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Céline Gounder, MD, ScM, FIDSA

13 Jul, 9 tweets, 4 min read

@TheAtlantic

1/ Great speaking with @TheAtlantic's @KatherineJWu about "breakthrough infections."
theatlantic.com/science/archiv…
We need to distinguish between breakthrough INFECTIONS and breakthrough DISEASE.

3/ The COVID vaccines are truly amazing: safe and highly effective in preventing severe disease, hospitalization, and death.

We vaccinate to save lives, not to prevent the sniffles.

4/ There are different phases of infectious disease containment:
- Control
- Elimination
- Eradication

We are nowhere near controlling COVID at this time. That needs to be our focus right now.

5/ It's unclear whether we'll ever be able to eliminate SARS-CoV-2 infection.
justhumanproductions.org/podcasts/s1e71…
It's more likely that SARS-CoV-2 will become endemic & that our vaccination & other mitigation strategies will be primarily about reducing the frequency & severity of DISEASE.

6/ Breakthrough INFECTIONS do matter if you're trying to ELIMINATE an infection.

To eliminate a virus, you need to be able to curb infection & transmission.

cdc.gov/mmwr/preview/m…

7/ Very few diseases can be ERADICATED.

Infections for which there are non-human hosts (e.g. SARS-CoV-2) cannot be eradicated.

Smallpox is the ONLY human infection eradicated to date.

cdc.gov/mmwr/preview/m…

https://twitter.com/celinegounder/status/1415006531125399552?s=20

8/ It's not that breakthrough infections don't matter at all.

Someone with a breakthrough infection after vaxx can transmit the virus to others. But except for certain high-risk groups (e.g. 80+, immunosuppressed), they're unlikely to get very sick.

https://twitter.com/celinegounder/status/1415006531125399552?s=20

https://twitter.com/celinegounder/status/1415006531125399552?s=20

9/ The folks who should be paying attention to breakthrough INFECTIONS are epidemiologists.

https://twitter.com/celinegounder/status/1415006531125399552?s=20

Breakthrough infections are likely to be enriched for emerging variants, and sequencing breakthrough infections is an important part of surveillance for variants.

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More from @celinegounder

Céline Gounder, MD, ScM, FIDSA

@celinegounder

8 Jul

1/ New data in the last day on how well natural immunity and vaccine-induced immunity protect us against the Delta variant.

Here's the take-home message:
2 doses of Pfizer or Moderna vaccine will protect you,
even against the Delta variant.

@NEJM

2/ Published in the @NEJM
nejm.org/doi/full/10.10…

Delta is 2.4-3.3x less susceptible to neutralizing Abs elicited by prior infection or Pfizer/Moderna vaccination as compared to the early WA1/2020 variant.

The dotted line represents protective immunity.

@Nature

3/ Published in @Nature:
nature.com/articles/s4158…

Left:
Low neutralizing antibody (nAbs) levels by 12 months after natural infection
4x decrease in nAbs vs Beta & Delta compared to Alpha

Right:
Dramatic bump in nAbs levels if vaccinated after infection, including vs Beta & Delta

Read 8 tweets

Céline Gounder, MD, ScM, FIDSA

@celinegounder

7 Jul

@EricTopol

1/ I really appreciated @EricTopol's guest essay in the @nytimes: nytimes.com/2021/07/01/opi…

I agree with much of this, but a few thoughts...

2/ There are really two questions here:

- How long will it take the FDA to grant full approval and why does it take that long?

- Will a full approval lead to greater confidence in the COVID vaccines and uptake among those not yet vaccinated?

@EricTopol

3/ Regarding the first question:

I agree with @EricTopol:

I don't understand why the FDA approved aducanumab for treatment of Alzheimer's. There's limited data on its efficacy and there are real risks.

3 FDA advisory board members resigned in protest of this approval.

Read 26 tweets

Céline Gounder, MD, ScM, FIDSA

@celinegounder

1 Jul

1/ What should you do if you got one shot of J&J COVID vaccine with the Delta variant spreading?

2/ The Delta variant is spreading in the U.S. as it did in the UK, as did the Alpha variant before it. The Delta variant is more infectious than other variants and can evade the immune response to older variants.

3/ The Pfizer, Moderna, and J&J vaccines remain effective in preventing severe disease and death from the Delta variant, but we see a significant drop in overall vaccine effectiveness with the J&J vaccine versus the Delta variant.

Read 6 tweets

Céline Gounder, MD, ScM, FIDSA

@celinegounder

9 Jun

1/ Our 4 Americas:
Free America celebrates the energy of the unencumbered individual.
Smart America respects intelligence & welcomes change.
Real America commits itself to a place & has a sense of limits.
Just America demands a confrontation with what the others want to avoid.

2/ "In Free America, the winners are the makers, and the losers are the takers who want to drag the rest down in perpetual dependency on a smothering government."

3/ "In Smart America, the winners are the credentialed meritocrats, and the losers are the poorly educated who want to resist inevitable progress."

Read 7 tweets

Céline Gounder, MD, ScM, FIDSA

@celinegounder

9 Jun

1/ This is how infectious diseases
that threatened EVERYONE
quickly become the scourge of the MOST VULNERABLE among us:

theatlantic.com/ideas/archive/…

2/ To forget is the definition of privilege:

3/ To close the book on the story is a privilege:

Read 5 tweets

Céline Gounder, MD, ScM, FIDSA

@celinegounder

9 Jun

1/ Dr. David Baltimore, the Nobel laureate who claimed there was a “smoking gun” supporting the lab-leak theory, now says he regrets using the phrase and doesn’t agree that it validates the lab-leak theory.
latimes.com/business/story…

2/ The now-famous "furin cleavage site" of SARS-CoV-2 doesn't prove the lab-leak theory either way:

3/ There's nothing really special about the furin cleavage site:

Read 4 tweets

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