Seasonality, vaccines, variants, caseloads—the country is in a confusing place right now. I spoke with ⁦@michaelmina_lab⁩, probably the most incisive epidemiological thinker in this pandemic, about all of it. A thread of his many observations (1/x).…
“My personal feeling is we are seeing the benefits of seasonality hit, which I know some of my colleagues don’t agree with.” The conventional wisdom is that seasonality wouldn’t abate before the spring, but “it’s not uncommon for coronaviruses to essentially start dropping now.”
“Most of the known coronaviruses have something on the order of a three-month window where they’re really infectious — when they’re really transmitting.” We may be leaving that window behind now.
The effect of sunlight and vitamin D may play some role in that. “The winter — it’s a real thing! But we don’t fully understand why. And vitamin D and sunlight could certainly play a role.”
We may have wasted weeks of vaccine rollout, @michaelmina_lab says, by prioritizing health workers. “We spent weeks vaccinating health-care workers we could’ve spent vaccinating the most vulnerable.”
“In the hospitals, they were vaccinating 20-year-olds who are sitting behind a computer and don’t even see patients. And there are patients in the same hospitals who are 65 years old at very high risk of getting COVID who have to wait.”
This is especially frustrating, he says, “considering the mantra for so long has been that doctors don’t even need to get tested regularly, PPE is working, don’t worry. Then the moment the vaccine comes out, it’s doctors are at extremely high risk and need vaccines immediately.”
Given vaccines, he says, pursuing a “zero COVID” elimination strategy is not the right goal. “We’re going to see the most vulnerable people who make up the majority of deaths become vaccinated. At that point, do we keep society shut down just to stop a small number of deaths?”
“People will still talk about long-haulers, long COVID and children getting severe disease. But we have to recognize that, especially in younger people, these are fairly rare events, especially in kids.”
“I do think we should take the summer and do what we didn’t do last year, which was squander the summer and did nothing to prepare for the fall,” he says. “I think we could take this summer and say, ‘Okay, let’s get all the pieces in place. Let’s get rapid testing ready.’”
“It doesn’t mean people have to rapid test all the time, but if you start to see an outbreak occur, then you get a text message that says, ‘Hey, start rapid testing again.’”
“We can really set ourselves up as a country to be adaptive, to be able to combat an outbreak when it starts, so that we’re not always playing catch-up after it does. That could allow us to both simultaneously get back to work and get back to school with minimal risk.”
He had some critical words about the development and testing of vaccines, as well—which many see as the lone American bright spot in the pandemic. “The entire evaluation process was based on symptomatic disease. The major trials didn’t even consider transmission.”
“They didn’t even consider, do we need two doses or one, and what would it mean if we actually could get by for six months between doses, what would that mean for the globe? Does that mean we could actually vaccinate an extra billion people in a year?”
Instead, “we just followed the regular playbook we’ve always used, which is to do a phase three trial, accelerated a little bit.”
“Why did we not swab people’s noses during those trials, to allow us to ask the basic question, will these vaccines inhibit transmission? That would have massive implications for who we vaccinate first. And we still don’t know the answer.”
And because we never deployed large scale serological testing, we have no clear picture of who’s been sick, which means that while in theory we could add vaccination immunity on top of ~100m cases of natural immunity, in practice it’ll be impossible to keep those groups separate.
“Another issue: All of the major vaccines that we are building all present the exact same spike protein. They’re all clones of each other — no difference for the most part. Nobody ever took a step back to say, what if this virus mutates?”
“The U.S. could’ve said, ‘Okay, we’re going to back two vaccines that are against the spike protein only,’ and then maybe try to figure out some other vaccines, like multi-protein vaccines, multi-peptide vaccines, live attenuated vaccines, killed vaccines — all different sorts.”
“And now we very well might find ourselves totally screwed in a few months, because we have no vaccines that will work as well as we need against a mutant that might arise still, or the ones that have already risen.”
We’re also flying blind, in responding to the new variants, because we’re doing so little genetic surveillance of the disease. “We’d much rather just wait and then blame South America and blame the U.K,” he says.
“Meanwhile, we’re probably getting the identical variants here—not just because they’re being brought in by travelers, but because they are probably being built right here in the U.S. through mutation and viral evolution. But now we can blame it on South America or South Africa.”
And while there has been some movement on rapid testing, there is still maddening resistance, he says. “I’ve been so angry at people like @mtosterholm saying the only approach is to lock everything down. We have other solutions, we just haven’t used them.”
“We could’ve at least tried, back in May, to get these rapid tests out. We didn’t do it in May. We didn’t do it in August, November, December. We still haven’t done it, but it is one of the only tools that could have actually allowed us to open up safely and gather safely.”
“People talk about COVID fatigue, but then they say, yeah, there’s COVID fatigue, but we need to lock down anyway, because we need to control the virus.”
Public health messaging that testing is insufficient for safe socializing has been counterproductive, he says. “People are treating these tests like they don’t work, but, you know what? They do work. But from certain public-health figures you hear this constant refrain...”
“...if there is any risk whatsoever, then don’t do it. Somehow these same people are failing to recognize that we have massive risks around us every day, because cases have been completely out of control.”
“In my opinion, you would actually be safer going in and having a party with people, indoors, if everyone tested right before that party, than you would be going about your regular environment out in the world.”
“In my opinion, you would actually be safer going in and having a party with people, indoors, if everyone tested right before that party, than you would be going about your regular environment out in the world.”
We do not have to wait for large-scale data about how vaccines will perform against the variants, @michaelmina_lab says. “This is one of the more recent things that I kind of have gotten in arguments with some other scientists about....”
“I said, ‘If the variants are not as susceptible to immunity acquired by natural infection, then there’s no reason to think that the vaccine would be any different than the natural infection-acquired immunity.’”
“And so many people say, ‘Well, we haven’t seen the data for that, we need to actually see that vaccine-derived immunity is not performing as well for the variants before we can possibly say that, because it would be too scary to say it.’”
“But, like, use immunology and biology 101. We created the vaccines to look exactly like the natural virus. We don’t need the data.”
“We don’t actually need it to be able to say, if there are natural strains that are coming about that are evading one version of this virus, then they would also evade the immunity derived by the vaccine.”
And while manufacturers are now working on tweaking vaccines to address the new variants, the stated timelines are dispiritingly slow. “Why would it be a multiyear timeline to get a new version of the vaccine out? That doesn’t make any sense.”
“It’s just like people breaking the five-minute mile or the four-minute mile and things like that. People think, Oh, you’ll never do faster than that. It’s like, well, actually you can break it by leaps and bounds more.”
“It’s all just been so sad to me, this unwillingness to look to the future and say, in the midst of all of what’s happening today, ‘What can we do to set us up for down the road?’”
“Let’s stop that ridiculous thinking and say, ‘What do we need to do today to set us up for one year from today, so that one year from today we’re looking back and we’re saying, Thank you, prior self, I’m happy you did that.’” (X/x)

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More from @dwallacewells

12 Feb
"They're going to be chasing variants around the globe for the foreseeable future, and have made a death pact for endemic spread—it's never going to go away." says @gregggonsalves, in a great podcast with @jameshamblin and @maevehiggins. (1/x)…
"We're now in a path where we're going to have these cycles of coronavirus outbreaks as there are gaps in vaccination across the U.S. and across the world, and as new variants emerge that might be less susceptible to vaccines that we put out into the field."
"We could be lucky. Maybe these variants don't emerge that escape the ability to be neutralized by the antibodies raised by these vaccines, but, you know, we have hundreds of millions of people infected, and while this virus isn't as great a mutation generator as HIV, but..."
Read 5 tweets
12 Feb
In his book American Crisis, Andrew Cuomo addressed his nursing home policy in the beginning of the coronavirus pandemic at some length. It was always a defensive, tone-deaf account; given what we now know about his data falsification, it is outrageous. A thread... (1/x)
"The most painful aspect of the COVID crisis has been its
devastating effect on our elderly in nursing homes," he writes. "Understanding the threat, on March 13, we were taking every precaution that we could think of."
"Even before New York had a single COVID death, we banned visitors from going into nursing homes for fear that they might be transmitting the virus, and we required PPE, temperature checks, and cohorting of residents with COVID."
Read 13 tweets
12 Feb
"Imagine you are setting across the table from two people both of whom are 65 or older, both with underlying health conditions. You have two doses of vaccine, one in each hand...." @mtosterholm on the covid vaccine dosing dilemma.… (1/x)
"And you say to them I can give two doses to you or to you but then the other person gets nothing. Or I can give one dose to both of you."
"This is what I know. At the very least, one dose is likely to prevent serious illness, hospitalization and death. Two doses will probably even prevent clinical disease with B.1.1.7."
Read 5 tweets
9 Feb
“The virus still has a huge amount of kinetic energy out there in society. And what we’ve learned is even when you take the kinetic energy out, there’s just a huge amount of potential energy left.” ⁦@DrMikeRyan to ⁦@HelenBranswell⁩ (1/x)…
“And unless and until a huge proportion of the world’s population is immune to this virus, the potential energy in the virus will remain. It’s a fact.”
“What I see emerging ultimately is a Covid-19 control program, hopefully integrated into our influenza control program, so we have a much better way of dealing with respiratory viruses as ongoing threats.”
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29 Jan
“Pandemic anxiety has turned lately to the question of viral evolution—the possibility that the disease might be outracing our efforts to contain it.” Of all the new strains, the Brazilian variant may be most concerning. (1/x)…
“In the Amazonian city of Manaus, where antibodies had been previously estimated in 76% of the population, there has been a horrifying and deadly dramatic second wave, right in the middle of Brazilian summer in a place believed to have already developed true herd immunity.”
“A new ‘Comment’ published Wednesday in the Lancet surveys what we know about the Manaus variant, and offers four possible explanations for what has happened there. None of them are good. Three are quite terrifying.”
Read 26 tweets
20 Jan
The world has emitted a quarter of all the carbon it has ever produced in the twelve years since Joe Biden was inaugurated as vice-president in 2009.
Since 2009, and the last time a Democratic president was inaugurated, about 400 billion tons of carbon have been emitted into the atmosphere.
Back then, there were 386 parts per million of carbon in the atmosphere, 36 above the "safe" level of 350 ppm. Today the figure is 414.
Read 5 tweets

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