Why is "I'm vaccinated, I'm fully protected" wrong?
The pivotal clinical trials, such as with mRNA vaccines, showed a 95% reduction of symptomatic infections, the primary endpoint. Not 100%
That was pre-Delta
nytimes.com/2021/07/22/hea… @apoorva_nyc /1
Now we have conflicting data for protection vs symptomatic infection post-mRNA vaccination for Delta
UK @NEJM 88% protection

Israel 40% protection (unpublished)
bloomberg.com/news/articles/… /2
We don't have an explanation for this glaring contradiction, which could include demographics, sample size, time from vax, all sorts of things. The delayed 2nd UK dose (8 wk) has been suggested by raising level of immunity. But we don't know yet /3
bbc.com/news/health-57…
It is clear that post-vaccination Delta infections are more common than prior versions of the virus, such as this preprint from yesterday /4 medrxiv.org/content/10.110…
There is certain risk for infection Delta post-vaccination, even with the most potent vaccines, although the level of risk is uncertain (between 39-88% protection so far. The risk for severe illness (incl hospitalization/death) is extremely low (<-can't be emphasized enough) /5
So as @ASlavitt reviewed in his excellent thread last night, avoid what I call a Delta stress test for your vaccine- induced immunity, wear a mask indoors until this wave clears and there's low levels of virus around /6

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More from @EricTopol

22 Jul
One of the most important advances in the history of life science today combines deep learning #AI, the human proteome, #openscience: accurately determining 3D structure of human proteins and organisms via amino acid sequence nature.com/articles/s4158… @Nature
This work by @DeepMind @embl @emblebi is made fully available to the biomedical community and sets the foundation for accurately predicting virtually all protein structures, >100 million
Essential for understanding biology, drug discovery, and many life science disciplines
Read 5 tweets
18 Jul
The "D" in Delta stands for a detour in genomic mutations.
Instead of the prior major variants which had N501Y, and E484K for Beta and Gamma, this one took a different path in its spike RBD and other key spots (sequences at @scrippsresearch's outbreak.info) /1
You can see (Delta, in orange) the marked differences from the other variants in multiple locations: receptor binding domain (RBD), N-terminal domain (NTD) and in S2 of the spike protein /2
graphic from @atelentia @Nature nature.com/articles/s4158…
We don't know much about the functional significance of the mutations in Lambda (C.37), a variant of interest that emerged in South America, that is also on a new path
medrxiv.org/content/10.110…
nationalgeographic.com/science/articl… by @Ecquis @NatGeo /3
Read 5 tweets
14 Jul
Just out @NEJM
New data for J&J vaccine:
—High titers of neutralizing antibody to Delta variant, improvement in these levels seen over time
—The antibody and T cell response was durable for at lest 8 months
nejm.org/doi/full/10.10… Image
We needed some good news for this vaccine. This is it.
No sign a booster vs Delta is necessary (study is limited by small number of participants)
@FT by @nikasgari Image
A new lab study preprint compares the 2-dose mRNA vaccines with 1-dose J&J for neutralizing antibodies vs Delta biorxiv.org/content/10.110… Image
Read 4 tweets
8 Jul
Just published @Nature
Delta variant protection by mRNA and AZ vaccines requires 2-doses, little neutralizing antibody (nAb) with 1-dose, and insufficient nAb with prior covid
nature.com/articles/s4158…
A couple of other points from the paper
The mutations unique to Delta (including other B.1.617 lineages, Alpha, Beta, Gamma) include T478K and other regions outside of RBD, highlighted
The large size of fused cells with Delta cf other variants
Read 4 tweets
5 Jul
Call for Full FDA approval of covid vaccines
The stakes could not be higher.
In print, @nytopinion
nytimes.com/2021/07/01/opi… Image
The @US_FDA is unhappy about this essay. That's good. Maybe they will do something.
Perhaps @DrWoodcockFDA will even make a public statement?
Read 4 tweets
2 Jul
The @US_FDA's overdue full approval of mRNA vaccines is holding us back from getting millions of more people protected, at a time of urgent need, with the Delta variant on the rise. My guest essay @nytopinion nytimes.com/2021/07/01/opi… w/ thanks for editing @jopearl
I start off w/ the paradox of FDA's accelerated approval of the Alzheimer's drug despite a 10-0 vote against it by their Advisory Committee, 2 clinical trials that did not show clinical benefit, and for any person w/Alzheimer's even though the trials were for early disease, MCI
Then a brief review of the exceptionally large, completed clinical trials and real world evidence for these vaccines—the 1st ever new vaccines to get Emergency Use Authorization (EUA)—now given to hundreds of millions of people /3
Read 9 tweets

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