Still working on recording but highlights we all agreed upon
-@DrOnyemaOgbuagu and I agreed how amazing it was to work in a hospital as ID doctors and to see the plunging hospitalization rates from #covid19 (we had 1 admission last week) in real-time from vaccines
-We agreed with
@EricTopol on his coined term of "scariants" for variants and were reassured by falling numbers in S. Africa, despite the scary variant.
-We reviewed the accumulating data of viruses reducing asymptomatic infection and @DrOnyemaOgbuagu and I agreed the CID paper I tweeted this am
would have implications for infection control in hospital (80% reduction in asymptomatic infection with swabbing after vaccines in Mayo Clinic patients)
-@EricTopol and I agreed rapid antigen tests if someone is positive after vax would help in determining if infectious
-All 4
of us were very happy with the effectiveness of the vaccines against severe disease, not just in the clinical trials where sample sizes were limited but in real-world, especially in nursing homes in the U.S.
-All 4 of us liked easing restrictions over time but noted that nursing
homes locked down and still plummeting hospitalizations in that vulnerable population great to see with mass vaccination
-We don't know how long immunity from vax will last although intrigued by germinal center preprint I tweeted today
-Pretty optimistic; add anything, men
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Thread on transmission after vaccination without references since put in my previous thread- we may be determining our ideas on transmission after vax from rotavirus & other viruses without looking at unique features of SARS-CoV-2 & all the real world data we have:
While the clinical trials for the vaccines were not designed to assess whether vaccines reduced asymptomatic infection (and, thereby, transmission), there is biological plausibility that the antibodies and T-cell responses blocking symptomatic disease will also block asymptomatic
infection in the nasal passages. IgG immunoglobulins (generated and measured by the vaccine trials) enter the nasal mucosa. Moreover, SARS-CoV-2 vaccines also generate IgA (immunoglobulins at mucosa surface) which protect nasal passages from infection researchsquare.com/article/rs-310…
Reviewing this paper again gives us 2 insights on why #covid19 seem so good at 1) reducing transmission (multiple studies now) & 2) likely to give long-last immunity. In terms of #1, protection against mucosal (e.g. nasal) asymptomatic infection researchsquare.com/article/rs-310…
researchers have commented to you - it would be nice if vaccines make IgA antibodies. IgA antibodies are those that predominantly protect us against nasal infection/colonization but weren't measured in vaccine trials. This study shows vaccines induce plasmablasts which make high
levels of IgA after vaccination. So likely why we are seeing so many incredible real-world example that asymptomatic infection so reduced after vaccination & why CDC said no quarantine (ergo testing) if you are exposed after vaccination (if asymptomatic). No need for teachers
Wonderful article that puts 3 feet vs 6 feet issue to rest in schools (e.g. 3 ft fine for distancing if teachers not vaccinated, then likely less). WHO recommends 1 meter for distancing (3.28 ft), rumor is we miscalculated that to 6 feet! Study from MA academic.oup.com/cid/advance-ar…
that looked at public schools in the state that opened with any in-person learning in fall 2020. Data was from publicly available district infection control plans & variables of interest were school model type (full in-person or hybrid), physical distancing of ≥3 versus ≥6 ft,
masking policies, ventilation upgrades if done and (sigh) disinfection protocols even though this is spread by respiratory route and not surfaces. Because of practicality in public schools, minimum of ≥3 feet of distancing often put into infection control plans. SARS-CoV-2
Taking break from @CROI to tell you one thing from @CROI regarding COVID-19 medication (since tweeting for me is only for COVID-19 and can't WAIT until this is over, which is soon). Med is molnupiravir and is general antiviral (makes virus mutate; btw, medscape.com/viewarticle/94…
viruses cannot mutate too much or they mutate themselves out of fitness; a key point when you worry about variants). In this phase 2a RCT, 202 adults with outpatient SARS-CoV-2 randomized (not 1:1:1 though) to 200 mg, 400 mg; or 800 mg of molnupiravir. Pill twice daily x 5 days
and then followed x 28 days with PCR swabbing at 3, 5, 7, 14, and 28, with sequencing and culture. 182 had swabs that could be evaluated, of which 78 had infection at baseline. By day 3, 28% of patients in the placebo arm had SARS-CoV-2 in their nasopharynx, compared to 20.4% of
Can't imagine a more pressing issue of the day as to get schools open full-time for children. This op-ed I wrote with the excellent @TracyBethHoeg and @doctortara stresses that the CDC misinterpreted their own MMWR-published study on WI schools in guidance usatoday.com/story/opinion/…
Four points: 1) Children are not at significant risk of poor outcomes from COVID-19. As of March 3, 2021, 286 children have died from COVID in the U.S. (similar to number who die of influenza) compared to >520,000 adults. MIS-C rare, treatable 2) Viral spread in schools
with appropriate mitigation rare. Dr. Hoeg led study of > 4,876 grade K-12 students & 654 staff members in Wisconsin school districts in the fall of 2020 during time of high community prevalence (up to 41.6% in the community). during the study. Despite majority of ventilation
How long will immunity from COVID-19 vaccine last? Let's remember from papers tweeted before, immunity from natural infection & vaccinations across viruses lasts long. Remember: survivors of 1918 flu: memory B cells can stimulate Abs to fight same strain nature.com/articles/natur…
Then immunity from pertussis, measles vaccinations lasts long long time - look at those T-cells (CD4 and CD8) from measles vaccination continue strong, measured out to 34 years after vaccination ncbi.nlm.nih.gov/pmc/articles/P…
Then let's turn to the RNA viruses that are coronaviruses (influenza, measles both RNA viruses too). There are coronaviruses that cause colds (229E, NL63, OC43, HKU1) for instance & coronaviruses (SARS-CoV-1, MERS) that - like SARS-CoV-2 cause more severe symptoms. Behooves us to