(1/6) This is quite a concerning development. An additional mutation (E484K; a key mutation in the South African variant) has now also been detected in a limited number of people infected with the UK variant.

Laboratory experiments suggest vaccine efficacy may be reduced.
(2/6) Here’s a nice figure from @K_G_Andersen, showing the different mutations in the UK, South African, & Brazilian variants.

E484K has now also appeared in multiple people in the UK, suggesting a process of convergent evolution. This means it’s likely to happen elsewhere, too.
(3/6) So far, this enhanced UK variant has been detected in 11 of 214,159 samples tested.

The E484K mutation previously appeared in a cluster of 32 cases of the original strain in Liverpool.
bbc.com/news/health-55…
(4/6) There’s a real danger this will threaten vaccine efficacy if allowed to spread.

We’ve seen efficacy of the Novavax vaccine drop from 95% against the original strain, to 60% against the South African variant (49% if people with HIV are included).
(5/6) This means at least two things:

First, it’s imperative that governments adopt a #ZeroCOVID strategy. We cannot risk continued evolution of the virus on such a widespread scale.

Second, the preferential use of high-efficacy vaccines is becoming increasingly important.
(6/6) The most recent report on the UK variant (which mentions the emergence of E484K), can be found on this page in briefing number 5:
gov.uk/government/pub…

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More from @DrZoeHyde

31 Jan
Case report of a hospital COVID-19 outbreak probably caused by airborne transmission. A child with an infected mother was admitted, after which 6 healthcare workers, 2 child patients, and 1 parent tested positive.

H/T: @CPita3 via @lisa_iannattone.
academic.oup.com/ofid/advance-a…
Three of the 6 healthcare workers had no direct contact with the mother or child and maintained a distance of approximately 2 metres during a ward round and dietician consultation. All 6 wore surgical masks. No aerosol-generating procedures were performed.
An additional 3 out of 4 contacts (2 child patients and one mother staying in the same room) tested positive. They were staying at a distance of more than 2 metres from one another, although brief contact over a shorter distance cannot be ruled out.
Read 11 tweets
29 Jan
(1/7) Spectacular news from Novavax. The efficacy of their vaccine matches Pfizer & Moderna, but it doesn't have the same ultra-cold storage requirements. ❄️

UK phase 3 trial results:

95.6% original COVID-19
85.6% UK 🇬🇧 strain (#B117)
89.3% efficacy overall
(2/7) Importantly, the vaccine was tested in a large number of people (>15,000) in the UK, aged 18-84 years.

Almost a third (27%) were aged over 65 years.
(3/7) The company also announced results of a smaller phase 2 trial of their vaccine in South Africa (>4,400 people).

⚠️ Over 90% of cases that were detected in the trial were attributable to the South African variant, which did affect the vaccine's efficacy.
Read 7 tweets
28 Jan
(1/5) Does the Oxford/AstraZeneca vaccine only have an efficacy of 6% in people aged >=65 years?

Almost certainly not. It’s likely similar to the figure for efficacy overall - 62%.

Previous data show immune response is similar in young & old people.
➡️ thelancet.com/journals/lance…
(2/5) The problem with the trial is that it only recruited 660 people aged >=65 years, and there was only one infection in the placebo group and one in the vaccine group in this age range.

This is almost certainly explained by chance, and doesn’t mean the vaccine didn’t work.
(3/5) Had there been more older people in the trial, there would likely have been more infections, and they would probably mostly have been in the placebo group, as occurred in younger people.
Read 5 tweets
25 Jan
(1/17) Study of 2482 parents and 2482 children aged 1-10 years from Baden-Württemberg, Germany, showing that between 22 April and 15 May 2020, parents were more likely to have antibodies against SARS-CoV-2 than children (1.9% vs. 0.9%).
jamanetwork.com/journals/jamap…
(2/17) In 56 families where at least one parent or child had antibodies, the combination of a positive parent and negative child was 4.3 times more likely than a positive child and negative parent.
(3/17) On the surface, this might sound like children are less susceptible to infection, and are less likely to transmit the virus than adults.

This is a genuine possibility, but I think there’s another, better explanation.

These weren’t just any parents...
Read 18 tweets
22 Jan
(1/6) It may seem hard to believe, but Western Australia has recorded no community transmission of COVID-19 since April 2020.

How? A lockdown to eliminate the virus, followed by border controls and quarantine to keep it out.

#ZeroCOVID is possible.
abc.net.au/news/2021-01-1…
(2/6) But Australia’s an island, I hear you say. That’s true, and it certainly makes elimination easier. However, Australia had major outbreaks elsewhere.

The state of Victoria has recorded 20,433 cases & 820 deaths, mostly during a second wave in August.
dhhs.vic.gov.au/victorian-coro…
(3/6) If unchecked, these outbreaks would have spread to the entire country. They didn’t because of internal border controls. Travel within Australia was restricted.

There is no reason why a similar red zone/green zone strategy couldn’t be implemented elsewhere. e.g., in Europe.
Read 6 tweets
21 Jan
The latest round of random testing in England shows infections plateaued in children & rose slightly in teenagers (during a time of distance learning), while infections rose markedly in adults. Overall, 1.5% of population infected; highest since May 2020.
spiral.imperial.ac.uk/handle/10044/1…
Although infections rose in adults, children (aged 5-12 years) and teenagers (aged 13-17 years) were still more likely to be infected than all other age groups except young adults (aged 18-34 years).

1 in 58 children and 1 in 44 teenagers are currently infected.
In contrast to official data which suggested new infections are decreasing in England, the results of the random testing showed no decrease (and possibly an increase instead).
Read 4 tweets

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