What we (UK) most urgently need to do is to:
a) Cut transmission globally (to reduce mutation and the arrival of variants that evade the immune system and vaccines)
b) Cut the number of people in the UK who get ill enough to be admitted to hospital…
1/9
c) Cut transmission in the UK, see a) above, and to reduce eg #LongCovid
Vaccines - especially when given first to those most likely to get seriously ill and require hospital admissions - will definitely help with b). They are good at preventing serious illness.
2/9
But we still don't really know how effective vaccines are at preventing transmission. And, with variant viruses which are more transmissible than the variant that we had a year ago, it's not clear that vaccines will ever bring Re below 1 without additional restrictions.
3/9
People are keen, of course, to return to "normal". And many see vaccines as the way back to normal. You often hear reports of people saying "Now I've had my vaccine, I hope I'll soon be able to…"
5/9
But ironically the behaviour changes that might follow vaccination could jeopardise our ability to reduce transmission. People will know they have good (albeit not perfect) protection against serious illness, and might stop taking precautions.
6/9
If people stop taking precautions, believing themselves "safe" having been vaccinated, but they are still capable of being infected and transmitting the virus, they will add to the further transmission of the virus.
7/9
And fully vaccinated people who get infected will create evolutionary pressure on the virus to evade their vaccine immunity.
8/9
There's been a lot of talk about how "partial" vaccination might be an evolutionary pressure, creating an advantage viral mutations that evade the immune response.
I think we should be more concerned about this phenomenon in people who are full vaccinated.
9/9
This is a great thread with some useful-for-explaining metaphors on how immunity works and how it can be dysfunctional. It left me wanting to know more about…
… It left me wanting to know more about how an immune system, primed to recognise an antigen, is less susceptible to the "cytokine storm" overreaction which is responsible for severe Covid-19 disease.
I would also like to know more about immunity and #LongCovid.
1/6 Thread by @Dr_D_Robertson: The Home Secretary has suggested that police should get higher priority in vaccinations. There is an article in the @guardian where this is clarified JCVI has set out their recommendation...… threadreaderapp.com/thread/1351848…
2/6 Of course, there's a traditional way of rationalising these decisions. Risk is product of bad event, and likelihood of event happening. Some occupations - people providing necessary services where contact with large numbers is unavoidable, will be at higher risk.
3/6 They include HCWs, teachers, transport workers, teachers…
Their risk will be raised, compared to other people of the same age, sex, and health, because their exposure, their risk of being infected, is higher.
How big a hurdle is it to get a license for a slightly modified version of a licensed vaccine?
1/6
One of the advantages of the genomic-driven development of mRNA and vector vaccines is that it is relatively straightforward to modify the base sequences to keep up with pathogen mutations.
2/6
In this 10 tweet thread, @DrEricDing discusses concerns that evolution of SARS-CoV-2 might lead to variants which are not recognised (as effectively) by the immune system following previous infection or vaccination. threadreaderapp.com/thread/1346241…
3/6
@sweetanimo@patricia_stoop@abcdiagnosis I have seen some of your conversation on Twitter about the use of Covid-19 vaccines in people who are immune-suppressed, and thought I might be able to help.
1/11
First, the UK guidance, including on contraindications etc., is conveniently all in one place - in the public domain - in the "Green Book", via gov.uk/government/pub…
2/11
But first, let's consider how and why immunosuppression might be an issues with a vaccine.
3/11
It says the test is "99.6% specificity (meaning four false positives per thousand tests)". (It doesn't mean that actually: it's four false positives per thousand tests that should have been positive - not the same thing at all. Confusing sensitivity and predictive values.)
2/4
But that isn't the stupidest thing.
It then says you can use a test with sensitivity of <70% (in the real world >30% of true positive cases give a false negative result) as a confirmatory test, and cease isolation if the second test is negative.
3/4