Hi @DocStrain - were you involved in this paper?

medrxiv.org/content/10.110…

I'm struggling to understand the first sentence of the abstract: "Delayed second-dose SARS-CoV-2 vaccination trades maximal effectiveness for a lower level of immunity across more of the population."
1/6
Longer prime-boost intervals generally elicit better immunity. So "delaying the second dose…" is likely to ensure a higher level of immunity across the population (once the booster dose has been given).
2/6
Also "…patients receiving these drugs should be prioritized for optimally timed second doses."

What is the "optimal" timing for a second dose?
3/6
It takes time for the immune system to respond to the first dose. In general, extending the prime-boost interval leads to a greater eventual response.

This paper suggests that patients on TNF blockers may not respond as well to a single dose, so…
4/6
…so delaying the second dose may leave them at risk for longer.

Perhaps the answer may be…
5/6
…Perhaps the answer may be that the optimum regime for such patients would be to give an additional, early booster dose, followed by a third dose (a second booster dose) when their immune systems have had more time to respond to the first doses.
6/6
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More from @petermbenglish

27 Apr
1/8
Pregnant women are at greater risk if they catch Covid-19.

1.Adhikari EH, Spong CY. COVID-19 Vaccination in Pregnant and Lactating Women. JAMA 2021;325(11):1039-1040. (doi.org/10.1001/jama.2…).
2/8
In Germany, the risk is considered so great in pregnancy that the household members of pregnant women are offered vaccination to reduce the risk of their spreading it to the pregnant woman.
3/8
Pregnant women respond well to Covid-19 vaccines.

2. Gray KJ, Bordt EA, Atyeo C, Deriso E, Akinwunmi B, Young N, et al. COVID-19 vaccine response in pregnant and lactating women: a cohort study. American Journal of Obstetrics & Gynecology 2021. (ajog.org/article/S0002-…).
Read 9 tweets
27 Apr
Why are leaseholders having to foot the bill?

Because most of them are poor and cannot fight it, of course!

1/5
Somebody else was responsible for fitting unsafe cladding to their buildings. Leaseholders had every right to expect regulations to ensure their buildings were safe.

Maybe property developers fitted unsafe cladding knowingly, to save money; or perhaps were misled.
2/5
Either way, the responsibility for regulating buildings' safety lies with government.

It may or may not be reasonable to force developers or building owners to pay, but there's no point bankrupting them, and the ultimate responsibility lies with government.
3/5
Read 5 tweets
22 Apr
Can anybody tell me how the "COVID-19 Antivirals Taskforce" announced this week gov.uk/government/new… relates to the "The COVID-19 Therapeutics Taskforce" which has I think existed since early 2020? gov.uk/government/gro…
1/8
Is this just yet another example of the government announcing something it's already done as something new, to make us think they are doing more than they actually are?
2/8
(They usually do this with money, announcing "new" spending which, when you look at the small print, isn't new at all.)
3/8
Read 9 tweets
16 Apr
This Cansion vaccine is intriguing. Like AZ, Sputnik, Janssen, it is an adenovirus vector vaccine. But it is given via inhalation - a little like nasal spray flu vaccines (although those are live attenuated virus vaccines).
1/7
The link @hildabast provided is to the trials page. A previous paper is here: thelancet.com/journals/lance…

2/7
In theory at least, inhaled vaccines may, by virtue of the fact that they act directly on the respiratory mucosa, induce a better mucosal immunity (IgA etc) than system (eg IM) injection.
3/7
Read 10 tweets
11 Apr
Intriguing conclusion to this generally excellent article on screening for Covid-19.

thelancet.com/journals/lanep…
1/
It is good to see references to the frameworks for thinking about screening - very familiar to public health specialists like myself, but less well understood by others, including some in the medical professions.
2/
The conclusion intrigued me because it didn't even attempt to answer the question in the title; and it sat on the fence wrt whether screening for Covid-19 (and any very widespread testing amounts to screening) is a good idea.
3/
Read 6 tweets
11 Apr
Healthcare staff - including those working in @PHE_uk or its successor organisations, and the public health profession has a duty to speak out and challenge the "lock them up [for longer]" view that is so prevalent, particularly in right-wing, populist politics.
0/17
In my >20 year career as a consultant in communicable disease control, prisons have been the setting I've struggled most with.
1/17
As a previous tory home secretary said, "Prisons are an expensive way of making bad people worse".

I've tweeted about this before. or threadreaderapp.com/thread/1373255…
2/17
Read 19 tweets

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