Herd immunity wont protect you: #COVIDisAirborne

80% of your network is vaccinated. They form a ring of immunity around you, they reduce your chance of contact with an infected person.
But virus is airborne, so it floats right over that immune ring and gets you

A thread 🧵
1/
When a substantial number of people are vaccinated COVID-19 cases will drop, we will even contain the pandemic. But that doesn’t mean unvaccinated people are safe!

Imagine you work in an enclosed office without ventilation or air filtration. No attention to indoor air quality
2/
80% of office co-workers are vaccinated. 10% aren’t vaccinated but recovered from COVID-19. 10% are not vaccinated nor have had COVID-19, they’re unprotected. Sam is one person in the unprotected group. Sam goes out to bars. Sam likes to party. Lovely chap. Good for a pint.
3/
Sam goes to a poorly ventilated and crowded bar. There are a few infectious COVID-19 patients at the bar. Sam is unprotected so Sam gets infected. Sam comes to office. When he coughs, sneezes, speaks and just exhales he expels plenty of virus laden aerosols.
4/
The virus is airborne and it floats on the air currents in the office. It floats in the break room. It floats in the lift. It floats in the washroom. The 10% of the office that’s unprotected may now get infected despite 80% of the office being vaccinated.
5/
Now consider that the virus is evolving to become more and more transmissible. It’s becoming better at making infected individuals generate more infectious aerosols and it’s becoming more infectious so even less virus than before can cause infection.
6/
If office had insisted on universal vaccination
+
Frequent rapid testing
+
Air quality that’s safe for health
Then everyone would have been safe.
The immunity of the herd can’t protect you from SARS-CoV-2. You need your own immunity!
When new variants emerge the rules change!
7/

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More from @swapneilparikh

4 Jun
Interesting...
Look at B.1.617.2 in March 21 in Delhi and J&K. Real time genomic epidemiology would have saved us a world of hurt. H/t @VidurMahajan1

Reduction in Ct values suggests an actively growing epidemic @michaelmina_lab @jameshay218 @mlipsitch et al paper linked below
1/ ImageImage
Real time genomic surveillance would have picked up on B.1.617.2 spreading in March and if policy makers responded appropriately we could have saved so many lives... need to start sequencing and analyzing in real-time. Need to integrate epi and clincal data like UK PHE
2/
Interesting that there was a drop in Ct values in Delhi starting in Feb and significant in March and April.

Paper below explains how this could have also served as an early warning sign of growing outbreak.

science.sciencemag.org/content/early/… (highlights images from @EricTopol)

3/ ImageImage
Read 4 tweets
23 May
In this thread I’m going to commit the cardinal scientific sin of oversimplification to try and explain vaccine, neutralizing antibodies and protection from infection/sickness/hospitalization/death

The numbers used here are to explain a concept and aren’t necessarily to scale
1/
Let’s imagine the virus can be killed by bullets.

These bullets are neutralizing antibodies - antibodies that neutralize (kill) the virus.

A few bullets will prevent death/hospitalization, more bullets will prevent illness, a lot of bullets may even prevent infection.
2/
When you get vaccinated against COVID-19 you have a gun loaded with bullets to destroy the virus (SARS-CoV-2)
These bullets are neutralizing antibodies (nAbs = bullets)
Eg.
OG SARS-CoV-2🇨🇳 was neutralized with 2 bullets
B.1.1.7🇬🇧 needed 4 bullets
B.1.351🇿🇦 needed 16 bullets
3/
Read 10 tweets
13 May
Provided COVAXIN single dose efficacy is >70%, models support delaying COVAXIN 2nd dose except for 65 years +
We should have had quality Ph3 data and real world data on COVAXIN by now. Unbelievable that we’re still doing guess work.
🧵
1/
Modeling study helps us understand lives saved with delayed second dose of Covaxin.

Assuming vaccination rate of 0.3% of population / day. The total cumulative mortality on day 180 is seen to be lower as below depending on efficacy. Makes sense if efficacy >70%
2/
Delayed second dose except for 65+ allows us to save lives but reduces the risk due to uncertain efficacy. Bottom line if COVAXIN single dose efficacy is >70% this approach makes sense given India’s daily vaccination rate. We’re unlikely to ever hit 1% population / day
3/
Read 9 tweets
12 May
Here’s a plan to get India 10-20% extra COVISHIELD vaccines doses overnight!

How could this be possible? Read on to find out.

🧵 1/

Antibody Responses After a Single Dose of ChAdOx1 nCoV-19 Vaccine in HCWs Previously Infected with SARS-CoV-2 medrxiv.org/content/10.110…
A study found that HCWs who had recovered from COVID-19 up-to 11 months prior responded incredibly to a single dose of AstraZeneca vaccine (COVISHIELD).
They had neutralizing antibodies against wild type virus but also neutralized P.1 & B.1.351 (immune escape variants)!
2/
In fact those who had COVID-19 in the past and took a single dose of AZ (COVISHIELD) had higher neutralizing antibodies than those who took 2 doses of Pfizer mRNA vaccine! That’s right - past infection plus 1 dose AZ higher nAbs than 2 doses of Pfizer!
3/

medrxiv.org/content/10.110…
Read 14 tweets
30 Jan
If we have to wait till June for COVOVAX, Indian regulators should hang their heads in shame.
They gave COVAXIN an EUA without any efficacy data or Ph3. Novavax has efficacy data from Ph3 in U.K. and Ph2 in SA. Ph3 in USA and Mexico underway. 1/
Indian regulators literally rewrote the rules for COVAXIN citing hypothetical superior efficacy against variants. What a load of BS (BOGUS science). They made up the restricted EUA in clinical trial mode BS. But a vaccine with 85%+ efficacy in Ph3 against B.1.1.7 is too risky! 2/
Is COVISHIELD good? Yes. But there’s a lack of data for >55 years. That’s more an issue with the trial than the vaccine. Is COVAXIN good? I don’t know, no publicly available Ph3 data. COVOVAX has AMAZING immunogenicity & reported AMAZING efficacy (need 2 wait for the preprint) 3/
Read 4 tweets
29 Jan
Let me just try to preempt all the BS (bad science) we will hear about hypothetical superiority of COVAXIN against variants vs Novavax. A thread 🧵 1/
Novavax is proven efficacious against OG COVID-19 and B.1.1.7 in a Phase 3 clinical trial in U.K. We should soon have the data in a preprint / peer reviewed publication. The confidence in the results will increase as more cases occur. 2/
Novavax has a Phase 2 trial in South Africa with an efficacy endpoint. That trial reported efficacy albeit reduced against B.1.351. The number of participants in the study was small, number of cases were low and therefore confidence in these results in lower than we need. 3/
Read 14 tweets

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