This new variant is making a lot of people REALLY nervous. Here’s why it should & shouldn’t. I’ll hit on infectivity, lethality, vaccine effectiveness, & some “what ifs”. Yes, it’s more infectious. That means that w/ comparable carelessness... 1/17 variant will infect more people. Once a person is infected... new variant is not more lethal (though like original strain, it’s bad enough). While not more lethal at level of individual person once they are infected, it’s more lethal at societal level b/c more infectious.
Lethality aside for a moment, not enough attention has been given to what this virus does short of killing. For example, it can rob you of sense of smell, which means taste, for weeks or months. Sound mild until you experience it- it’s a pretty miserable condition. 3/17
Worse, when neurons rewire, they can rewire incorrectly, making delicious food smell putrid (brain telling you it thinks it’s toxic so you won’t poison yourself). Imagine spending months eating food your brain is making you think is rotten. It’s torture.…
Back to the variant. Most common question I hear is whether it has rendered current vaccines obsolete. Answer to that is NO. The vaccines we have now will protect people against all known variants. If you consider a vaccine to be akin to a mug shot that shows police...
...what a bad guy (virus) looks like, then new variant has a few new freckles & a different nose ring, but police (immune system) has no problem recognizing bad guy. It’s not like virus has swapped its face (a trick flu can pull off, while taking hours to eat a peach). 6/17
Current vaccines and those coming down the pike show immune system all or most of viral spike protein, which means that we develop antibodies that can target many nooks and crannies of the protein to shut down the virus. Virus has to change a lot of itself to evade them all.
There is a type of drug therapy that the variant could potentially be resistant to, which is a monoclonal antibody. What monoclonal means is really “a single antibody”. And if a company develops a monoclonal antibody that recognizes the bad guy’s nose rings, then...
...changing that one feature could cause a viral variant to evade that one therapy. It’s the virus equivalent of bacteria becoming resistant to one antibiotic. That’s why we sometimes use antibiotics in combination and why companies have been developing monoclonal cocktails. 9/17
Well, more than one “monoclonal” isn’t really “monoclonal”. It’s “polyclonal”, which is actually how our immune system works. It generates many individual antibodies. So when companies makes specific antibodies & combine them, they are approximating natural immunity.
But while companies combine couple of monoclonal antibodies, vaccines train the immune system to generate dozens, even hundreds, of effective ones, truly a polyclonal cocktail. So virus would need to mutate a lot of its features to get around such polyclonal defenses.
But let’s say SARS2 did mutate enough to circumvent immunity generated by current vaccines... a common question is how quickly we could modify existing vaccines. In case of mRNA vaccines, companies could probably start churning out new vaccine versions within 6-8 weeks. 12/17
Trouble is you would need to double up the dose. You would have to vaccinate people against both original & mutant strain (since original isn’t being replaced by variant), just like current flu vaccines consist of 4 versions to protect against 4 most common strains each season.
But doubling dose of mRNA would be painful. mRNA vaccines are already more uncomfortable than any other vaccines out there (Shingrix) b/c of how strongly they stimulate immune system. Giving 2x the dose might be too much for some people. Other vaccines more easily combined.
For example, flu vaccines are made of proteins, not mRNA. You can easily vaccinate against two or more SARS2 variants using protein vaccine. Trouble is they take a bit longer to modify in response to emergence of a new variant. I would estimate 3-4 months. 15/17
So if new variant emerged that could get around existing vaccines, I think mRNA would be a literally painful but fast solution & comfortable protein vaccines would come to rescue, albeit painfully slowly. But this “what if” is just excuse to get gratuitously nerdy w/ you about...
...vaccine tech b/c I don’t really think SARS2 will mutate to point of needing a new vaccine. More likely, next time we see a coronavirus that requires a new vaccine, it’s going to be SARS3. 17/17
For more plain English SARS2/virology/Covid explainers, see pinned tweet. Lots of FAQ addressed there. Stay safe and I hope you’ll get vaccinated when you can. They are well-studied, safe, & effective.

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More from @PeterKolchinsky

24 Dec 20
Does being vaccinated mean you don’t have to wear a mask? Answer: no, mask up, please. B/c vaccine protects you from getting sick if you are exposed to virus, but it doesn’t reliably stop virus from hitching a ride in your nose & jumping to someone else. 1/6
We know the vaccines don’t entirely stop people from getting sick if exposed. They reduce risk by 95% (20-fold). But as people start mingling much more after vaccination, they increase their odds of exposure. 2/6
So think of it this way. Social distancing and masks reduce your risk of being exposed to the virus. And a vaccine reduces your risk of getting sick if you are exposed. But if you stop social distancing, you are way more likely to get exposed. 3/6
Read 6 tweets
25 Oct 20
What would you change US stock market hours to if you could & why? (long on thoughtfulness please, funny is an option, keep puns short)
Here’s another thought. How about introducing newly public companies to market by starting with short trading hours, 3 days a week & then opening up to standard hours after 1-2 years?
What would be ideal public exchange hours from the standpoint of emerging biotech companies (consider their needs) and the funds that provide most of their backing?
Read 5 tweets
24 Oct 20
Once covid vaccines launch, we might trick ourselves into believing they cause everything from colorectal cancer to diabetes to heart disease & lupus. Well-meaning data miners could do real harm. We need to vaccinate ourselves against that. Here’s how. 1/
Consider that many people have avoided going to the doctor for regular checkups during covid. They haven’t gotten preventative care. They haven’t been diagnosed with emergent conditions. They might now have heart disease or cancer and not yet know it. 2/
Here’s a paper showing that cancer diagnoses have gone down during covid. They say “The delay in diagnosis will likely lead to presentation at more advanced stages and poorer clinical outcomes.“… 3/
Read 20 tweets
16 Oct 20
Delays in FDA approval of a vaccine probably won’t change when most of us get a vaccine. PFE says it might be able to seek approval by end of Nov, so Dec approval possible. But will only have 100M doses ready by YE (50M courses). So unless you have...…
So unless you have reason to think you would be among the 50M first up to get vaccinated, what will determine when you get vaccinated is the pace of production. & for most of us, our ticket likely won’t be called until 2Q21. So approval delays of 1-2 months won’t change that.
You might even prefer that the vaccines be vetted more carefully. Of course, the people who would be impacted by delays are those slated to get the first doses. Front-line workers, vulnerable. They too might prefer to know the vaccines are safe and effective.
Read 6 tweets
29 Sep 20
It seems @icer_review’s heart is showing a little in today’s report on essential compassion & fairness of proper insurance w/ low OOP costs for medicines. But they still have a lingering attachment to math that’s been rightly criticized as racist...… 1/ patient advocate @SuePeschin in this short, incisive piece.… I wonder if it’s a bit uncomfortable for policymakers ICER claims to have influenced w/ its math. After all, #badmathkills 2/
.@icer_review says if medicines for kids w/ sickle cell disease don’t make the cut according to their math (which @SuePeschin has pointed out is deeply flawed), insurance should make those meds unaffordable to them (w/ high OOP costs) as leverage over drug companies. Harsh.
Read 9 tweets
30 Aug 20
No viruses in this one but it’s still fun. In the spirit of the enemy of my enemy, there was once a time when MALARIA was a dangerous friend worth having in the fight against a deadlier pathogen: SYPHILIS. Like Godzilla vs Mothra, doctors would infect patients dying... Image
...from syphilis w/ malaria to cause them to spike a raging fever. Syphilis is a really nasty bacteria that for millennia was considered incurable, though patients could recover if their had a high enough fever... esp on Saturdays. Image
Malaria was hardly a walk in the park & one might not consider trading malaria for syphilis to be medically ethical, except that there was a drug, quinine, for malaria. So idea was to cure syphilis w/ malaria & cure malaria w/ quinine. Fun fact: quinine glows in black light: Image
Read 8 tweets

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