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6 Dec, 6 tweets, 2 min read
COVID question I've been getting: Why do I need a vaccine when there's a 99.7% survival rate? It's a fair point (and makes for a lively discussion!).
Here is my response: 1/
Survival is an important metric, but it's the wrong one to focus on. Coronavirus is different than anything we have seen before. It causes strokes, it inflames blood vessels. It alters your sense of smell because it gets into your brain. It causes oxygen levels to plunge and.. 2/
you might not even feel it. It causes symptoms that last for months and we don't know why. When someone contracts the virus, I'm not just worried about survival. 3/
The other thing that hasn't gotten any attention: #coronavirus can trick your body into making antibodies against one of the immune system's most powerful signaling molecules: interferon. This brilliant sleight of hand may explain why some people get...4/
science.sciencemag.org/content/370/65…
severe disease (and why it tends to be older men). If I had to choose between natural immunity or immunity through vaccination, I'd choose the latter. 
Focusing on survival rate dismisses everything we know about the virus. 5/
Takeaway: If you get COVID, you'll probably survive. But your life could be fundamentally altered. This is why a vaccine that prevents symptomatic disease fills us with such hope.

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More from @DrMattMcCarthy

Matt McCarthy Profile picture
8 Dec
COVID Question I've been wrestling with: How does Pfizer's vaccine actually work? There are plenty of explainers out there, but they don't give a complete picture of what's happening inside the human body. Here's what we know and what we don't: 1/
Pfizer & Moderna have created COVID vaccines using a novel platform: messenger RNA (mRNA). When one of these vaccines is injected into your arm, your cells take up the mRNA & use it to make a coronavirus spike protein.
Note: You are NOT getting injected with the full virus. 2/
Spike protein is the part of coronavirus that's responsible for binding to human cells. When your immune system sees it, a cascade of immune responses are initiated, including antibody production, that ultimately provides you with protection.  3/
Read 8 tweets
Matt McCarthy Profile picture
7 Dec
COVID question: "Should people avoid Tylenol after vaccination?"
Fever is an expected side effect of mRNA vaccines & the reflex is to treat it. But treating fever can, in some cases, dampen the immune response.
When a patient gets a post-vaccination fever, what should we do? 1/
For most of the #COVID19 trials, volunteers were allowed to use temperature-lowering medications (antipyretics) after vaccination. This is understandable; fever is uncomfortable and, in rare cases, can be dangerous. 2/
But most of the time it's not. Fever is an adaptive response. It helps the immune system optimize performance. B cells make some antibodies more efficiently at higher temperatures. Treating a post-vaccination fever might be a mistake. 3/
chop.edu/news/journals-…
Read 6 tweets
Matt McCarthy Profile picture
6 Dec
UPDATE: We've been clamoring to see the vaccine data for months. That will finally happen on Tuesday (December 8), when Pfizer’s info is released to the public. Here are some things I’ll be looking for that were not revealed in press releases: 1/
1. What do we know about the memory T cells of vaccinated volunteers? There’s been a shift in thinking on the role of these immune cells. They may be more important for protection than neutralizing antibodies, which have previously been the focus. 2/
2. Most major adverse events appear within 6-8 weeks of vaccination. (Minor events have a different timeline). After tens of thousands of vaccinations, there does not appear to be a common, severe side effect associated with this vaccine. What about uncommon events?  3/
Read 8 tweets
Matt McCarthy Profile picture
5 Dec
UPDATE: I’ve been asked to provide guidance to some doctors who are trying to figure out: 1) whether to take a #COVID19 vaccine issued under emergency authorization and 2) what to recommend to their patients.
Here’s my approach:  1/
On December 10, I'll watch the Vaccines and Related Biological Products Advisory Committee discuss Pfizer's data. I have many questions about subgroup efficacy, safety, & memory T cells. I’m confident those will be addressed. Then, fighting the urge to do something, I’ll wait. 2/
We’ll do it all again on December 17th when the same panel meets to discuss Moderna’s data. After that, I’ll speak with colleagues, compare notes, and hash out a recommendation. I'll explain the rationale and my level of confidence in that recommendation. 3/
Read 6 tweets
Matt McCarthy Profile picture
4 Dec
The controversial argument to continue placebo-controlled vaccine trials after emergency authorization hinges on this idea: The obligations researchers have to volunteers in a trial are distinct from the obligations that physicians have to their patients. 1/
Researchers must always ensure that placebo-controlled trials remain ethically appropriate, and that takes into account a variety of factors, including local transmission rates and individual risk profiles (volunteer age, medical conditions). 2/
The case for continuing these trials is laid out here by NIH bioethicists: science.sciencemag.org/content/early/…
Read 4 tweets
Matt McCarthy Profile picture
4 Dec
COVID Question: Will vaccination be a yearly thing? Maybe. After the rollout, we'll do surveillance to determine: 1) How long protection lasts and 2) If mass inoculation causes coronavirus to mutate.
It's an RNA virus, and replication is often sloppy, so it could change. 1/
We don't yet know if #coronavirus will behave more like measles or influenza. Both are RNA viruses, but they require vastly different vaccination strategies. Most people are protected from measles by childhood shots; by contrast, influenza requires yearly vaccination. 2/
The difference has to do with how these viruses mutate. Measles has one serotype; influenza has several.  3/
Read 5 tweets

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