Joanna Poole Profile picture
20 Nov, 16 tweets, 3 min read
What is an mRNA vaccine? One that instructs the human host cell to make isolated viral proteins (not the whole virus just a surface protein!) so the immune system learns about it and will be ready in future.
How do we know the vaccine is safe? “Safe” is a relative term in medicine because sleeping, paracetamol, and driving isn’t even safe yet we do such things frequently. However rates of adverse events have been extremely low
Because vaccines work by provoking an immune response - and we know the vaccine does, and in a time scale less than 6 months - we would expect adverse events to be within this time frame.
RNA is broken down very fast in the body and certainly isn’t going to be there in ten years time.
How come mRNA vaccines have never been licensed in humans of they’re safe? Well actually plenty of trials have shown that they are safe. Indeed drugs and vaccines have to be shown they are safe before they are proved effective! Ethics rules 101.
But what this does mean, is because it is a medical treatment like any other, outside of a study, the risk of the disease has to be greater than the risk of the vaccine or existing treatment.
We haven’t needed an mRNA vaccine ever before! We already have vaccines for a lot of problematic human diseases so it’s quite hard to make the ethical and financial case for mRNA vaccines. In fact because they don’t even inject the pathogen itself, they’re pretty safe!
Why has it been so fast? So the main issue with a lot of drug development is actually funding and committed and ethics and business cases and getting the right people in the same place and time to review them. Actual data collection is usually shorter and quick to analyse.
Compare the amount of planning for a wedding versus the day itself...but come covid everyone is obsessed, getting emergency funding, priority review and emergency ethics approval and like whole continent resources thrown at one company
There is no way on God’s green earth the FDA and other drug licensing companies are going to license something where evidence is the vaccine is riskier than the disease.
The vaccine is only 90% effective. Well most childhood vaccines are 85-95% effective. Flu is like 40-60% effective. TB vaccine was 60-70%. 90% is great!
The vaccine might not reduce transmission, just symptoms. Just like flu vaccine then! I’d rather get mild covid than fatal covid.
I’m young and don’t have much risk of dying from covid. Firstly, long covid sounds rubbish. And you can still give it it all your loved ones. The more people get the vaccine, the less people get symptoms, the less hospital fills up.
1500 people currently ventilated out of 4000 intensive care beds. Congratulations, your chance of getting a ventilator after having a car crash, asthma, operation, sepsis or major blood loss from childbirth, has magically reduced by more than a 1/3. And that’s with lockdown!
So. As an intensive care medic, I will be getting the vaccine because a) I don’t want “long covid” b) I want to protect my family c) I’m heartily tired of seeing people with no medical conditions go into multi organ failure and die d) knowing it’s avoidable
e) 8/10 floors of hospital full of covid wards f) having to cancel operations due to no beds g) wanting to explore exotic places without having to worry what covid care is like on safari h) contributing to exterminating covid before it mutates into something worse...

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More from @Jopo_dr

20 Nov
So I am really worried about anaesthetic recruitment @Anaes_Trainees I know it is discussed frequently but I recently found out that a recent paper showed that self-assessment shows bias (80%) for male selection as likely to higher score and having helped
A trainee revise for the exam that is being introduced in January (used for GP recruitment) and extended to anaesthetics and other specialties, includes niche dermatology questions, niche gyne questions and GP referral guidelines
all of which I was only able to answer because I have done MRCP. What on earth is this exam doing to shortlist anaesthetic interviews? What evidence is there available this improves recruitment? I genuinely feel by trying to appoint more medic minds they can fund the shortfall
Read 4 tweets
19 Nov
So the more I think about this problem the more obvious it seems. We focus very much on stabilisation and crosslinking and surface receptors when it comes to platelets and thrombosis. We aren't considering the internal actin filaments/cytoskeleton
that affects activation and binding. Having just read a paper where one of the key host proteins going missing in nasty vs mild covid, is gelsolin, an actin removing enzyme, I am trying hard not to imagine we are missing something.
e.g. if you don't take actin out of the fibrin clots, you stay very clotty.
Read 4 tweets
19 Nov
This is a thread on how the moon made mitochondria. So some billions of years ago (4-5billion) a Mars like body called Theia collided with proto Earth.
The collision drove the iron core of Theia deep into Earth’s crust, whilst it’s surface accreted with Earths mantle. The impact superheated Earth to above 1500 degrees and made it molten. The moon catapaulted off (and possible was at least two moons that later smashed
Into each other, hence why moon thicker on one side.). Anyway everything molten, and lighter elements like silicon rose more superficially, iron sank deeper. If you ever wondered why there is a truckload of silicon on beaches, and not iron sand, like me.
Read 22 tweets
18 Nov
3 acute phase proteins to know: CRP has genetic turnover, named for particular fondness for strep, opsonises strep, and can be infused to reduce sepsis mortality in rats...
Ferritin helps reduce heme available for infection/prevents heme induced oxidative stress - particularly vital for surviving infection by yersinia (plague) to whom heme is virulence the point ferritin response from plague vaccine protects the recipient
Against re exposure mere hours later. And having haemochromatosis makes non lethal lab plague, fatal.
Read 5 tweets
16 Oct
Every so often I see people reassured when actively bleeding patients have a systolic BP of 100. To get a ballpark multiply their MAP by 80 and then divide that by 2000 (a squeezed shut systemic vascular resistance in stupid units - dynes.sec/cm5)
Eg BP 100/60 MAP = 72.
x 80 = 5760
/ 2000 = 2.88L/min
HR of 150 means stroke volume of 19ml when normal is 60-100ml
These patients are peri peri peri arrest and they need blood that second, and they scare me tbh, and the number of times I’ve seen it handed over “but they’re okay their BP is stable” and 😱
Read 6 tweets

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