A misleading headline
No question about the profound crisis in India but to ascribe it to B.1.617, a variant of interest, in inaccurate,
It's not a "double mutant"—there are 13 mutations /1
2 other major variants, B.1.351 (SA)and B.1.1.7 (UK), are circulating (graph via @trvrb) See his🧵
"It's hard for me to infer the degree to which new variants are driving the surge in cases in India" /2
The 3 key spike mutations in B.1.617
E484Q is unlikely to be of consequence
cell.com/cell-host-micr…
L452R is shared with CA variant; it has some but not very high level of immune evasion
P681R in many other variants, of uncertain significance /3
Other good news: Recent lab studies indicate vaccine's ability to neutralize B.1.617, as expected from its structure economictimes.indiatimes.com/industry/healt… /4
Here are the data and preprint to back that up
biorxiv.org/content/10.110…
via @RiddhiKaul

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More from @EricTopol

25 Apr
In 2020, T cells were largely ignored w/r to covid infections.
In 2021, T cells are being largely ignored w/t to covid vaccinations.
In part, because they are rarely assessed.
A review of some recent studies /1
Lack of effect of variants on T-cell responses /2
biorxiv.org/content/10.110… Image
The strong vaccine-induced T-cell response in people with prior covid @TheLancet
thelancet.com/journals/lance… /3 Image
Read 5 tweets
22 Apr
Just published @nature
The largest study of post-covid sequelae, >70,000 hospitalized, >13,000 out-patients, with controls, characterizing the significant risks across all organ systems #LongCovid nature.com/articles/s4158…
"We got caught unprepared for Covid. Let’s not drop the ball on long Covid.”-- @zalaly, the author of the study
@NYTHealth coverage by @PamBelluck nytimes.com/2021/04/22/hea…
Good graphic to go along with the findings of the study
@WUSTLmed via @zalaly
Read 5 tweets
14 Apr
New case report and correspondence @NEJM
nejm.org/doi/full/10.10… “Our case suggests that the rare occurrence of vaccine-induced immune thrombotic thrombocytopenia (VITT) could be related to the adenoviral vector”
If you have zero cerebral venous sinus thromboses (CVST) and low platelets after 182 million doses of mRNA vaccines but do see this, albeit very rarely, with at least 2 adenovirus vector vaccines, I think "could be related" is an understatement.
I am disappointed that ACIP is putting off any J&J vaccine recommendations for another 7-10 days to review more data, since it is unlikely that will change anything or the need to make a decision
Read 5 tweets
13 Apr
I wrote about the variants @nytopinion today, concluding:
"The science of virus variants and evidence from our vaccine armamentarium should instill confidence that we’re moving toward the [pandemic] exit ramp"
nytimes.com/2021/04/13/opi…
Why should we be confident about our ability to prevail over the virus variants?
All variants are innocent until proven guilty.
Most are scariants. A handful are real.
A thread to update what we know about them
My summary table, updated:
1. The magnitude of B.1.1.7 higher lethality now in question with new @TheLancetInfDis paper (for review of all studies, see table by @_nickdavies: )
2. New York and California variants added
Read 5 tweets
12 Apr
A new study @TheLancetPH today questions the higher B.1.1.7 lethality in a small sample of hospitalized patients with viral sequencing, before there was resource limitation thelancet.com/journals/lanin…
It is at odds with the prior multiple, much larger independent reports of higher lethality (~1.6X), as also pointed out in the accompanying editorial (Table), which were community-based and did not use whole genome sequencing thelancet.com/journals/lanin…
Another study @TheLancetInfDis confirms higher transmissibility of B.1.1.7 (as did the other, vs ancestral strain) and highlights its lack of reinfection risk (cf ancestral) thelancet.com/journals/lanpu…
Read 4 tweets
10 Apr
This is blatantly wrong, Jeff Zients @WhiteHouse, refusing to surge vaccines to Michigan as @GovWhitmer has pleaded for weeks. It is the singular US outlier, weeks ahead of any other potential hotspot. nytimes.com/2021/04/09/us/…
No, that's not how its done, Mr. Zients. Maybe you should review the data from Israel for how you surge out of a surge.
Where there's a fire, you put it out.
Read 4 tweets

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