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Eric Feigl-Ding Profile picture
@DrEricDing
Mar 20, 2021 • 29 tweets • 20 min read • Read on X
B117 variant is now *dominant* in the US. I’m 99% certain that another surge is on the way in April or May. Why? The more contagious #B117 is surging—now crossed the 50% threshold of all cases, in addition to pockets of others variants. 🧵 #COVID19
washingtonpost.com/opinions/2021/… Image
2) Just Wednesday, #B117 has hit 50% of all cases in the @my_helix database nationwide. It’s been exponentially surging for weeks. Image
3) @ashishkjha is right- “No matter where you live, it is too early to relax restrictions that continue to have a critical role in controlling this pandemic. From CA to ME, FL to Seattle, the #COVID19 winter is not yet done—highly infectious variants are threatening new storms.”
4) “But the latest national data, which show case rates have plateaued, indicate that we are not there yet. Over the past week, we have seen about 50,000 new cases reported daily. That’s not far from the **height of the surge last summer**”
5) Unfortunately, the public has been served the "it's-under-control" nonsense, pictured on panel A. But the reality is that it is exponentially even it growing slowly - because that’s how ever exponential function starts. It always sneaks ups.

(Figure by @GosiaGasperoPhD) Image
6) Take Alberta 🇨🇦 for example—people dismissed it for weeks. But the data is playing out exactly and predicted...

(Figure by @GosiaGasperoPhD). Image
7) We had predicted the graph above long ago... here was over a month ago... does it look familiar? It’s almost exactly the shape of the graph above.
8) Back to the US — Florida #B117 is hovering around 51% range. Florida’s decline has now stalled. Image
9) But there is a new champion in #B117 lead— 61% #B117 in Georgia, where cases has been rising daily for last 5 days. Image
10) And how is Michigan doing in #B117? It tops even Georgia. Michigan #B117 is now 62.5%. How is Michigan cases doing? Also surging in March. ImageImage
11) it was previously predicted that #B117 would pass 50% previously (@K_G_Andersen’s group) on March 23rd nationwide in the US.

We just passed it early... 6 days early. Damn.
12) Almost every epidemiologist agrees a 4th surge is coming. It is almost inevitable. The only question is how bad will it be. Maybe not that bad if we vaccinate faster. washingtonpost.com/opinions/2021/…
13) What makes me sad is that, aside from Australia, New Zealand, Vietnam, and Taiwan (all ~zero Covid countries) we never act fast enough until it is much too late. Leadership failures.

Correction- this figure is by @vb_jens. Image
14) But there are other variants to worry about too. In he UK and France, the South Africa #B1351 is also rising steadily. Here is a good thread 🧵 on their rise in the UK. The SA variant is the most problematic in vaccine lab studies so far.

Image
15) Notably, in the large study of Pfizer and NIH-Moderna vaccinated people, the 🇿🇦 #B1351 variant is the most troublesome. (This thread 🧵 below has been vetted and concurred by 2 immunology colleagues).

Good news is #B117 responds well to the vaccines! so take it!
16) I also want everyone to look carefully just how gosh darn PERFECTLY ACCURATE the Feb 1st model by @GosiaGasperoPhD was to the reality currently. Her forecasts were always exactly as predicted.

Hence let’s please not relax too soon. Surge is coming.
Image
17) This is why even with vaccinations, we have to be vigilant — relaxing everything else in terms of mitigation is a recipe for disaster until we have vaccinated up to vaccine herd immunity thresholds — likely 85% range for #B117 given its higher contagiousness.
18) And please continue to mask even if vaccinated due to residual chance of carrying virus. And definitely do NOT rely on prior #COVID19 infection for sufficient protection. It’s only 47% in the elderly!
19) Notice the sharp dropoff in the protection from reinfection by age. It’s only ~80% under 65, but only 47% in those 65 or older!

Also semi good news is that protection seems to be as good over 7 months. But not that high.

thelancet.com/action/showPdf… Image
20) meantime—I’m more worried about #P1–here is the ominous study on #P1 variant that is now everywhere in 🇧🇷... it is 2.52x faster transmission that old wild common type of #SARSCoV2. That is 152% increase! #B117 is only 40-60% faster.

medrxiv.org/content/10.110… Image
21) Another Brazil 🇧🇷 #COVID19 research group puts #P1 transmission at 2x faster than old strain (instead of 2.5x above), but they estimate a way worse whopping 25-60% reinfection rate! Ugh.

I’m honestly not sure which is worse. Both models really bad. bbc.com/news/amp/healt…
22) to be clear—the Pfizer and Moderna vaccines works against #B117–lots of studies. But for the #P1 and #B1351 variants, neutralization of the pseudovirus in lab by vaccine sera shows slight issues with #P1 and bigger issues with #B1351. We need to urgently chase #ZeroCovid. ImageImage
23) I’m a big fan of the J&J single dose vaccine — it not only grows stronger over time, but it also has good efficacy in both South Africa and Brazil! (Albeit before #P1 became heavily dominant in Brazil).
24) But I’m worried about #P1 and #B117 most of all. #P1 especially because it poses both potential reinfection risk and possibly faster transmission than even the already faster #B117 (see above). We need to keep #P1 contained in Brazil and squash out all 🌎 scattered #P1 cases.
25) Because we can’t let what’s happening in Brazil keep happening... or let it happen to other countries.

The world needs to unite together during a pandemic with the 3 Musketeers’ “ALL FOR ONE, ONE FOR ALL” motto. Or else we will sink as one planet. Image
26) Now the US needs to share its vaccine stockpile and vaccine excess orders with the world. And send aid to Brazil 🇧🇷. Or else we will all drown under the variants.

Let’s unite to fight this pandemic... all for one, one for all!

God help us.
27) I’m so tired... been trying to warn about this exact #B117 for over 6 weeks. So so tired.
28) things in South Florida are going as well as can be expected... #B117 variant surging there.

Why do we ignore this warning sign? I didn’t suffer through a doctorate in epidemiology by age 23, just so that DeSantis can pretend to govern in a pandemic.
sun-sentinel.com/coronavirus/fl…
29) #B117 update—Germany entering a new stricter lockdown after #B117 is growing and fueling another increase across EU.

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More from @DrEricDing

Eric Feigl-Ding Profile picture
Feb 26
BREAKING—FDA suddenly cancels meeting to update next season’s flu vaccines, with zero explanations. Any delays will jeopardize next year’s vaccine supply chain. Image
2) Folks who follow me know that I’m no bullshitter. I criticized past pandemic response right and left, and have called balls and strikes without bias. And I often say things that doctors & epidemiologists are whispering among themselves but don’t say publicly. (Cough cough) ⬇️
3) While I don’t recommend hoarding… I think stocking up on flu antivirals, which you can obtain prophylactically (preventively) from doctors if you ask nicely why you’re high risk, can be a good idea. I know many doctors, epidemiologists and virologists who do for their family.
Read 6 tweets
Eric Feigl-Ding Profile picture
Feb 26
Doctors are debunking RFK Jr’s claim that 20 hospitalized measles cases in Texas are there for mainly quarantine. Doctors on the ground say the 20 kids hospitalized are having trouble breathing. Oh and they are all unvaccinated against measles, which RFK Jr neglects to mention. Image
2) RFK Jr told Trump today there’s now 2 measles deaths.
3) RFK Jr is a tear with his FDA today. A dark Darwinian future lies ahead for America.
Read 4 tweets
Eric Feigl-Ding Profile picture
Feb 26
BREAKING—Reports coming in about potentially *2 measles deaths* in Texas, not just one, according to an HHS briefing to the White House today.
2) Earlier today, one measles death in an unvaccinated child was reported in Texas. Image
3) It seems to be RFK Jr who said it in an official Trump WH cabinet meeting today. Not saying he doesn’t lie, but he is now HHS Secretary
Read 6 tweets
Eric Feigl-Ding Profile picture
Feb 21
Woke or biology? There are actually more than the basic “male” XY & “female” XX sexes. Why? Because biology also creates people with single X chromosomes, or extra chromosomes like XXX, XXY, XYY, or XXX+, plus many 🧬genes. 👉All I’m asking is— please be kind to others. Thanks🙏 Image
Image
Image
2) “The most frequent SCAs include Turner syndrome (45,X), Klinefelter syndrome (47,XXY), Trisomy X syndrome (47,XXX), and Double Y syndrome (47,XYY).”

pmc.ncbi.nlm.nih.gov/articles/PMC10…
3) “The phenotype seen in SCAs is highly variable and may not merely be due to the direct genomic imbalance from altered sex chromosome gene dosage but also due to additive alterations in gene networks and regulatory pathways across the genome as well as individual genetic modifiers.”
Read 5 tweets
Eric Feigl-Ding Profile picture
Feb 16
I'm shocked a lot of doctors don't know about this newer flu antiviral drug called Baloxavir (XOFLUZA)... that shortens your flu illness by 33%, and reduces your viral load by day 2, versus what a placebo takes 5-6 days to achieve. Baloxavir also seems superior to TAMIFLU (oseltamivir) for smashing your viral load on 2 day, achieving what takes Tamiflu 3-4 days. CDC even lists Baloxavir on their website as one of the top 4 drugs that it tracks whether it works against new flu strains (it works)Image
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2) "Baloxavir was associated with significantly more rapid declines in infectious viral load than placebo or oseltamivir (Figure 3A and 3B)."
nejm.org/doi/full/10.10…
3) Adverse events for baloxavir were no different than placebo. in fact theres even hints that it could be lower than Tamiflu.

"Adverse events that were considered to be related to the trial regimen were more common in oseltamivir recipients (8.4%) than in baloxavir recipients (4.4%, P=0.009)"Image
Read 13 tweets
Eric Feigl-Ding Profile picture
Feb 14
⚠️WORST FLU SEASON ever since 2002-2003 when we began to track flu (red, first graph). Worst hit this year are children ages 0-4 and 5-17. ▶️We also have significantly LOWER flu vaccine uptake this year, one of the lowest flu vaccine coverages (red 3rd graph). Indisputable facts. Image
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2) I don't need to tell you that certain US states have vastly lower vaccination rates than others. See map (lighter green, less flu vaccination coverage), and which have higher (darker green)...

If you want to see details and demographics on which state has the LOWEST flu vaccine coverage rates... the data is here.
cdc.gov/fluvaxview/das…Image
3) It’s not just the flu that is going around… Gaines County, TX, where the epicenter of the measles outbreak is, has one of the lowest measles vaccination rates too.
Read 7 tweets

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