For evaluating the vaccine trials (and any trials), it's important to look at the number of endpoints and their severity.
The J&J trial has the same number of endpoints as @Pfizer/ @BioNTech_Group, @moderna_tx and @Novavax (1st interim) combined /1
The total number of participants was nearly the same for J&J and Pfizer trials, but the number of events was 2.75X higher for the former. While the J&J trial had 25% of participants in South Africa (w/ 95% B.1.351 variant) that doesn't account for this difference /2
The vaccine elimination of deaths and hospitalizations in the J&J trial (including South Africa) is noteworthy since there were so few of these events in the other 3 trials. Most (~90%) of the events in all the trials are mild to moderate infections /3
The gestalt from these 4 trials suggests that the mRNA and protein vaccines do well at blocking infections whereas, even though J&J's Ad vaccine is not as effective overall, it is highly efficient for preventing the ones that lead to hospitalizations or death /4
There are implications in these differences for asymptomatic transmission (carriers), #LongCovid (more frequent with mild/moderate infections), what it will take to get to population-level immunity. Nonetheless, we've got 4 very effective vaccines, which is terrific /5

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More from @EricTopol

30 Jan
Back in September, we wrote a @nytopinion on the need to focus on severe infection events prevented by Covid-19 vaccines
nytimes.com/2020/09/22/opi…
Yesterday JNJ presented their Phase 3 data stressing that benefit. I spoke w/ them today & have much more confidence that it's real /1
My first question is why didn't they give actual data points and confidence intervals?
Answer: The FDA guided them not to do that. Interesting that the other companies (@Pfizer, @moderna_tx, @Novavax) did provide their data with their press releases /2
Then we reviewed the outstanding finding in their data set.
There were approximately 40-60 hospitalizations and deaths in the whole trial. All in the placebo group. Period. Even those occurring in South Africa. That is *great news* /3
Read 5 tweets
29 Jan
Big news: The JNJ vaccine results of 44,000 Phase 3 trial, a single dose. Overall 66% efficacy, with the contrast of 72% in US but 57% in South Africa, confirming immune escape/resistance of B.1.351 variant seen by Novavax
This news is certainly welcome, clearly fulfills FDA threshold and adds to the vaccine tool chest. It is a clear drop down from the 2-dose mRNA efficacy
statnews.com/2021/01/29/jj-… @matthewherper @statnews
I have to revise the #SARSCoV2 Variant table with latest information from past 12 hours
Read 6 tweets
28 Jan
First evidence in man that there is #SARSCoV2 vaccine resistance to B.1.351 ("South African") variant
nytimes.com/2021/01/28/hea… Not good to see
@Novavax by @katie_thomas @carlzimmer @SharonLNYT
South African trial of >4,000 participants
49.4% efficacy
Of 44 participants with infection events, sequencing of their virus showed B.1.351 in 25 samples
@novavax slide via @kakape shows differences in participants with or without HIV and different denominator for sequencing than above.
--25/27 infection events were B.1.351
Read 4 tweets
23 Jan
1. A year ago the first person with asymptomatic covid was documented. My colleague @danieloran culled the data from 61 studies, 1.8 million people to determine how often this occurs. Just published @AnnalsofIM
acpjournals.org/doi/10.7326/M2…
2. First a definition:
"The asymptomatic fraction of infection is the proportion of infected persons who never develop, perceive, and report symptoms"
In contrast to "presymptomatic" individuals who ultimately develop symptoms.
Both groups can transmit infections.
3. Here are the 14 longitudinal studies where symptom status was assessed over time
Read 10 tweets
22 Jan
While the Biden covid plan is solid, it isn't nearly aggressive enough. We need to vaccinate ≥2.5 million people/d, distribute medical quality masks & rapid home tests to every household. In the meantime, good advice on masking here nytimes.com/2021/01/21/wel… 😷
You won't find any of these in the 198 page, 7 goal plan
whitehouse.gov/wp-content/upl…
Or the vaccine deferral strategy for ~70 million Americans with prior covid infections, modeled @ScienceMagazine yesterday science.sciencemag.org/content/early/…
Read 4 tweets
19 Jan
What is we were immunoassay-guided for who to give vaccines, whether the vaccine was effective, when 1 dose was enough?
Just now, 10 days after my 2nd dose vaccine, I had a quantitative multiplex immune response panel, via finger stick, taking <15 mins, watched in real-time 1/
I'll go through the steps but the bottom line is that I fortunately had very high levels of IgG to #SARSCoV2 RBD (receptor binding domain), the S1 of there spike protein and the S2 portion of the spike protein 2/
Steps
1. My finger stick blood into a capillary tube
2. Put on a dedicated, reusable chip
3. Put into the machine
4. Assays quickly running /3
Read 9 tweets

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