As you've probably heard, we're getting close to having #CovidVaccines authorized in western countries (and they have been in the UK). It's tantalizing to think that life will be "normal" again soon, but there's a lot of factors to consider—a thread 1/x qz.com/1941409/how-ma…
2/x For simplicity's sake, let's assume "normal" means people have been vaccinated to the point of herd immunity, everything is open, travel is fine (but expensive, like the good ol' days).
3/x Okay: Herd immunity means that enough people are sufficiently immune to an infection that it can't be transmitted to others. How many vaccinated people will that take? Well, it depends on two factors:
4/x 1) How well does the vaccine actually work in practice? We've only seen press releases from various companies about the vaccine's EFFICACY in clinical trials. Real life is messier than clinical trials! People may not get doses on time, which could give folks less protection.
(4.5/x -- for background on efficacy in clinical trials vs real-world effectiveness, see here: qz.com/1930285/what-d…)
5/x Next, we gotta ask: Does the vaccine actually stop transmission? We don't know. It should! Bc it should make it hard/impossible for SARS-CoV-2 to replicate, making it less likely to shed. But trials have only examined if people got Covid-19 so far.
6/x Assuming each person infects between 2 - 3, more people (R0 for all you nerds out there), and assuming effectiveness is similar to demonstrated efficacy, we could assume ~60 - 70% of the population needs to be vaccinated for herd immunity, @Sms3Steven told me
7/x BUT that vaccine needs to be equitably distributed! You can't have your 70% of a population all in one place!! And that's a whole other can of worms to open; we know there won't be equitable access to Covid-19 vaccines across countries/the globe.
8/x And then there's the fact that herd immunity is a nice idea and all, but theory isn't the same as real-world transmission. THOSE metrics, like community rates, new daily cases, and hospitalizations, should be the ones to inform public health decisions...
9/x ...Like loosening mask mandates, reopening schools/bars, and allowing mass gatherings. Community rates SHOULD decrease as vaccines get rolled out, and we should be able to learn about their actual effectiveness—but we can't assume on vaccination rates alone.
10/10 So anyway, that's a lot more unknowns than we'd like. But at least we've got metrics that we can watch moving forward: qz.com/1941409/how-ma…

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More from @katherineefoley

19 Nov
The race to be the first to get a a #COVID19vaccine available is getting spicy: @pfizer / @BioNTech_Group, @moderna_tx, and @AstraZeneca are all close to releasing partial/full phase 3 trial data. But being 1st isn't the only way to win: qz.com/1935017/ A thread: 1/x
One excited thing buried in @pfizer's announcement yesterday was that it seemed like their candidate had 94% efficacy in adults over 65. 41% - 45% of their trial participants were 56-85 yo 2/x

pfizer.com/news/press-rel…
3/x This is huge*: The changes in older adult immune systems mean that generally, vaccines don't work as well in these populations. ncbi.nlm.nih.gov/pmc/articles/P…

*If true beyond the press release!! We want data!
Read 11 tweets
10 Nov
One thing I don't see anyone talking about in the @pfizer #CovidVaccine discussion is the difference between efficacy and effectiveness. It's a small nuance, but it matters when we're talking about how to end the pandemic. A short thread: 1/x qz.com/1930285/
2/x We got the news* yesterday that Pfizer's vaccine candidate seemed "90% effective." If we're going by the @CDCgov's definition, the company really meant "efficacy."

*It's from a press release. We want independent, peer-reviewed, published data before we make any conclusions
3/x "Efficacy" means a vaccine seemed to work at preventing illness in a randomized controlled trial. These trials are the gold-standard of scientific data, but they're also not reflective of the real world.
cdc.gov/csels/dsepd/ss…
Read 8 tweets
8 Nov
Folks, a lot of you are hearing about Wilmington, Delaware. As someone who essentially grew up in the biggest city in Delaware (pop: 71k) here’s what you’ve been missing every time you merely drove by it going up and down the east coast instead:
1) The Wilmington Blue Rocks, our minor league baseball team. Our mascots are, I kid you not, a stalk of celery and a blue moose named Rocky Bullwinkle (to avoid copyright infringement with the show “Rocky & Bullwinkle”) Image
2) Bellevue, Brandywine, Rock Creek, and White Clay creek state parks, where I spent my Saturday mornings running cross country races. These courses featured some of Delaware’s only hills (the state is a pancake). We have only 1 national park in the whole state (thanks, obama!)
Read 10 tweets
29 Oct
💩 Back in May, I heard about scientists trying to use wastewater as an early #covid19 warning signal. As I dug into that idea, I learned about their much larger ambition: giving one of the oldest public health tools a major glow-up.
A ~crappy~ thread: 1/x
qz.com/1923774/covid-…
2/x We've got a love/hate relationship with poop. On the one hand, VERY BAD bc it transmits a lot of diseases; hence why we built sewers to keep it out of our drinking water. But on the other, a complete record of everything we've eaten, drank, or otherwise been exposed to...
3/x In the past, wastewater #Epidemiology has shown where there were pockets of polio outbreak or opioid usage—even before cases or overdoses popped up. Turns out, it looks like we can do the same thing with #COVID—it's RNA shows up in poop days before cases do.
Read 14 tweets
11 Oct
An important reminder that just bc Trump's doc says he's no longer #COVID contagious, he STILL may not be out of woods. Older immune systems respond differently to infectious than younger ones; to understand how, we gotta talk about PUS! A thread 1/x qz.com/1913864/what-a…
2/x There are hundreds of types of immune cells in your body. Broadly, they're classified as innate or adaptive. Innate = faster and less specialized; they hit HARD w/ collateral damage. Adaptive = slower and more like assassins that go for specific cells + cause less damage
3/x Pus is the result of neutrophils, innate immune cells that patrol your blood lookin for infection. When they see one (like bacteria from a cut or scrape), they rush in and BLOW THEMSELVES UP, making that yellowish liquid. The sticky, slimy aspect is neutrophils' shredded DNA.
Read 10 tweets
21 Sep
A lot of people, myself included, have taken a #Covid_19 test before going to see a new group of family or friends. Practically, though, these tests can create a false sense of security bc of their high false negative rate. I'll explain in a thread: 1/x
qz.com/1905604/should…
2/x Some context: In the US, there are still some local testing shortages. But bc capitalism, private companies like @LabCorp, @everly_well, and @LetsGetChecked have started offering @US_FDA emergency-use authorized at home collection kits that get shipped off to a lab.
3/x These kits are ~$120 out of pocket, but insurance can cover them. It's a swab + PCR test, looking for SARS-CoV-2 genetic material. They typically return results in a couple of days, and you don't have to leave your home.
Read 10 tweets

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