Wanted to put all real-world effectiveness data for you on the vaccines together in a thread with slides so you can see where we are in the world- have come long way from our clinical trial data table with all of this real-world date. Image
Data from Israel Ministry of Health released by Pfizer press release on March 11, 2021 Image
Data from Israel and the UK Image
Data from nursing homes here in the US (CDC) Image
Health care workers in US with vaccination despite winter surges Image
CDC data from March 29 Image
And Pfizer data from this morning (April 1) on 40K participants, 6 months data, works against variants as well, 100% protection severe disease. No joke, these vaccines really work. Ok, super busy x 2 days but will tweet on weekend (vax after COVID-19?) & if huge news before Image
Good news on real-world data on Moderna vaccine at 6 months (more details later today): >90% effectiveness against all symptomatic COVID; > 95% against severe COVID. Efficacy: how works in clinical trials; effectiveness: how works in real world
Another study on real-world effectiveness, this time among healthcare workers in Mayo Clinic system (Florida, Minnesota, Arizona). Very large study & these studies compare groups likely taking same "risks": unvaccinated cohort 23,931; 2-dose vax 44,011
876 symptomatic infections in unvaccinated (37 out of 1000); 22 symptomatic infections in fully vaccinated (0.4/1000). 96.8% effectiveness for Pfizer vaccine; 98.6% effectiveness for Moderna in this real-world large study. Higher than clinical trials. Image
Another article here on real world effectiveness on vaccines, this time among those >65 in US. Examined respiratory illness admissions among adults >65 from Jan 1, 2021–Mar 26, 2021 in 24 hospitals across 14 states as vaccines first given in this group
January-March 2021 still high circulating virus in U.S., most vulnerable group for severe illness (>65) &hospitalizations for COVID-19 down 94% with vaccines (Remember, Moderna had few outcomes in their clinical trial among >65 so real-world reassuring on Moderna) Image
Another stunning study on the real-world effectiveness of the vaccines detailing the vaccine roll-out in Israel even with 95.4% of strains being B.1.1.7 during later phase of roll-out (this paper details findings from Jan 24-April 3 roll-out) thelancet.com/journals/lance…
Pfizer vaccine 95% effective overall against symptomatic COVID-19; 92% effective in preventing asymptomatic infection; 98% effective against hospitalizations, 97% effective against death across all age groups even >=85 yrs. Cases still declining despite full opening March 2, 2021 Image
This high level of effectiveness seen across all age groups even those >= 85 years. Also, even though children not vaccinated (can only use vaccine >16 years old), cases in all age groups massively low even with opening of society. Fastest vax campaign on planet. Image
And though I had this study on "why not to worry about variants" thread, realized important to add here which is Qatar mass vaccination campaign from Dec 21 2020-March 31, 2021. Although virtually all circulating virus in country at end of that period was
either B.1.351 (South Africa variant) or B.1.1.7 (UK variant), the effectiveness of the vaccine (Pfizer) remained extremely high for severe outcomes at 97.4%. So must really add here that the effectiveness of the vaccines in real-world settings is Image
even higher than the efficacy of the vaccines in clinical trials so we should not longer be saying "you have a 5% chance of catching the virus" if you have had the vaccine. These studies show real-world effectiveness even higher & of course your chance of being
exposed depends on circulating cases in your community ( going down in US). Data from 4/26-out of <95 million fully vaxed in US, 6025 symptomatic breakthroughs (0.006%); 0.0006% hospitalizations for COVID; Deaths 0.0001% for COVID (1 in million); cdc.gov/vaccines/covid…

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More from @MonicaGandhi9

Jan 30
POPULATION IMMUNITY: Nothing stresses a respiratory pathogen like winter months & this 3rd pandemic winter shows what high population immunity has done to decrease mortality rates from COVID:
Place with the lowest amount of population immunity is China as less natural infection from zero COVID policies and vaccination (and boosting rates in elderly) not as high as desired. World & @WHO very rightly worried about China- need vax & therapeutics
PANORAMIC trial (ongoing) in UK will define use of Paxlovid with high population immunity- latter not there in China; China vulnerable 65 & up vax'd or unvax'd high risk need wide availability of Paxlovid (Pfizer CEO ruling out generic in China troubling)
Read 8 tweets
Jan 29
ADOLESENTS: NIH Study (Stanford study, SF). "School shutdowns, severed social channels, and amplified stress at home and in their communities" during COVID amplified anxiety, depression, and brain aging "reflecting more lasting effects of adversity"
Important piece from @NEJM this week on #harmreduction in pandemic management. Do everything in your power to minimize severe disease but stop interventions which cause harm without decreasing pathogen impact; new era in COVID 2023 w/ immunity/vaccines
A holistic view of public health during a pandemic (consider societal effects of interventions; are they really helping?), can increase trust in public health. I - like most ID MDs on this platform- am concerned about trust & less uptake of other vaccines
Read 4 tweets
Jan 23
ONCE YEARLY? Agree with most on here that 1) yearly vaccination needed but for older & more vulnerable (co-morbidities multiple, immunocompromised); 2) May not able to adapt mRNA vax quickly enough
FDA considers major shift in COVID vaccine strategy npr.org/sections/healt…
to new subvariants (e.g. our last bivalent is against BA4/BA5 but Omicron up to XBB1.5) & not clearly better due to adaptive power of cellular immunity (see thread on B cells) so any boost probably ok. Latter in line with @WHO endemic plan put out on March 30, 2022
Immunity works beautifully. Lancet ID 30 million people UK study shows who is still at risk after 2 doses of vaccine for severe disease (>80, immunocompromised, multiple 5 comorbidities) & needed boost. B cells adapt antibodies they make - B cell thread:
Read 7 tweets
Jan 19
Excess deaths during COVID are very complicated & vary by region & duration/degree of lockdown; this was very true at Ward 86 (our HIV clinic at county hospital); sorry to hear this for the city of San Francisco; very much appreciate hard work of addiction teams at SFGH
Good article-excess mortality in COVID likely neglect other med care: "in countries like Belgium/Sweden [highly vax'd], ratio between excess deaths & COVID deaths 1..net change mortality [from] other diseases/injuries during pandemic period minimal" there
In US (like article in SF), excess deaths in young people up from accidents, overdoses, suicides, homicides, and internal causes from neglect of medical care (no, not from the vaccines). Very disruptive time for other services & caused despair
Read 4 tweets
Jan 8
Yes immune system works
-Please see cellular immunity pinned tweet; so many papers! Will post more
-This is 7th human coronavirus; we know how coronaviruses work
-Retroviruses (HIV: start RNA & go to DNA) & coronaviruses (RNA virus) different
-Basic principles of immunology hold
Below simple tutorial I hope is how cellular immunity & immune memory work- there will always be variants that may evade antibodies but we are lucky immune system more than antibodies! T and B cells too for variants; Media, good science reporting please!
Cellular immunity (high population immunity from the vaccine, natural infection or hybrid immunity) why hospitalizations not rising MA (& why hospitalizations so linked to vaccine rates with delta & BA1; now high immunity from natural/hybrid too)
Read 4 tweets
Jan 7
EXTREMES: Alan Watts (“This is it”): “Furthermore, so far from being the smug rationalization of a Mr. Pangloss, the experience has a tendency to arise in situations of total extremity or despair, when the individual finds himself without any alternative but to surrender himself
entirely. Something of this kind came to me in a dream when I was about eight years old. I was sick at the time and almost delirious with fever, and in the dream I found myself attached face-downward and spread-eagled to an immense ball of steel which was spinning about the earth
I knew in this dream with complete certainty that I was doomed to be spun in this sickening and terrifying whirl forever and ever, and the conviction was so intense that there was nothing for it but to give up—for this was hell itself and nothing lay before me but a literal
Read 5 tweets

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