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13 Dec, 9 tweets, 3 min read
Here are the most challenging #COVID19 questions I got this week: 1/
1. When will life return to normal? Some answer this by looking at when we'll hit herd immunity. That's not how I think about it. I don't believe we'll reach herd immunity in the US in 2021 (vaccine hesitancy & escape mutations), but I do think we'll get normalcy by the fall. 2/
Coronavirus will eventually mirror influenza: The goal isn't to make it go away; the goal is give people the opportunity to get vaccinated. We've just accepted that there will be millions of influenza cases and tens of thousands of deaths every single year. At some point...3/
...we'll accept something similar with #COVID (assuming hospitals aren't overwhelmed). Life returns to normal once vaccines are widely available. It's about production, not herd immunity. 4/
2. Why aren't we using ivermectin? On Dec. 8, a physician appeared before the Senate Committee on Homeland Security claiming ivermectin is a "miracle drug" for COVID and cited several international studies to back up the claim. Some are shocked and angered this isn't getting...5/
more attention. When I got this question, I was aware of one ivermectin trial in Argentina that was going to enroll 229 people: 
clinicaltrials.gov/ct2/show/resul…
subsequently published results on nearly 1200 volunteers. 
trialsitenews.com/argentinas-ive…
There may be a good reason for this. 6/
The jury's still out on ivermectin, but I need much more information before I change my practice. We don't use the drug for COVID in the U.S.; we'd only give it as part of a clinical trial. For some, that's not good enough. We're working on a more satisfying answer. 7/
3. What worries you? Many things! But mostly two things: 1) What this is doing to our kids and 2) That we'll let our collective guard down now that vaccines have arrived. 8/
4. What are you looking for with vaccine rollout? Waste. There's little room for error when dealing with subzero temps. How many vials will be compromised? I've seen 10% thrown around. That could mean hundreds of thousands of wasted vaccines. I hope that estimate is wrong. /end

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Matt McCarthy Profile picture
15 Dec
UPDATE: After an initial dip reported in late November👇, #coronavirus infections actually increased in London during the final weeks of a nationwide lockdown. 1/
New results from the REACT-1 study found that infections grew from 0.98% in mid-November to 1.21% in early December while a nationwide lockdown was still in place.  2/
imperial.ac.uk/news/210873/co…
Important implications as other countries consider lockdowns. Is transmission more likely to occur at home? Is a new viral mutation to blame (one that makes the virus more contagious but not more lethal)?
Perhaps lockdowns only work in short bursts. 3/
timesofmalta.com/articles/view/…
Read 4 tweets
Matt McCarthy Profile picture
15 Dec
Reassurance isn't what's called for. And it's not what people are searching for.
What's needed is honesty. Here's what I say: 1/
1. mRNA vaccines (Pfizer, Moderna) appear to be incredibly effective at preventing symptomatic disease. Better than we'd ever dreamed.
2. The side effect profile after two months is similar to other vaccines that protect against viruses. 2/
3. These vaccines are not FDA approved; rather, companies have permission to vaccinate people under an emergency authorization. Approval won't happen until spring because we don't know the rare and/or long-term side effects. 3/
Read 5 tweets
Matt McCarthy Profile picture
9 Dec
UPDATE: Pfizer's data demonstrates its vaccine is safe & effective (at least in the short term). But the trial wasn't designed to detect a reduction in several meaningful outcomes, including: 1) hospitalizations, 2) use of intensive care, or 3) deaths.
This isn't surprising. 1/
These trials often lack statistical power to assess severe outcomes. (Moderna won't answer the questions either). Example: we still don't know if influenza vaccination in the elderly improves mortality. Randomized trials measuring this haven't been done. 
thelancet.com/journals/lanin…
Pfizer acknowledged this in its data release yesterday: "higher attack rates would be needed to confirm efficacy of the vaccine against mortality." (page 48). Large observational studies will be needed, presumably after authorization.
Read 5 tweets
Matt McCarthy Profile picture
8 Dec
UPDATE: I've been digging through Pfizer's vaccine data. It's incredibly encouraging and frankly, I'm stunned that this was all done in one year.
The FDA's advisory panel will review this data publicly on Thursday. You can check it out here: 1/
fda.gov/media/144245/d…
mRNA vaccines are described as new (there aren't any on the market) but they've been studied for decades. Pfizer has overcome the challenges limiting their use, including: 1) instability of free RNA in the body, 2) unintended inflammatory outcomes, & 3) mild immune responses. 2/
It's also reassuring that Moderna had such similar topline results using the same mRNA platform. This doesn't appear to be an aberrant outcome.
If there's one thing I'd like to know more about from Pfizer's data, it's at the bottom of page 43: 3/
Read 5 tweets
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

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