Thread by @EricTopol

If you want to know about #SARSCoV2 as it started and where it is going, you talk to @edwardcholmes, a leading evolutionary virologist @Sydney_Uni
medscape.com/viewarticle/94… @Medscape video and transcript
a 🧵 /1

Eddie's Jan 10th tweet that will go down in history since the virus sequence led to the design of mRNA vaccines 2 days later /2

Prof Holmes has been studying viruses for 30 years, in recent years a lot of metagenomic sequencing, the technique used to identify #SARSCoV2, and a major collaboration with Prof Zhang in Shanghai
time.com/collection/100… /3

The impact of sequencing:
Back in the HIV days it took 2 years to find the causative virus.
With SARS it took a few weeks
With SARSCoV2 it took 40 hours (Prof Zhang's lab)
Now over 250,000 SARSCoV2 genomes have been sequenced /4

By Jan 5th sequencing this was known to be a novel coronavirus, Profs Zhang and Holmes submitted a paper to @nature Jan 7th, and while on a plane cellphone Prof Zhang, encouraged by Eddie, said yes, the "open-access moment"
w/ @JeremyFarrar @arambaut /5

The sequence also was pivotal to design PCR tests, such as by @c_drosten and @MarionKoopmans.
Getting the sequence accurate before posting it was nerve-racking as Eddie reviews here /6

As Prof Zhang said about posting the sequence,
"It is a turning point for China. It was a turning point for the world" /7

Now we've at a another turning point. The evolution of new, more infectious variants, especially B.1.1.7, becoming dominant in the UK, with 23 mutations, and the South African variant (N501Y). Both have key mutations in the spike protein's receptor binding domain /8

Both of these are associated with higher viral load infections (lower Ct values), showing up quickly with higher frequency in people w/ infections in the areas noted they've appeared /9

We discussed the potential impact of convalescent plasma and in situ acceleration in immunocompromised hosts as potential causes of these variants. And it is not yet resolved as to their impact on current vaccines but experiments are underway /10

It's unlikely to make a difference now. But eventually we're going to need booster shots to deal with the drift (immune selection pressure) of the virus...it may take 2 years, 5 years
A key part of our conversation here: /11

The virus is going to be endemic
"It's going to evolve and escape immunity like everything always does." /12

Eddie reviewed the 3 major things we have to do to prepare and be smarter for the next pandemic
--distancing ourselves from the animal world
--global surveillance
--stockpiling universal vaccines, antivirals (like an Apollo project) vs 3 major virus families /13

There's a lot more that I haven't summarized here. Prof Holmes is an exceptionally informative resource and his impact on this pandemic, his support for open science, and keen insights for how the virus will evolve are all notable /f