⚠️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—🧵
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.
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.
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.
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.
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.
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.
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.
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’.
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.
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.
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.
2) RFK Jr told Trump today there’s now 2 measles deaths.
Woke or biology? There are actually more than the basic “male” XY & “female” XX sexes. Why? Because biology also creates people with single X chromosomes, or extra chromosomes like XXX, XXY, XYY, or XXX+, plus many 🧬genes. 👉All I’m asking is— please be kind to others. Thanks🙏
2) “The most frequent SCAs include Turner syndrome (45,X), Klinefelter syndrome (47,XXY), Trisomy X syndrome (47,XXX), and Double Y syndrome (47,XYY).”
3) “The phenotype seen in SCAs is highly variable and may not merely be due to the direct genomic imbalance from altered sex chromosome gene dosage but also due to additive alterations in gene networks and regulatory pathways across the genome as well as individual genetic modifiers.”
I'm shocked a lot of doctors don't know about this newer flu antiviral drug called Baloxavir (XOFLUZA)... that shortens your flu illness by 33%, and reduces your viral load by day 2, versus what a placebo takes 5-6 days to achieve. Baloxavir also seems superior to TAMIFLU (oseltamivir) for smashing your viral load on 2 day, achieving what takes Tamiflu 3-4 days. CDC even lists Baloxavir on their website as one of the top 4 drugs that it tracks whether it works against new flu strains (it works)
2) "Baloxavir was associated with significantly more rapid declines in infectious viral load than placebo or oseltamivir (Figure 3A and 3B)." nejm.org/doi/full/10.10…
3) Adverse events for baloxavir were no different than placebo. in fact theres even hints that it could be lower than Tamiflu.
"Adverse events that were considered to be related to the trial regimen were more common in oseltamivir recipients (8.4%) than in baloxavir recipients (4.4%, P=0.009)"
⚠️WORST FLU SEASON ever since 2002-2003 when we began to track flu (red, first graph). Worst hit this year are children ages 0-4 and 5-17. ▶️We also have significantly LOWER flu vaccine uptake this year, one of the lowest flu vaccine coverages (red 3rd graph). Indisputable facts.
2) I don't need to tell you that certain US states have vastly lower vaccination rates than others. See map (lighter green, less flu vaccination coverage), and which have higher (darker green)...
If you want to see details and demographics on which state has the LOWEST flu vaccine coverage rates... the data is here. cdc.gov/fluvaxview/das…
3) It’s not just the flu that is going around… Gaines County, TX, where the epicenter of the measles outbreak is, has one of the lowest measles vaccination rates too.