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Michael Lin, PhD-MD

@michaelzlin

24 May

Some people are wondering, with some scientists expressing opposing views about the possiblity of a lab leak in COVID19 origins, how do they know who to trust? In this thread I describe how to recognize the rhetorical devices or fallacies used to push weakly supported views.
1/🧵

First some background. Scientists face the situation of figuring out the steps that lead to an outcome all the time. For example it’s what molecular biologists do on a daily basis to work out the molecular reactions that underlie initially mysterious biological events.
2/🧵

We start by brainstorming all the possible hypotheses that are consistent with the known outcome *the more the better* to makes sure we don't miss the right answer. Then we gather data that can help rule out one hypothesis or not.
3/🧵

Read 26 tweets

Michael Lin, PhD-MD

@michaelzlin

23 May

Was just thinking that the CRISPR baby episode foreshadowed many of the issues were now grappling with on SARSCoV2 origins. And then because it can read my mind, my news feed told me that my colleague Hank Greeley has a book out about it this week. irishtimes.com/news/science/c…

What are the similarities?
- A controversial line of investigation because of its potential for harm
- A high-visibility topic, so some fame to those who navigate safety and ethics properly
- Chinese scientists eager to show they are as technically capable as Western scientists

Now we don't know where SARSCoV2 came from, so there could be no involvement of Chinese scientists. But in both cases, the central PR China government has squelched the release of certain records that, if everything was done properly, would have exonerated the people involved.

Read 11 tweets

Michael Lin, PhD-MD

@michaelzlin

22 May

For those following the less-perfect vaccines (what most of the world will get), a medrxiv study from Chile this week provides some very valuable data: neutralizing antibody levels after natural infection vs 1 or 2 doses inactivated virus or RNA vax. medrxiv.org/content/10.110…

Most interesting finding: Similar nAb titers after natural infection vs. uninfected after 2 doses CoronaVac or after 1 dose BNT162b2 (Pfizer/BioNTech). These are columns 1, 6, and 8 in the below chart.

What does it mean?

Several things:
1. The data are in line with Coronavac Phase 1/2 trials. There, nAb levels after 2 doses 4 weeks apart reached ~0.6x of convalescent sera. Here the graph shows nAb levels after 2 doses > convalescent sera, but the text says a bit less (1595 vs 1860, not sure why)

Read 11 tweets

Michael Lin, PhD-MD

@michaelzlin

22 May

https://twitter.com/Poynter/status/1392207536221159426

Like others, I admire Fauci for being a straight and clear talker.

It's big news then that, at 13:00 below, he says we can't rule out lab involvement in COVID19 origins. That completely blows up claims by certain people that no serious scientists could consider that.

His words:

https://twitter.com/Poynter/status/1392207536221159426

"No I’m not convinced about that [natural origin]. I think that we should continue to investigate what went on in China until we find out to the best of our ability exactly what happened.”

"Certainly the people who’ve investigated it say that it likely was the emergence from an animal reservoir that then infected individuals but it could have been something else, and we need to find it out."

Read 5 tweets

Michael Lin, PhD-MD

@michaelzlin

18 May

@NatureMedicine

New study in @NatureMedicine correlating neutralizing antibody levels to vaccine efficacy. Has a nice Fig. 1 that summarizes both data and model well. Suggests that maybe you can predict vax efficacy from neutralizing antibody levels. Quick impressions ...
nature.com/articles/s4159…

Conveniently all studies on vax-elicited nAbs also measured nAbs in convalescent sera, so the authors could normalize the former by the latter. We have to hope convalescent nAb levels don't vary too much from study to study. Not perfect but better than no normalization.

When that is done, and one assumes having nAb levels at ~20% of mean convalescent sera gives you a 50-50 chance of getting symptoms after SARSCoV2 infection, then based on the gaussian distribution of nAb levels among individuals, you can predict % breakthrough infections (Fig 1)

Read 17 tweets

Michael Lin, PhD-MD

@michaelzlin

1 Apr

🧵A year into COVID19, despite the heroic efforts of many, our regulatory and medical systems have clearly NOT adapted adequately.

Here's an infuriating look at how pre-pandemic SOPs are preventing patients from getting life-saving treatment.
nytimes.com/2021/03/31/opi…

2) "Because mAb treatment can be administered only in an outpatient setting ... in one case I had to persuade the admitting team to discharge a patient from the hospital so that they could send him to the emergency room to receive the care he needed." This is absurd.

3) Why does it happen? It's what I'd call the tyranny of the drug label. FDA approved this particular mAb treatment for outpatient use, and apparently no doctor at this hospital could be persuaded to use it off-label for inpatient use, even though the drug will definitely work.

Read 14 tweets

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