Some observations from the UK:
• Vaccines provide ~95% protection against death from Delta
• Deaths in vaccinees are in older people with preexisting conditions

Numbers as we expect for AZ and RNA vax, as is breakthrough severity risk factors

msn.com/en-us/health/m…
J&J is still expected to be a bit less efficacious. So rather than conclude everything's ok and that's the best we can do, I take it as certain people can use a booster if they are high-risk
We can do a back-of-envelope calculation for the expected impact. We’re predicted to get 30M cases, 1M hospitalizations, and 100k deaths in the next wave among unvaxxed. If our vaccines are 90/95/95% effective on these measures, and half of people are vaccinated, then...
...assuming similar exposures, there will be 3M cases, 50k hospitalizations, and 5k deaths in vaccinated people. If 6% of these are J&J, they would account for 150k cases, 3k hospitalizations, and 300 deaths if the vaccine is similarly effective.
If J&J is only 70/80/95 effective on cases/hospitalizations/deaths, then breakthroughs would be more like 450k cases, 12k hospitalizations, and 300 deaths. CDC may see those #'s as too small to alter guidelines, but they're suitable #'s for individual pt-doctor consults.
The goal of boosters for J&J would be to get back to 90/95/95% efficacy on cases/hospitalizations/deaths, saving 300k cases and 9k hospitalizations. If we extended boosters for everyone at risk, we could address the 3M cases, 50k hospitalizations, and 5k deaths in all vaxxed.

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More from @michaelzlin

2 Jul
OK! Finally found data on breakthrough cases by each vaccine type. Includes hospitalizations and deaths too. Numbers currently too small to make any conclusions, but worth keeping an eye on this space, especially those curious about J&J efficacy:
oklahoma.gov/covid19/newsro…
Yes these Oklahoma Health Dept reports are excellent. Here's the # of breakthrough cases up to last week by manufacturer. I ran some Fisher's exact tests. The difference between J&J and Moderna case numbers comes up stat sig. Nothing else does (small #'s means low stat power)
If we get more #'s, we can run more stat tests to see if any of these differences become statistically significant (not more than 5% probability of being due to chance). But even better would be if we can find numbers from more populous states. Please help look if you have time!
Read 11 tweets
2 Jul
The US at large is now in positive growth for COVID-19 cases, as are exactly 25 states. This reverses a trend of decreasing cases in most states until last month. I'd love for the "no surge" prediction to be true, but it's looking like math is winning over wishful thinking again.
Sorry, 24 states. I do know DC, Guam, and USVI are not states, just tallied wrong
Read 4 tweets
2 Jul
Was going to do the J&J news later, as it's actually the same info I presented yesterday, but need to correct some mistakes about it that are going around Twitter already.

Most importantly, J&J did *not* report its vaccine is 85% effective on Delta.

jnj.com/positive-new-d…
The press release was a bit confusing. In the section on Delta, it says "in the ENSEMBLE trial, Johnson & Johnson’s single-dose COVID-19 vaccine was 85 percent effective against severe/critical disease and demonstrated protection against hospitalization and death."
You might think that some trial demonstrated 85% efficacy against Delta, but that's not correct actually. ENSEMBLE was the trial finished in January that showed 85% efficacy against severe disease, back when Beta and Zeta were going around. That's mentioned in the next sentence.
Read 15 tweets
1 Jul
Some quick thoughts on long COVID.

First, the issue has the attention of the medical community. But some people will inevitably stake out the extreme positions of everything reported is real and nothing is real, so expect a lot of debate. See below.
nejm.org/doi/full/10.10…
A challenging and herculean task for the next year will be to organize rigorous studies to determine which symptoms occur above control levels. Probably some central efforts at NIH, others by university researchers via grant submissions, others carried out by hospital systems.
At the same time there is the task of figuring out which tests are useful. So there will be a lot of case studies, which will in turn spur even more studies on the diagnostics, which will help set the conditions for more studies. There are probably multiple pathologies involved.
Read 5 tweets
1 Jul
RNA-vaxxed have 91% lower risk of getting sick with COVID19, and when they do get it, they have 40% lower peak viral titers and the course of disease is reduced from 9 to 3 days. That makes about a 80% reduction in viral emissions per illness, if emissions are linear with titer.
In reality the nonvaccinated probably remove themselves from socialization when they reach peak symptoms at around day 4, so relative transmission by vaxxed vs unvaxxed per illness might only be ~60%. So risk of onward transmission probably not that different practically.
The big difference remains the 91% lower risk of getting a detectable infection in the first place. The 91% protection was averaged across many people in many situations, but it's << 91% if you are in a room with a sick person generating Delta aerosols.
Read 9 tweets
1 Jul
Just don't get it. Why is a 2-week lag between cases and hospitalizations so hard for some people (MDs no less) to understand? We've only been studying that every day for the last 15 months.

To be specific: Israel wave lagging UK wave by ~2 weeks. Too early for champagne.
The original image (chart labels were cropped away in the above screenshots). I mean I've got the bubbly chilling like everyone else, but I don't see anything to celebrate here.
Yeah, cases triple May 24 to June 14. Hospitalizations triple June 7 to June 28. "It's different this time."
Read 4 tweets

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