere - of course... it’s not been a year yet - we can look to the southern...

16/x
In the South Hemisphere - not on equator - most nations with a lot of cases were in the clear until ~June. And then cases started. Some July. The dynamics and timing is quite different than North. Almost no outbreaks requiring shutdowns when North did - were all months later.

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More from @michaelmina_lab

Jun 12
I've been thinking on my review of RFK Jrs 8 new ACIP members

When announced, I found myself thinking "could've been much worse" and so was relatively favorable

However, the bar being set so low caused me to miss a huge piece... and there's still great risk!

Short thread
1)
While I was pretty favorable to a majority of the new members - the bar is set inredibly low -

I was just happy the 8 were not the most hard core ideologues for whom destroying vaccines is practically religion (like RFK Jr)

That obscured the biggest problem of the group

2/
Perhaps the biggest problem is it is a panel of people who, generally speaking, are generally NOT:

experts in diseases vaccines prevent
experts in vaccines
infectious disease epidemiology
clinical trials

If this was the private sector, no way would this group pass muster

3/
Read 6 tweets
Jun 12
RFK Jr released names of 8 ppl he is placing into ACIP to replace 17 removed

Actually a majority are v reasonable - 2 of 8 however align heavily w conspiracy & anti-vax but as I discuss, their presence may have a silver lining

My thoughts:
Thread



1/cnbc.com/amp/2025/06/11…
Joseph Hibbeln MD has long researched and advocated for optimizing nutrition, including studying things like seafood consumption in pregnancy and role of mercury consumption and whether it is linked to autism. Generally he’s come out saying it’s not.

Summary: No evidence of anti science or anti vaccine. Likely very balanced and nuanced rigorous scientist to serve on ACIP. 
2/
Cody Meissner MD
Is a pediatric infectious disease expert at my Alma mater - Dartmouth. He is a rigorous scientist and has defended vaccines while formally recognizing underlying issues that are causing people to turn away from them - such as vaccine success driving down disease - affording people the luxury of focusing on very rare side effects while forgetting the real impacts of the diseases. 

For example in @NEJM he wrote: 

Summary. Terrific Choice

3/Image
Read 11 tweets
Feb 26
This is horrible & exactly what we are afraid of - measles kills ppl

In ~100 infections in TX, someone has already died

For those w/out vacc- it is not the benign virus you’ve been told

1:5 hospitalized
1:100-1000 die

This will spread further.

1/

apnews.com/article/measle…
The measles vaccine is exceedingly safe

It stops infections & spread extremely well!!

Measles on the other hand

1) kills 1:100-1000
2) hospitalizes 1:5
3) Kills immune cells & deletes protection against other infections
4) causes early immune suppression / coinfections

2/
I am extremely concerned that the communities of vaccine hesitancy have grown enough that they are now “bleeding into each other”

Which means infection in one may well ignite outbreaks of many thousands

That will come w more disease and death

Vaccination will prevent this

3/
Read 4 tweets
Feb 19
Measles cases may likely grow into the 1000’s

The TX measles outbreak continues

With “bubbles” of undervaccination getting bigger, we can expect outbreaks in one to catch on to the next

Igniting transmission that may catch and spread across the U.S.

cnn.com/2025/02/18/hea…
One of the most common tropes is that measles is fine & doesn’t cause damage…

This is highly inaccurate

Measles literally grows by infecting and killing memory immune cells. It causes loss to existing immunity creating vulnerabilities & acute damage that is often severe

2/
To discover the massive-stealth-impact measles has on immune protection against infections not associated w measles, we looked at what happened in populations after measles outbreaks swept through, decade after decade across nations…

What we found was astonishing…

3/
Read 19 tweets
Dec 27, 2024
Important wake up call:

#H5N1 BirdFlu just sequenced by @CDCgov from severe Louisiana patient

Most important, the H5 virus mutated inside the single patient to gain an ability to bind human receptors in the upper respiratory tract

It takes just one…

cdc.gov/bird-flu/spotl…Image
This is exactly the type of thing we worry about.

The mutations developed anew in this patient have been linked to severe cases elsewhere

Thank goodness the patient didnt (as far as we know) spread to any people or wildlife but this is the real concern…

We must do better

2/
And what should we do… there are many things we (USGov) should be doing yet barely have:
Read 6 tweets
Oct 3, 2024
🧵 On Seasonality:
SARS-CoV-2 has "seasonality" as a contributor to transmission dynamics

People often refute it - So I made graphs and this thread

NOTE: Seasonality does NOT = "just a cold"
Many of worst viruses have seasonality

Transmission Dynamics ≠ Pathogenicity

1/Image
Image
Image
The first figure is Wastewater SARS-CoV-2 RNA levels averaged across the whole United States

See the REMARKABLE stability in the winter peak

The peak happens in the exact same week each year

Additionally, the start up the upswing to the peak (triangles) is also consistent

2/Image
A common misconception is that "Seasonality" means "no transmission out of season"

That is NOT TRUE

Seasonal forces are those that drive predictable behavior - like a winter peak in the first week of each year

3/
Read 14 tweets

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