In light of the recent article from the UK discussing antibody waning - it’s important to read additional reports that show that while the antibodies are waning, they are not disappearing. This is expected and the natural course of an immune response.

1/
After a primary infection, antibodies go sky high - along with the cells that produce them - and then after the virus clears, those cells must subside and the antibody production falls. Antibodies this wane, almost by definition, after a primary infection

2/
Importantly, the antibodies do go down and, like in the UK report may fall below the limit of detection. But like in the @SciImmunology paper above by @florian_krammer among others, when a more sensitive test is used, they often remain detectable...

3/
In many people though even those detectable antibodies may eventually become undetectable. The important thing to know is that the detectable antibodies are not the end all of immune protection...

4/
To form a good antibody, the cells undergo a lot of effort to figure out how to make it-that effort is stored in the body as a memory B cell. So even if the antibodies are no longer floating around, when someone gets a second infection, the B cell remembers and can act quickly
5/
The memory B cell - with the memory of the virus already formed - can act quick, can multiply, and can create new cells that rapidly start producing new antibodies after the second virus exposure.

6/
So while its encouraging/comforting to see the antibodies, their absence does not mean an absence of immune protection. The B cells remain T cells likely remain

It’s sort of like putting jets back on an aircraft carrier. They’re still there, ready, even if not flying about

7/7
Correction it is a Science @ScienceMagazine paper... I wrote @SciImmunology ... though there have been a few additional papers in Science Immunology that have also shown this.
Correction above... it is a Science @ScienceMagazine paper... I wrote @SciImmunology ... though there have been a few additional papers in Science Immunology that have also shown this.
See this from @NIHDirector for two additional papers as well. The post discusses two additional and very nice recent papers published in @SciImmunology showing persistence of antibodies.

directorsblog.nih.gov/2020/10/20/two…

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More from @michaelmina_lab

28 Oct
New paper showing strong agreement between nasal (ie self collection) and nasopharyngeal swab on rapid test. This is an important finding since, in US, rapid tests currently authorized for nasopharyngeal swabs and thus need healthcare collections

1/ medrxiv.org/content/10.110…
These types of studies are needed to identify how well rapid antigen tests may work with self collected swab - essential for wide distribution and public health screening use of these tests to help curb outbreaks.

Other notable items from this paper:

2/
One is that the rapid antigen tests in this paper (SD Biosensor) performed very well up to a Ct of about 30. This is what we have expected for these tests and is likely at this rate to capture most infections with viable virus. Great for a public health screening test

3/
Read 8 tweets
27 Oct
Eli Lilly’s antibody therapy unfortunately is not working in hospitalized patients. A blow to a hopeful “remedy” that could help tip the balance between risk of infections vs risk of economic fallout

But this isn’t the last of this story.. not by far

1/

nytimes.com/live/2020/10/2…
First, there are other antibody based therapies that are being developed, are in trials and new versions in early R&D phase.

Monoclonal antibodies have a huge potential and we mustn’t let this get us down.

2/
Regeneron’s monoclonal antibody therapy for example (the drug given to the president) remains in trials for hospitalized patients. This is but one of many that will be in trials!

3/
Read 7 tweets
25 Oct
This is incredibly sad and bad news for the US.

In only 3 days, the 14-day average change in #COVID19 HOSPITALIZATIONS has skyrocketed from 7% to 15%!

This means hospitalizations are not simply increasing but accelerating upwards at a fast pace.

1/
For the 14 day average change to >double in only 3 days means that the actual current change is much more than 15% (to pull a 14-day change that far up in only 3 days means the past three days have seen remarkably large increases).

2/
This is not some fear tactic. This is peoples lives. This is the proper functioning of our healthcare system (already stretched to the brim at baseline).

We are only at the beginning of this “spike” and it could continue accelerating up for months!

3/
Read 6 tweets
24 Oct
I’m glad tests are becoming more available... but not like this. Not for $130!!! 10x more than cost!

I’ll say it here, #COVID19 has become commoditized. Labs are making millions of $$$ bc people are desperate. This is not how public health should work

foxbusiness.com/lifestyle/cost…
This is for a saliva based PCR test. The test actually likely costs <$10.

Add overhead for staff and the lab. Maybe - MAYBE - get to $25. But $130. This is extortion in my opinion.
#SalivaDirect on the other hand (as one example) has made a strong concerted (and so far successful) effort to drop prices and raise awareness that these exorbitant prices need not exist

Not surprising - they are not-for-profit and doing what’s right

@awyllie13 @NathanGrubaugh
Read 5 tweets
24 Oct
#COVID19 Cases at all time high.
#COVID19 Hospitalizations up 40% in last month

Deaths lag cases! Herd Immunity = deaths

Step 1) Stop Virus
Step 2) Open Up

Step 2 will NOT cause Step 1 without 100,000’s more deaths.
Step 1 WILL allow Step 2 to happen safely.

Solutions exist!
We don’t have a vaccine. Rx won’t bail us out

We must stop spread.
Economic/human fallout too costly for total shutdown

We must think creatively and can’t let perfection paralyze us

Simply, we must know who’s infectious and remove them

Frequent rapid tests can enable this
**Natural Herd Immunity that is **
Read 4 tweets
22 Oct
This happened faster than I expected, and I’ve been anticipating major upswings. We’re unfortunately just at the beginning

Going into fall w 60k cases/d means winter may well dwarf the spring and summer peaks

It’s up to us to change the course. But won’t w/out proper leadership
I’m referring to the fact that we are right back to our summertime peak. So early into this long winter.
This makes me mad as hell and really really sad. Not just for the ppl who will die (1000/d right now) but for the stores that will close, the families that will lose jobs, the health effects due to COVID and as important as anything else, the mental health effects that will occur
Read 5 tweets

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