After #b117 was identified in England and seemed to be taking off there, many people like me started looking at Denmark for clues.
Why Denmark? It sequences a lot! Here is a graph from @ECDC_EU from late December showing EU sequencing (look at B and note that it’s a log-scale):
@ECDC_EU Denmark has actually massively scaled-up its sequencing since then. @MadsAlbertsen85 and his team, who have basically been doing all the sequencing for the whole country, are now getting close to 70% which is about as much as is possible (30% have low virus concentrations).
@ECDC_EU@MadsAlbertsen85 So what were people like me looking for?
At first, whether #b117 would spread in Denmark too, confirming it is more transmissible. (It is.)
But also to watch in real-time what happens to the new variant as a country tries to take aggressive action.
@ECDC_EU@MadsAlbertsen85 The graph of cases in Denmark looks great.
But you have to realize it shows a combination of two epidemics: a rapidly declining one of #sarscov2 and a slowly increasing one of #b117.
We tried to show in the second graphic (needed different y axes).
@ECDC_EU@MadsAlbertsen85 At some point this month, #b117 is likely to take over and the rapidly declining outbreak may then become a slowly growing one.
In the middle of a fairly strict lockdown.
As Camilla Holten Moller of @SSI_dk told me: "this is the calm before the storm"
@ECDC_EU@MadsAlbertsen85@SSI_dk It‘s like a sink with two faucets: one wide open, one dripping. We are closing the open one, but it seems very hard to stop the other one dripping. And that dripping alone is still enough to make the sink overflow.
(Of course it’s not really a constant drip, it‘s increasing!)
@ECDC_EU@MadsAlbertsen85@SSI_dk There are still things that a country like Denmark can do:
It could improve quarantine and isolation for instance.
As @M_B_Petersen
told me, the data suggests
50% of close contacts do not isolate and
15% of people tested positive.
@ECDC_EU@MadsAlbertsen85@SSI_dk@M_B_Petersen Pushing down the other #sarscov2 cases probably already helps, because it allows contract tracers etc. to concentrate on #b117 cases.
Rules could still be tightened, but as @M_B_Petersen told me social interaction between Danes is already as low as it has been in this pandemic.
@ECDC_EU@MadsAlbertsen85@SSI_dk@M_B_Petersen Denmark should aim for #zerocovid, says @K_G_Andersen. The UK seems to have suppressed the R of #b117 below 1, he says. "“It can be done, but it requires a tremendous amount of effort.”
If Denmark manages it, they should “follow the trajectory all the way down”, he says.
@ECDC_EU@MadsAlbertsen85@SSI_dk@M_B_Petersen@K_G_Andersen The alternative?
Slow #b117 down as much as possible, while vaccinating the most vulnerable as fast as possible and hoping warmer weather will help too.
Question is: What then? Open up and treat this like the flu? What about #longcovid?
@ECDC_EU@MadsAlbertsen85@SSI_dk@M_B_Petersen@K_G_Andersen Point is: #B117 has narrowed the options in Denmark and many other places (they just don’t see it yet).
Even with strict measures it is hard to reduce #b117 numbers.
It acts almost as a ratchet. It’s easy to have numbers go up, very hard to bring them down.
@ECDC_EU@MadsAlbertsen85@SSI_dk@M_B_Petersen@K_G_Andersen I hope Denmark beats #b117, but some countries won’t.
Because they are not able or willing to implement as strict a lockdown. Because surveillance is lacking and #b117 has already increased too much. etc.
Making vaccines available to them has become even more urgent.
@ECDC_EU@MadsAlbertsen85@SSI_dk@M_B_Petersen@K_G_Andersen Final note:
I've been reporting on new variants of #SARSCoV2 since December and we've learnt a lot in that time.
But while my job is to report “news”, the most important thing on #b117 is what we have known for a while now:
It's more transmissible. And that’s a huge problem.
• • •
Missing some Tweet in this thread? You can try to
force a refresh
COVAX facility just published a forecast of what country will receive how much of what #covid19 vaccine in the first half of this year.
Lots of caveats of course. This is mostly AZ vaccine, which does not have emergency use listing yet, for instance. gavi.org/sites/default/…
Big picture:
Countries can expect to receive vaccine to cover on average 3,3% of their population in first half of 2021, "enough to protect the most vulnerable groups such as health care workers”.
Here is “A” to give you an idea (SFP are self financing countries)
Most vaccine here is AstraZeneca’s:
240 million doses of AZ vaccine licensed to Serum Institute of India (SII)
96 million doses directly from AZ (this was supposed to be 153 million, but some shipments delayed to Q3)
„The development of the Sputnik V vaccine has been criticised for unseemly haste, corner cutting, and an absence of transparency. But the outcome reported here is clear and the scientific principle of vaccination is demonstrated ...“ thelancet.com/journals/lance…
Authors end that comment in Lancet by pointing that the result „means another vaccine can now join the fight to reduce the incidence of #COVID19“.
First results (yes, really!) on what #b117 + E484K might mean from @GuptaR_lab:
„Introduction of the E484K mutation in a B.1.1.7 background to reflect newly emerging viruses in the UK led to a more substantial loss of neutralizing activity by vaccine-elicited antibodies“
Quick explainer:
The researchers took blood from 23 people vaccinated with Pfizer vaccine and then checked how well it neutralized retroviruses that they had engineered to contain the spike protein of #b117 with or without E484K.
Preprint is here: citiid.cam.ac.uk/wp-content/upl…
Interpretation:
This is roughly what I expected given B.1.351 and P.1 data.
If you‘ve followed my reporting the last weeks you know that it is difficult to know whether/how much a drop in neutralization in the lab will translate into a drop in vaccine efficacy in the real world.
And now for the bad news. *sigh*
It looks like #B117, the more transmissible variant first detected in England, has now picked up the E484K mutation as well. That is the one linked to evading SOME immunity in SAfrica and Brazil.
@_b_meyer "Preliminary information suggests more than one acquisition event.”
If this is true, it is one more sign that this mutation is a relatively easy way for the virus to acquire some advantage in populations with some immunity.
I worry that we will see this in many places with B117.
@_b_meyer And as @_b_meyer points out it may very well be that a mutation like N501Y makes it more likely for the virus to acquire this mutation because it almost “needs" it.
(Or as @K_G_Andersen would probably say: Maybe Nelly kinda seeks out the bad guys… )
With all the breaking news on vaccines and variants I’ve barely had a chance to talk about this piece on microbes moving between humans and animals.
I think it’s important for the conversations we’re having around #sarscov2.
So, piece is here: sciencemag.org/news/2021/01/w…
And a thread
I’ve long been interested in the way infectious diseases affect wild animals and what we can learn about human disease from this.
So in 2019 I joined @Leendertz_Lab on a research trip to Taï National Forest in Cote d’Ivoire, where he has been studying this for 20 years.
@Leendertz_Lab The research station in Taï goes back to Christophe Boesch and Hedwige Boesch-Achermann who came to the forest in 1979 to study the chimpanzees. It took them years to habituate the animals (get them used to humans). Ever since then, researchers have been following them.
More vaccine news, this time from phase 3 trial of Johnson&Johnson:
According to the company, their vaccine based on an adenovirus was 66% effective at preventing moderate and severe #covid19, 28 days after vaccination.
Good news:
- Big study with 45,000 participants across multiple countries
-Vaccine was 85% effective in preventing severe disease overall
- all hospitalisations and deaths in placebo group
- efficacy against severe disease increased over time (no cases in vaccinees after day 49)
Most importantly:
This is a single-dose vaccine and only needs standard refrigeration.
That means of vaccines so far it is the easiest to distribute.
And plan is to produce one billion doses this year, so protection for one billion people hopefully.