Thread by @InfectiousDz

The story of Manaus is worrisome

1. Manaus, Amazonas, Brazil had an overwhelming initial surge (44% seropositive, likely 76% infected)

2. Cases now surging again

3. Mutant variants found spreading

4. Variants like the UK variant, but arose separately in Brazil

https://twitter.com/InfectiousDz/status/1348733845814829069?s=20

https://twitter.com/virological_org/status/1348729697732079618?s=20

Here's the first and current surges. Given the initial infection rate thought to be 76%, this is concerning for reinfected

https://twitter.com/josegallucci/status/1348729040702742528?s=20

Here's the documentation of the first huge wave with 44% antibody positive and an expected 76% infected in Manaus, capital of Amazonas science.sciencemag.org/content/early/…

A new variant has been documented to cause reinfection and even be more severe the 2nd time. We will need to see how common reinfections and whether others are severe

https://twitter.com/AliNouriPhD/status/1347016588579508224?s=20

More on reinfection in the presence of antibodies academic.oup.com/nsr/advance-ar…

Here's more on the on-the-ground clinical situation in Manaus. "Hospitals and cemeteries are again overwhelmed, resembling the brutal outbreak last April"

https://twitter.com/TelGlobalHealth/status/1348653274170347527?s=20

Travelers are often the canary in the coal mind. 4 travelers in Japan were found to have this Brazilian variant

https://twitter.com/NikkeiAsia/status/1348316512491368449?s=20https://twitter.com/japantimes/status/1348631273191985153?s=20

Punchline, with all the unchecked spread, COVID has been rolling its dice again and again. A few times around the world - and maybe more - it has morphed into a more transmissible form that can cause surges where 3/4 have been infected.

Some of the vaccines that are being rolled out do not have any published efficacy data and others have efficacy in the 60% range. There are lessons here from Manaus. COVID may be a long game of whack-a-mole

For those who asked about the climate in Manaus: red is the temperature, pretty much the same warm temps month to month. Blue is precipitation.

In a radio interview yesterday

https://twitter.com/InfectiousDz/status/1348975416225247232?s=20

And don't ever expect natural herd immunity to be the answer

https://twitter.com/InfectiousDz/status/1348977210313601026?s=20