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פרופ' אייל שחר Profile picture
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10 Jun, 5 tweets, 2 min read
1/
 Question: How does a dominant seasonal flu strain start simultaneously in geographically spread locations?

Spread from one location to another is unrealistic:
1) Too fast
2) No moving wave pattern.
2/
 Answer: Virus arrived sooner.

Stays dormant in the body, awaiting seasonal stimulus (viral dormancy, old theory)
ncbi.nlm.nih.gov/pmc/articles/P…
3/
 Support here.
4/
 SARS-CoV-2 dormancy before seasonal stimulus?

Compatible with world-wide spread months before the pandemic (2019)

If so, what is the site of dormant SARS-CoV-2?

Two possibilities: lung, small intestine (!)
ncbi.nlm.nih.gov/pmc/articles/P…
(A 2004 paper about SARS-COV)
5/
 On SARS-Cov-2 and the small intestine.
pubmed.ncbi.nlm.nih.gov/32343593/

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More from @prof_shahar

פרופ' אייל שחר Profile picture
7 May
1/
Peer review (unsolicited)
Another analysis of Israel data on vaccine effectiveness. Fully vaccinated vs. unvaccinated
Observation period: Jan 24-Apr 3
Bottom line: again, likely over-estimation of effectiveness.
thelancet.com/journals/lance…
2/
 Over the study period:
1)People shifted from unvaccinated to fully vaccinated.
2)Rate of infection was declining (peak Jan 20)
3/
 Distribution of unvaccinated on the calendar is shifted to the left (time of HIGHER infection rate)
Distribution of vaccinated is shifted to the right (time of LOWER infection rate)
So, part of the difference between vaccinated & unvaccinated is due natural wave decline.
Read 8 tweets
פרופ' אייל שחר Profile picture
1 Apr
Thread: US excess death
1/
 Rough estimation of US excess deaths, Oct 2019-Sep 2020 (“flu year”)

Impact of recent winter belongs to “flu year” Oct 2020-Sep 2021

(“Flu year” avoids arbitrarily split of winter mortality between two calendar years.)

At the end: Sweden
2/
 Inference derived from just 7 “flu years” (shown in rectangle) + heuristics.

Counts of all-cause deaths obtained from a table in this tweet.

Image
3/
 Notice a pattern: a year of “high” mortality is followed by a year of lower/similar.

Pattern disrupted in 2017/2018, severe flu season. Should have been lower/similar to 2016/17.
Estimated flu deaths: 61,000 ImageImage
Read 10 tweets
פרופ' אייל שחר Profile picture
18 Mar
1/ Important question: Once infected, what is the effect of vaccination status on death/severity?

Here is relevant statistics from Israel data.

Disturbing observations on the early period after 1st dose. Image
2/ Table shows rate of death & severe disease, since the vaccination campaign began.

Notice that risks are higher in vaccinated than unvaccinated. That’s misleading. At any time, vaccinated were older than unvaccinated (and older, on average, in sequential vaccination groups.) Image
3/ The phenomenon is called confounding. Illustrated in a causal diagram. All comparisons are not valid. They don’t estimate effects. Image
Read 12 tweets
פרופ' אייל שחר Profile picture
16 Mar
1/
 Theories & evidence of bias in Israel data on vaccine effectiveness.
nejm.org/doi/full/10.10…

Theories:
1. Important endpoints (hospitalization, severe illness, death) included many patients with incidental positive PCR
2. Preferentially in unvaccinated
2/
 All figures taken from Supplementary Appendix Figure S3. (The Y-axis scale seems wrong, but I assume it is just a labeling error)

Key figure: Time to hospitalization

Most patients were hospitalized within 1-2 days (!) of a first PCR swab that was found positive

Unexpected. Image
3/
 Typical course much longer: symptoms->test->worsening symptoms-->hospitalization

What happened?

Many patients were likely tested in the ER. They showed up in severe enough condition, for which no outpatient PCR was done. Thus, their condition on admission was not COVID
Read 10 tweets
פרופ' אייל שחר Profile picture
11 Mar
1/
 What is vaccine effectiveness in the most vulnerable population? Is it indeed >90%?

What is happening shortly after dose 1 of the vaccine?

A large cohort study (Denmark) of nursing home residents (and health care workers) provide interesting answers

medrxiv.org/content/10.110…
2/
 Retrospective cohort during vaccination campaign, which coincided with winter wave

Key points:

Wave trajectory (date) was a major confounder.

Estimated effectiveness of full vaccination much lower in nursing home residents (64%) than health care workers (90%)
3/
 Not surprising. The claim that effectiveness is just as high in the elderly does not fit knowledge of immune response with aging.

See here, for example.
Read 7 tweets
פרופ' אייל שחר Profile picture
10 Feb
10 שאלות מטרידות שמותר לשאול, בינתיים:

1. מדוע נמחקת הנורמה שאין לכפות על הפרט, ישירות או בעקיפין, התערבות רפואית?

2. מדוע נמחקת נורמת החיסיון הרפואי לפיה מידע מזהה על טיפול/היעדרו שייך בלעדית לפרט?
3. מדוע אישר ה-FDA בנוהל חירום (בניגוד לסטנדרט מעקב) חיסון לאוכלוסייה שאינה בסיכון חריג? (מקובל לגמרי אישור בנוהל חירום לאוכלוסייה בסיכון.)

4. מדוע התקשורת בארץ ובעולם לא מציגה לציבור הערכות שיעורי תמותה בקבוצות גיל צרות, במקום לדווח אנקדוטות?
5. האם חסינות לאחר חיסון (באמצעות זיהוי חלבון הספייק) תגן בפני מוטציות באותה אפקטיביות של חסינות נרכשת לאחר הידבקות?

6. מה קורה במערכת החיסון כאשר נדבקים בסמוך לחיסון הראשון ומערכת החיסון מזהה בו זמנית את הנגיף ואת חלבון הספייק שלו על תאי גוף? האם יש תגובת-יתר חיסונית?
Read 6 tweets

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