1/21 Several people have asked about whether vaccines will protect against the variants in India. B.1.617 is the major variant of concern, although there are undoubtedly others there.
2/21 Although many are calling it a "double-mutant", this is a misnomer. It carries a number of mutations, but two are concerning. These are found in the receptor-binding domain.
3/21 However, these do not to thwart immune responses generated by mRNA vaccines as much as the B.1.351 variant (1st found in S Africa), which is currently the most concerning variant with respect to vaccine responses.
4/21 However, even for B.1.351, there are reasons to believe that mRNA vaccines will induce more than adequate responses in most people to protect, especially against severe disease, hospitalization, and death.
5/21 B.1.617 has been studied in the lab, and does not really change the ability of vaccinees (who received mRNA vaccines) to neutralize this virus substantially. No adequate real-world data, yet.
6/21 The prediction is that B.1.617 may be ~20% more infectious that the prevalent circulating variants (although until this is proven, I will remain skeptical).
7/21 This has limited implications for individuals, but of course compounds over populations so that you will see strain at the level of the health center and hospital.
8/21 I know it seems that the variant is the major reason why things are out of control in India. But time and time again, in every place where there has been a surge, it has been behavior that has determined cases.
9/21 One concerning and even tragic aspect to what is happening in India now is how many young people are getting sick and hospitalized. However, this is being tallied by people in health centers, who are only seeing the sickest.
10/21 What we need to see are the data from the community - if a larger proportion of younger people in a community are getting sick, then that reflects some difference biologically.
11/21 But until then the null hypothesis (meaning the one that requires a burden of proof to refute) is that the more people who get infected, the more health centers will see young people.
12/21 In other words, if a small proportion of younger people require hospitalization in any part of the world, but in India the total number of people infected is astronomical, then that small proportion will translate to large numbers being seen in the hospital.
13/21 For instance, take the 1-3% mortality rate estimate for SARS-CoV-2: aggregated over all of India's 1.7 billion people will leave a staggering 17-51 million dead (if every single person is infected).
14/21 That still leaves the question of B.1.617 and the vaccines that are available in India, Covaxin (Bharath) and Covishield (Astra-Zeneca). The bottom line is that aside from press releases, we have no idea.
15/21 I suspect that these vaccines will confer *some* protection, but there has not been sufficient pressure on these companies to actually show their data.
16/21 Bharath especially needs to be pressured to share the data as they have been shouting out their efficacy numbers for months without being held responsible for showing any data.
17/21 A brief word on vaccine diplomacy: many are arguing that the US is standing in the way of vital vaccine ingredients for India, or that the US is preventing the mRNA vaccines from coming off of patents.
18/21 Immediate help in the form of vaccines would be to deliver vaccines from a country's stockpiles to India, including mRNA vaccines.
19/21 Although India does need to solve longer term production problems as well, transferring intellectual property immediately will not save India in the immediate, although it will allow vaccine manufacturers in India to also become rich.
20/21 Don't listen to the propaganda-if the US can help it will be to send mRNA vaccines to India. And if India wants to help, it can build, overnight if necessary, the necessary cold chain and electrical infrastructure to allow for proper delivery of mRNA vaccines to its people
21/21 You can't claim that there are too many power cuts in India for this to be reliable, because we all know that the chief ministers' palaces and nuclear missile silos never suffer power cuts. The rest is just political will.

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More from @ashwin_id

14 Jan
Question for #IDtwitter @soupvector and evolutionary virologists about B.1.1.7 VOC: I see that the 'wild type' SCV-2 had a measured R0 in the UK of 0.95, while B.1.1.7 was 1.45, which is admittedly *greater*. But is that enough to conclude it is much more transmissible?
Reminder, Measles R0 is >10. Other points, when uninfected hosts are not limiting, why is wild type being fully replaced by B.1.1.7 unless there is some degree of founder effects?
Confidence interval on B.1.1.7 (if I'm reading the PHE document properly) is 95% CI: 1.34-1.59, and the change in R0 is estimated at 0.74 [95%CI: 0.44- 1.29], so perhaps not at all more transmissible?
Read 6 tweets
11 Jan
I haven't seen the calculation for the protective benefit of a #sars_cov_2_vaccine against asymptomatic transmission yet, so here it goes : Suppl. Table 18 in the Moderna NEJM efficacy/safety manuscript: nejm.org/doi/suppl/10.1…
Asymptomatic infection at the time of dose #2 administration, appears to be diagnosed by PCR. For the placebo group there were 39 PCR+ infections out of 14598 people; for the vaccine recipients there were 15 out of 14550,
Vaccine efficacy is (((332-293)/14598)-(15/14550))/((332-293)/14598), or 61.4%, against asymptomatic infection.
Read 6 tweets

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