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Eric Feigl-Ding Profile picture
@DrEricDing
Jul 23, 2021 • 30 tweets • 14 min read • Read on X
⚠️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
4) Let’s now look at breakthrough rates by when someone got their vaccination— you clearly clearly see than January vaccinated people currently have the most breakthrough per capita, followed by Feb… and so on. This is partly age (elderly vaxxed first) but possibly also waning. Image
5) This worrisome news is not just my perspective, the Israeli govt is quite worried too. They warn of “decreasing potency” i24news.tv/en/news/corona…
6) but is it just elderly effect in the weaker Jan/Feb potencies? Not sure… if you look at breakthrough rate in age 60+ versus 16-59, the 16-59 have similar if not higher breakthrough rate if comparing Jan vs Jan, Feb vs Feb of same month! That implies waning not just age. ImageImage
7) here was 2 weeks ago… VE was 64% for preventing infection in early June. 94% in May. But now it’s 39-40%. Gee.
8) Let me be clear—vaccines are amazing miracle. But we can’t just rely on just vaccines alone—must do other mitigation to get us out of the pandemic. Epidemiology models show that because #DeltaVariant so contagious, we *must must must* add masks and other NPI measures! ⬇️
9) Boosters—Biden WH Officials Now Expect Vulnerable Americans to Need Booster Shots—The growing consensus that at least some Americans will need a booster is tied in part to research suggesting that Pfizer’s vaccine is less effective after ~6 months. nytimes.com/2021/07/23/us/…
10) “Senior officials now say they expect that people who are 65 and older or who have compromised immune systems will most likely need a third shot from Pfizer or Moderna.”
11) “That is a sharp shift from just a few weeks ago, when the administration said it thought there was not enough evidence to back boosters yet.
12) “On Thursday, a key official at @CDCgov said the agency is exploring options to give patients with compromised immune systems third doses even before regulators broaden the emergency use authorization for coronavirus vaccines, a step that could come soon for Pfizer vaccine.
13) “Dr. Amanda Cohn, the chief medical officer of CDC immunizations division, told an advisory committee to the agency that officials were “actively looking into ways” to provide certain people access to booster shots “earlier than any potential change in regulatory decisions.”
14) there is some debate about the new 🇮🇱 ~40% efficacy data. Some say unvaccinated are tested more—true, but in that case, then we’d find relatively more cases in the unvaccinated, which would make the vaccine efficacy look BETTER, not worse (seen here).
timesofisrael.com/israeli-uk-dat…
15) Thus to rephrase—if unvaccinated are tested more than vaccinated, then we would fine more of the milder / asymptomatic infections in unvaccinated relatively, and that would make the vaccine efficacy look relatively higher, not lower. So that is unlikely to explain the VE dip.
16) another debate is that early vaccinations “reflect time that has passed since vaccination, but also… often people with health conditions and who are more prone to infection, such as the elderly.” We discussed this above—but again age isn’t explaining this—60+ & <60 similar. ImageImage
17) Some others say “oh it’s a smaller dataset than UK”—yeah but it’s still VERY significant. Notice how the 95% confidence intervals’ lower bounds all exclude zero—and by comfortable cushion of certainly. And the 40% VE’s upper bound excludes 88% from 🏴󠁧󠁢󠁥󠁮󠁧󠁿 data. So these are diff. Image
18) also if we look at just the elderly age 60+ (stratification is one form of adjustment in epidemiology), we still see the jump up among the January vaccinated even among these elderly. This implies this is an effect by time (stratified adjusted roughly for age), not just age. Image
19) given the new data—in following the precautionary principle—we need to now urgently reconsider reimposing mask mandates again. @CDCDirector - it is time. Tick tock ⏰
20) Whenever you see vaccine efficacy —keep in mind vaccines are amazing. But data suggest we need to also do both vaccines & public health measures (rather than rely on treatments). Iron lung machines was a good polio treatment, but it could never eradicate polio until vaccines.
21) Welp—there’s discussions among epidemiologists now whether we can hold the #DeltaVariant down. With a R0=6 we can just barely. But with an R0=8 it’s much harder under 60% efficacy and 64% vaxxed. What is the estimated R0 range of Delta? 5-8 ➡️ more contagious than smallpox.
22) large numbers of experts (including @JeromeAdamsMD) now support masks even if vaccinated. @CDCDirector needs to update mask rules ASAP now in light of the new data^
23) #DeltaVariant cases ➡️ hospitalizations. Period. The “link is broken” disinformation machine is running wild that they aren’t correlated anymore. Completely false. Do not fall for that nonsense. Hospitalizations rising in UK and US and Israel.
24) Vaccines are a miracle but we need other mitigation against #DeltaVariant. Iceland is one of the most heavily vaccinated countries in the world… but yet… and yes their ICUs are filling up too.
25) sure looks like we are headed to 3rd shot boosters… both the original vaccine booster as well as a #DeltaVariant tailored booster according to Pfizer. Their internal data also shows waning. finance.yahoo.com/news/pfizer-bi…
26) This is not good. Even under rosy optimistic scenarios, containing #DeltaVariant was already hard. But it’s not easy…. see details 🧵
27) REMINDER— even *mild* COVID still leads to drop in intelligence according to UK 🇬🇧 studies on #COVID19 survivors. The cognitive drop is stronger as it gets more severe, but even significant in the mild cases too! Avoid infection not just hospitalization!
28) Another reminder: mild breakthrough #COVID19 infections can still cause transmission. This is why we mask even if vaccinated! It slows and helps stop the spread. Mask and vaccinate … not just ‘or’.
29) we are mostly pretty certain boosters are coming… the issue is not if but when… and who first.
30) Pfizer reports 12% symptomatic efficacy after 4 months. But it was mostly data from the pre-#DeltaVariant era. Just FYI.

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More from @DrEricDing

Eric Feigl-Ding Profile picture
Mar 28
My god—Earthquake (a Richter ~7.7) causes a skyscraper to collapse in Bangkok. Hope all the construction workers made it out.
2) this skyscraper collapse was captured from a distant car’s dashcam while on a highway

3) another view of the collapse. For those who lived through 9/11, this collapse is a bit triggering.
Read 5 tweets
Eric Feigl-Ding Profile picture
Mar 27
Welp—kiss public health & medical research infrastructure in America goodbye for the next 4 years. RFK Jr plans to cut 10,000 jobs from Trump HHS. Image
2) this will not make America healthy again… not by a long shot. So dangerous and irresponsible.
3) “Kennedy is set to announce Thursday the planned changes, which include axing 10,000 full-time employees spread across departments tasked with responding to disease outbreaks, approving new drugs, providing insurance for the poorest Americans and more”.
Read 5 tweets
Eric Feigl-Ding Profile picture
Mar 15
SICKENING—Trump’s DHS just deported a surgeon from Brown University Medical School—who is here legally on an H1B visa that doesn’t expire until 2027, and has committed no crimes. Trained in the U.S. at Ohio State, University of Washington, and Yale as a **transplant surgeon** (one of the most difficult surgical fields in all of medicine!!!), she is a highly trained doctor on kidney transplants, which cannot be easily replaced. Her phone was seized at the border. A federal judge handed down an injunction against her deportation—but she was already deported on a plane en route to Paris. Brown’s kidney transplant clinic is now strained by her deportation.Image
Image
2) Full text:

PROVIDENCE — A Rhode Island doctor who had traveled to Lebanon to see her parents was prevented from re-entering the United States at Boston’s Logan International Airport on Thursday evening, her lawyer and a colleague said.

Dr. Rasha Alawieh, 34, who lives in Providence, has been working at Brown Medicine’s Division of Kidney Disease & Hypertension since last July, and she [has] been part of the transplant service at Rhode Island Hospital, according to Dr. George Bayliss, the organ transplant division’s medical director. She has been studying and working in the United States for about six years, he said Friday.

The US consulate in Lebanon had issued her an H-1B visa, which is given to people in specialty occupations requiring expertise. The visa was valid through mid-2027, said Thomas S. Brown, an attorney representing her and Brown Medicine.

Alawieh was detained when she returned to Logan airport, and family members are afraid that she is about to be deported to Lebanon, he said.

“We are at a loss as to why this happened,” Brown said. “I don’t know if it’s a byproduct of the Trump crackdown on immigration. I don’t know if it’s a travel ban or some other issue.”

He said her phone has been seized and he has not been able to contact Alawieh.

Bayliss said a lawyer filed a petition with the US District Court in Massachusetts, and Judge Leo T. Sorokin issued an order saying Alawieh should not be moved outside of Massachusetts without 48 hours notice. But he said that message apparently did not reach immigration officials in time, and a plane carrying Alawieh left for Paris.

“This is outrageous,” Bayliss said in an interview. “This is a person who is legally entitled to be in the U.S., who is stopped from re-entering the country for reasons no one knows. It’s depriving her patients of a good physician.”

A US Customs and Border Patrol spokesperson, Ryan Brissette, was not able to immediately answer questions about Alawieh on Friday evening.

Bayliss said Alawieh graduated from the American University of Beirut medical school and came to the United States for a nephrology fellowship at Ohio State University. She then landed a transplant fellowship at University of Washington and had a residency in the Yale hospital system before starting at Brown Medicine last July, he said.

“She’s really a very humble and able person,” Bayliss said. “She takes care of her patients. She is talented and thoughtful and a great addition to our division.”

Bayliss said Alawieh went to Lebanon to visit parents and planned to be gone for two weeks. He said she texted a colleague at 6:30 p.m. Thursday saying she was back in Boston, but then her family heard from immigration officials.

Dr. Paul Morrissey, surgical director of the organ transplant division at Brown University Health, said Alawieh works on getting people in Rhode Island on the list for a kidney transplants, and that’s a crucial job at a time when there has been a lot of focus on the need for kidneys and their equitable distribution.

He said Alawieh should not have had any problem traveling out of the country with an H-1B visa.

“It’s an unfortunate set of circumstances,” Morrissey said. “It’s putting a strain on our office. Her work has been exceptional.”

bostonglobe.com/2025/03/14/met…Image
3) There is a new Trump ban against many countries, including tourist visa bans against all countries in the red and orange lists. This list is still tentative. And it shouldn’t have affected people with existing visas, such and the Brown kidney transplant surgeon Image
Read 8 tweets
Eric Feigl-Ding Profile picture
Mar 14
I’ve said it before, and I’ll say it again… once upon a time, liberals did have our own “Leftist Joe Rogan”… his name was Joe Rogan…

Here he is advocating for socialized medicine, healthcare for all, and supporting labor unions to protect workers.
2) Recall, Rogan was once pro Obama and pro Bernie Sanders, and pro Yang Gang, and anti Trump. It’s sad he has since failed to the dark side. But like Vader… maybe he can be redeemed someday and come back to the light.
3) *Fallen, not failed (above).

Joe Rogan was also pro gay rights and pro DACA and pro helping inner city communities that suffer economic and social injustices. It’s sad what he has become. I feel we should try to pull & welcome him back someday. Everyone can be redeemed.
Read 4 tweets
Eric Feigl-Ding Profile picture
Feb 26
BREAKING—FDA suddenly cancels meeting to update next season’s flu vaccines, with zero explanations. Any delays will jeopardize next year’s vaccine supply chain. Image
2) Folks who follow me know that I’m no bullshitter. I criticized past pandemic response right and left, and have called balls and strikes without bias. And I often say things that doctors & epidemiologists are whispering among themselves but don’t say publicly. (Cough cough) ⬇️
3) While I don’t recommend hoarding… I think stocking up on flu antivirals, which you can obtain prophylactically (preventively) from doctors if you ask nicely why you’re high risk, can be a good idea. I know many doctors, epidemiologists and virologists who do for their family.
Read 6 tweets
Eric Feigl-Ding Profile picture
Feb 26
Doctors are debunking RFK Jr’s claim that 20 hospitalized measles cases in Texas are there for mainly quarantine. Doctors on the ground say the 20 kids hospitalized are having trouble breathing. Oh and they are all unvaccinated against measles, which RFK Jr neglects to mention. Image
2) RFK Jr told Trump today there’s now 2 measles deaths.
3) RFK Jr is a tear with his FDA today. A dark Darwinian future lies ahead for America.
Read 4 tweets

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