📍A revealing outbreak among gold miners infected with #P1 #GammaVariant in French Guiana—55% of 44 infected—no severe but 87% symptomatic—65% fever, 22% difficultly breathing. Attack rate was 60% in fully Pfizer-vaccinated, 75% in unvaccinated miners.🧵
2) It all likely started with an asymptomatic index case… “Patient 40 could be the index case-patient; he reported visiting his family the previous week and had an asymptomatic SARS-CoV-2 infection with Ct of 33–35.” 👀—a very low viral load index that triggered the cluster!
3) Any vaccine cold chain break? No. “Several BNT162b2 batch numbers were involved. Vaccine temperature had been monitored and electronically recorded by LogTag Analyzer (LogTag Recorders, logtag-recorders.com) without any break in the cold chain.”
4) Mine workers mostly men (42/44); median age 53.3. 18 of the workers had risk factors: high blood pressure (11/44), diabetes mellitus (4/44), or obesity (4/44). Miners lived onsite in separate rooms but shared meals and machine cabins. They also worked outside without masks.
5) “However, other VOC, such as Beta or Gamma, harbor mutations conferring potential escape from humoral response induced either by prior infection or vaccination, as proven by both decreased seroneutralization in vitro (5–7) and in vivo by observational studies”
6) #P1 #GammaVariant is the main variant that ravaged Brazil 🇧🇷 previously. It is also the predominant variant in French Guiana (just north of Brazil), where it is causing hospitalization surges. guyane.ars.sante.fr/system/files/2…
7) authors: “Such a low vaccine efficiency against infection by the #Gammavariant was not expected because in vitro studies have shown a similar reduction of neutralization for Beta or Gamma variants by BNT162b2-elicited antibodies” pubmed.ncbi.nlm.nih.gov/33794143
8) “Given the surprisingly high attack rate, we hypothesized potential dysfunctions of conservation or administration of vaccines, but the absence of traceable cold-chain interruption and the use of different batches seemed to refute this hypothesis.” (Not cold chain issues)
9) “The relative isolation of the mining site and careful contact tracing suggested limited numbers of viral introductions inside this community.” (the outbreak was isolated among local miners, not due to outside community spread).
10) “The low Ct of positive PCR (high viral load) despite prior vaccination suggested that a complete vaccination scheme with BNT162b2 vaccine was not sufficient to prevent symptomatic SARS-CoV-2 infection and its transmission in this communal life without masks.” ➡️MASKS needed.
11) “The working conditions of some miners (heat, humidity, aerosol) and the sharing of machine cabs for others could also have contributed to transmission” ➡️ we need ventilation or air disinfection too.
12) “Our observation suggested that BNT162b2 protected from severe COVID-19. However, this single unexpected outbreak in a small and isolated vaccinated population requires further real-life studies on BNT162b2 vaccine effectiveness against the VOC Gamma.
13) “Masking and social distancing —even among those fully vaccinated— may be necessary among persons with frequent exposure in Gamma variant–endemic zones.”
14) A good thread on breakthroughs from @Survivor_Corps — there is LongCOVID even among breakthrough.
15) Great piece on understanding breakthrough infections by @apoorva_nyc. Vaccines work but not perfectly for milder infections - hence we need to mask and ventilate. nytimes.com/2021/07/22/hea…

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More from @DrEricDing

24 Jul
“IRON LUNG 🫁”—before the polio vaccines, the iron lung machines was the mechanical lung needed to keep kids alive. Let’s create a world where **NO CHILD IS EVER PARALYZED BY POLIO** ever again. #VaccinesWork #vaccinate

Thanks Dr @Cleavon_MD -follow him.
2) 99.9% of all polio is now eliminated. How? we once vaccinated almost a million people in just 2 days in just 1 county. We can do it again if we try.
3) this is how much excitement others have for vaccines around the world… ⚽️ 🥅
Read 5 tweets
23 Jul
⚠️ANOTHER EFFICACY DROP—Not good—Israel 🇮🇱 Ministry of Health just released another vaccine efficacy update due to #DeltaVariant—only 39% Pfizer VE for #COVID19 infection, 40.5% for symptomatic, 88% for hospitalization, 91% for ICU/low oxygen/ death. More—waning efficacy too—🧵 ImageImage
2) Gets worse, 🇮🇱 report also reveals waning potency, showing just 16% effectiveness against transmission among those 2nd-shot vaccinated in January, 44% VE if vaccinated in February, 67% VE if 2nd shot in March, 75% if vaccinated in April. Partly also age effect—but still bad. Image
3) I’m trying to find good things in the report—the 88% efficacy against hospitalization and 91% VE for severe #COVID19 death is good. But it is much weaker than the 93% reported 2 weeks ago for hospitalization, and 98% from May.

gov.il/BlobFolder/rep… Image
Read 24 tweets
23 Jul
⚠️10x hospitalization ⬆️ jump—many hospitals in Florida have more #COVID19 patients than ever before—all time pandemic record. At 2 UF hospitals in Jacksonville, the number of patients has risen to over 140, up from just 14 last month. Please #vaccinate
2) in some regions with lagging vaccination rates and rising virus cases — such as Northeast Florida, Southwest Missouri, Southern Nevada — the highly contagious #DeltaVariant has flooded intensive care units and Covid wards that, not long ago, had seen patient counts shrink.
3) At the two hospitals in Jacksonville, the number of Covid-19 patients is higher than last summer, and higher than over the winter. “It’s very frustrating,” said Dr. Leon L. Haley Jr. “Each day we continue to go up. There’s no sense of when things are going to curtail.”
Read 11 tweets
22 Jul
Hospitalized guy refuses to get vaccinated—asked further if he would have wanted to prevent his #COVID19 hospitalization, he still doubles-down saying no. Should we charge higher insurance premiums for unvaccinated, like we do for cigarette smokers?
2) “I would have gone through this (still get hospitalized), don’t shove it down my throat”… 🤦🏻‍♂️
3) this is how life insurance companies adjust for smoking. 2x to 3x the life insurance premiums. Because actuaries know what cost them money.
Read 6 tweets
22 Jul
📍BREAKING & BROKEN—CDC guidance on masking unchanged, even as #DeltaVariant surges, @CDCDirector Rochelle Walensky said Thursday. @RWalensky declined to say if the CDC is considering changing the guidance. ➡️History will also judge critical inactions. 🧵 reuters.com/business/healt…
2) Her comments come a day after U.S President Joe Biden said that the CDC is likely to advise unvaccinated children to wear masks in school as districts around the country prepare to reopen for the coming school year. reuters.com/world/us/biden…
3) The seven-day average of new cases in the United States is up 53% over the previous week, Walensky said. The Delta variant, which was first found in India, now comprises more than 80% of new cases nationwide and has been detected in more than 90 countries.
Read 6 tweets
22 Jul
📍Great airborne policy from Belgium: ➡️‘Fitness centers, dining, health clinics, concert & sports halls are required to install a CO2 meter—if a problem (with high CO2), ventilation & air cleaning systems must be installed.'

HT @PedroFacon @mdc_martinus.
2) VENTILATION is key. Both ventilation and masks needed to reduce risk indoors. But most buildings not ventilated well enough. CO2 meters help provide a proxy for ventilation of fresh air.

3) “Until we recognise that #COVID19 is airborne we are setting ourselves up for repeated failure”
Read 4 tweets

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