Comparison of antibody response between covishield & covaxin by @singhak_endo & team.

515 subjects, of whom 90 got covaxin

95% overall anti Spike antibody response

98% for covishield, 80% for covaxin

Lower response in older people & diabetes

🧵

1/5

medrxiv.org/content/10.110…
Cont’d

Antibody titre 115 AU/ml for Covishield and 51 for covaxin.

27 breakthrough infections occurred (4.9%) after both doses: 25 were mild, 2 were moderate, no deaths.

Risk of breakthrough infection:
5.5% with covishield
2.2% with covaxin

2/5
Listing some facts which will help understand the context of the study:

1. Anti Spike antibody is not the same as neutralising antibody. Its level is not known to reliably correlate with NAb, which is typically measured only in research labs. See my earlier tweet on this.

3/5
2. Immunity is multipronged, like the “Army, Navy and Airforce”. Antibodies form only one segment of this.

⚠️The % or level of Anti Spike Antibody measured in the study cannot be taken as “% of protection delivered” to the recipient.

4/5
3. What matters in the end is:

a) the % of people who get infected inspite of vaccination
b) how sick they get
c) duration of protection

Both vaccines are seen to be providing excellent protection on the ground. The exact %, as the authors say, will only be seen in an RCT.
5/5
Congratulations to Dr AK Singh @singhak_endo and colleagues for conducting this study and for writing it up comprehensively using professional language, covering all possible angles, discussing the limitations and correlating with published research.
Study by Dr Padmanabha Shenoy @drdpshenoy and co from Cochin shows similar trends, although their work was primarily among patients with rheumatological disease.

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More from @RajeevJayadevan

6 Jun
Evidence based medicine, finally.

The latest COVID-19 guideline from Directorate General of Health Services at Ministry of Health & Family Welfare @MoHFW_INDIA, are pristine no-nonsense science.

✅ NO UNNECESSARY MEDICATIONS. Period.

See thread.

1/5

dghs.gov.in/content/1376_3…
Major features:

1. Bold and clear statement about asymptomatic infection:

“NO MEDICINES REQUIRED”

2. No antibiotics

3. No place for HCQ, Zinc, Vitamins, Ivermectin on the document

4. Clear instructions on steroid dose. One dose, fixed duration.

2/5
5. No steam inhalation advised (people sometimes do this in excess).

6. Hydration, diet and positive mindset/social connections get attention.

7. Clear instructions on Remdesivir and Tocilizumab, these are to be carefully used - only in highly selected patients.

3/5
Read 6 tweets
6 Jun
Apparent increase in % of deaths among 30-44 years in Himachal Pradesh from 7% in 1st wave to 13% in 2nd.

On taking a closer look, (see thread) it is likely because the older age groups have come under vaccination umbrella.

1/4

m.tribuneindia.com/news/himachal/…
As early as May 31, over 31% of >45 years age group in HP had been vaccinated, ranking first in the country.

This means that the death rates in the older age group will be lower.

Therefore, the % of deaths in <45 will appear larger.

See below.

2/4

tribuneindia.com/news/himachal/…
(Continued, see thread above)

The shaded (green) parts are the vaccine-protected segment. (A few <45 also got vaccine, but mainly in healthcare/frontline worker groups).

If vaccination had not been done, the 2nd wave numbers in the shaded areas would have been higher.

3/4
Read 5 tweets
5 Jun
Study on 287 “black fungus” mucormycosis cases last year (4 months from Sept to December 2020) in India, published in CDC.

See thread for main points.

-37% were not diabetic. -18% were on home treatment.
-Excess steroid use was a risk factor.

1/12

wwwnc.cdc.gov/eid/article/27…
Among the 287 mucormycosis cases of Sept-Dec 2020, 187 (65%) were associated with COVID-19, or “CAM”.

154 out of 187 were “late CAM” or occurred >8 days after diagnosis of COVID-19.

33/187 (17.6%) patients were managed for COVID-19 at home before developing CAM.

2/12
Among the total 187 CAM patients, only 63% had diabetes.

The % of underlying diabetes was the same as non-COVID-19 mucormycosis.

COVID-19 was the ONLY underlying disease in 61/187 (33%) CAM patients, among whom 48 (79%) received glucocorticoid treatment for COVID-19.

3/12
Read 12 tweets
4 Jun
The neutralizing ability of vaccine drops with time, and age. The variants of concern B.1.617.2, B.1.351
and B.1.1.7, have a 5.8, 4.6 and 2.6 - fold reduction respectively when compared with the original Wild type strain. Study from UK comparing variants against vaccines.

1/5
The study measured neutralizing ability of post-vaccine serum against variants. Theoretically, it means VOC are more likely to get past vaccine protection, esp. those who had only 1 dose.

However, such lab studies are best interpreted along with clinical observations.

2/5
The reason for seeking clinical correlation is that immunity is multi-pronged, and we are not measuring T cell protection in such studies.

While neutralizing antibodies stop the virus from infecting our cells, what happens AFTER the infection is largely decided by T cells.

3/5
Read 7 tweets
4 Jun
Among 506 healthcare worker infections from a cohort of 12,248 at PGI Chandigarh, 64% were unvaccinated, 9.5% were fully vaccinated (>2 weeks past II dose)

However, the shorter follow up post 2nd dose (time bias) means the real % could be higher.

1/10

nejm.org/doi/pdf/10.105…
Cont’d

The graph does not factor in the duration of follow up. During an ongoing vaccination process, those who are unvaccinated “get longer time” (compared to the vaccinated healthcare workers) to pick up the infection.

2/10
Cont’d

Since vaccination takes time, those who were 2 weeks past second dose in the pie chart would have had fewer days of observation, than others.

This means that the odds of picking up infection will be smaller by default. This also gets reflected in the pie chart.

3/10
Read 10 tweets
3 Jun
mRNA vaccines linked with myocarditis in young people.

Both Pfizer & Moderna are being looked at. Israel reported the link, which has since been under CDC & EMA’s scrutiny.

Cases are mild, except for ? 2 fatalities in Israel. Details awaited.

1/2

sciencemag.org/news/2021/06/i…
CDC’s position on myocarditis following mRNA vaccination.

“More in male adolescents, 4 days after 2nd dose, cases are mild”

This is an evolving story and could impact decisions to vaccinate children - if “signal” found to be >> “noise”.

2/2

cdc.gov/vaccines/acip/…
Thread on the topic by @andrewbostom has the details emerging from Israel
Read 4 tweets

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