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Michael Lin, PhD-MD Profile picture
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9 Jul, 5 tweets, 2 min read
"I am a little surprised how quickly Delta has become widespread,” said Ashish Jha, dean of Brown's School of Public Health. “We’re one week into July and it is everywhere. It suggests that it is far, far more contagious than the Alpha variant."

Well...

politico.com/news/2021/07/0…
We knew 10 days ago Delta was 50% of sequences in the US, so that realization is both late and not surprising. The below came to me via @ScottGottliebMD on 6/28, and if Jha wasn't following Gottlieb or Delta progress by then, he should have been

We also knew Delta is far far more contagious than the Alpha variant, based on how quickly it supplanted Alpha in the UK. That happened in May.
Also I noted on 7/4 that FL hospitalizations rose together with (actually a bit before) cases. That suggests undertesting, as cases should rise ~1 week before hospitalizations. By masks off, I think CDC also signalled that it was okay to stop testing.

This would all be consistent with Delta being dominant since late June, and underdetected.

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More from @michaelzlin

Michael Lin, PhD-MD Profile picture
8 Jul
Claims of decoupling between cases, hospitalizations, and deaths in the UK have been premature.

No doubt we'll see lower death rates, but we'll also see (1) plenty of acute and likely long-term morbidity, and (2) breakthrough deaths in sick/elderly.

UK researchers weigh in...
Our sources will be two UK newspapers from opposite ends of the political spectrum: The conservative Daily Mail and the liberal Guardian. First up, the Daily Mail quotes the government for 100k daily cases and ICL epidemiologist Ferguson for a CFR of 0.1%.
100k looks plausible to me. With 50% not vaccinated, 20% of whom might be prev infected (based on total deaths so far), that makes 40% nonimmune. Half of those (20% of UK) might get Delta before herd immunity sets in. That's a similar number to all infections so far.
Read 16 tweets
Michael Lin, PhD-MD Profile picture
7 Jul
Health officials' oversimplistic message that vaccines were perfect and treatment of breakthroughs as taboo has, predictably, led to defensiveness/apologeticness upon local breakthroughs that undermines confidence in both officials and vaccines.
sacbee.com/news/politics-…
Take this explanation by the CA senate secretary after a local outbreak: "Even fully vaccinated individuals can be infected with COVID-19. However, public health experts indicate that fully vaccinated individuals are less likely to suffer...
... the most serious symptoms of COVID-19, and for this reason, the Senate continues to encourage all staff to protect themselves by receiving the vaccine.”

Does one sense a little awkwardness here? Isn't the way the outbreak is discussed sound like an apology for vaccines?
Read 22 tweets
Michael Lin, PhD-MD Profile picture
5 Jul
Must always consider mechanism and data quality in COVID19 curve. Factors Topol misses: (1) UK cases started rising early June, and deaths lag by 1mo (2) cases in the other countries cited may be underreported, increasing the death/case ratio (Russia curves esp make no sense)
Another thing to consider is if Topol included precisely those countries that have the highest death/case ratios to make a contrast with UK, then he would have filtered in exactly those countries that are underreporting their cases.
Kind of frustrating that Topol would continue to make the same mistakes in data interpretation (no mechanism, no awareness of data quality, no awareness of selection bias)
Read 7 tweets
Michael Lin, PhD-MD Profile picture
5 Jul
Posted today: Delta evades RNA vax too

6 of 100 vaxxed attendees at open-air wedding got sick.

In 2 with Covaxin, 1 (groom) died
In 4 with RNA vax, 1 hospitalized

All expected from measured 80% efficacy, yet PH officials say we don't need to worry.

disq.us/t/3yqfdib
Measured efficacy of 80% for RNA vaccines on Delta variant in the below paper. That's equivalent to 20% breakthrough rate relative to unvaccinated.

Remember this next time you hear someone claim vaccinated people can't get sick from COVID-19.

thelancet.com/journals/lance…
CDC advice that vaccinated should feel comfortable spending all the time they want indoors and unmasked with the 50% unvaccinated population while Delta surges through their communities doesn't sound so reassuring now, does it?
Read 13 tweets
Michael Lin, PhD-MD Profile picture
3 Jul
This thread, and probably the one it refers to by Topol, should be pulled. The study did not look at transmission from vaxxed people at all. Topol wrote "91% efficacy of blocking transmission of infection" when he should have just written "91% efficacy of blocking infection"
You can see the game of telephone going on here:
Actual results: 91% refers to the reduced infection of vaxxed people, similar to the 95% in clinical trials. All of this is pre-Delta. So kind of non-news.
Read 4 tweets
Michael Lin, PhD-MD Profile picture
3 Jul
Sorry gotta go against Fauci on this one, just as I did in March 2020 on masks. If you don't want to be a breakthrough infection and pass on the virus (vaxxed still have ~20% the chance of unvaxxed with Delta) and you're highly exposed, then wear a mask. Simple, cheap, convenient
👏LA's Ferrer "We have enough risk and enough unvaccinated people for Delta to pose a threat to our recovery. And masking up now could help prevent a resurgence in transmission. This is a precautionary recommendation, given that we don’t have all the information we wish we had.”
Ferrer said there’s “increasing evidence that a very small number of fully vaccinated individuals can become infected with the Delta variant and may be able to infect others.”
Read 6 tweets

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