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Rajeev Jayadevan Profile picture
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9 Jun, 6 tweets, 2 min read
Cell-to-cell (sideways) transmission of the SARS-CoV-2 virus is described in this research from Ohio State Univ & Washington Univ.

Authors find this process, unlike the traditional 'cell-top entry', is not deterred by neutralizing antibodies.

1/n
biorxiv.org/content/10.110…
Traditionally we hear about virus entering the exposed surface of the cell, like a bug flying in through the open window of a multi-apartment complex.

Now, imagine this bug burrowing through the walls into all the neighboring units. That essentially is cell-to-cell entry.

2/4
The problem with this process is that our neutralising antibodies might not be able to stop it.

These antibodies are designed to stop the bug from entering through the window, but not from burrowing through the walls between adjacent apartments.

3/4
Several viruses use this method. Apparently the SARS-CoV-2 virus is better than its predecessor the SARS virus (of 2003) at doing this. This means it is easily able to find its way deeper into tissues.

This research has implications on our strategies to fight the pandemic.

4/4
Work from Gamaleya National Research Center for Epidemiology and Microbiology, Moscow showing that side-to-side cell entry of the SARS-CoV-2 virus is ~fully resistant to neutralizing antibodies.
biorxiv.org/content/10.110…
Work from Anamika Basu et al from Gurudas College and Jadavpur University, Kolkata, India from over a year ago on the topic of cell-to cell transmission of the SARS-CoV-2 virus
biorxiv.org/content/10.110…

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More from @RajeevJayadevan

Rajeev Jayadevan Profile picture
10 Jun
Covaxin tested against two variants B.1.617.2 (India) & B.1.351 (S Africa). Mild reduction in neutralization ability noted; 2.7 and 3-fold, which is a smaller loss compared to other vaccines, reports ICMR/NIV study.
See graph for comparison.
Thread.
1/n biorxiv.org/content/10.110… Image
Neutralizing ability is one of the parameters scientists use to measure a vaccine's firepower against a virus.

If the vaccine is very effective, then its ability will be 1 or close to 1 -that is, in comparison with how effective the same vaccine was against the old virus.

2/12
If the virus has become so smart, it will then take several times the original "neutralising power" to kill it.

e.g. If the amount of vaccine required to kill the new variant is 10 times what it took to kill the old virus, we say the neutralising ability is 10-fold lower.

3/12
Read 14 tweets
Rajeev Jayadevan Profile picture
9 Jun
ICMR-NIV study on P.2, the variant originally found in Brazil since ~April 2020 (WHO). Also called B.1.1.28.2 or zeta, it is now being rapidly replaced by P.1 in Brazil.

ICMR/NIV observed its effects on hamsters in comparison with P.1.

See thread
1/13

biorxiv.org/content/10.110…
Presenting some context first. This variant P.2 was only seen in 2 samples so far in India; from asymptomatic travelers who arrived from Brazil and UK.

In Brazil, it is also being phased out by P.1 (deeper colour in recent weeks of 2021, genomic data from Manaus, Brazil).

2/13
Study from Brazil showing how P.2 is being phased out by P.1. The latter variant has the N501Y mutation in addition to E484K, among several others.

3/13

virological.org/t/increasing-f…
Read 14 tweets
Rajeev Jayadevan Profile picture
8 Jun
D Dimer: A test that leads nowhere?

25% of 150 recovered COVID-19 patients had elevated D Dimer at 4 months. 81 were outpatients.

The exact role of D-dimer in COVID-19 is unclear; it does NOT predict PE unless there are concomitant clinical clues.

1/10

healio.com/news/hematolog…
Traditionally D-dimer is elevated when there are fibrin degradation products associated with clots. But D dimer is also elevated in other inflammatory conditions, trauma, post-op state / malignancy.

In COVID-19, its role is primarily as a marker of severity & inflammation.
2/10
Studies in COVID-19 patients have shown that unless there are specific clinical pointers to a clot (leg or lung), an elevated D-dimer value ALONE will not be worth pursuing: we might end up chasing a bird that was never there.

3/10
Read 10 tweets
Rajeev Jayadevan Profile picture
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
Rajeev Jayadevan Profile picture
6 Jun
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
Read 7 tweets
Rajeev Jayadevan Profile picture
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

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