Bit counterintuitive to think that vaccinated people with antibody & T cell islands in their nose to transmit infection at the same rate as those who are unvaccinated. So, would be good to see data & probably need culture data to confirm not dead viral particles from vax success
However, I think it is about inoculum. If you are vax'd & have high rates of community transmission around you, more likely for virus to get in, cause a mild breakthrough as stimulate antibodies (T cells, which fight severe disease already there)
Delta variant has higher viral loads than alpha or ancestral strain so I am sure -with those higher viral loads, vaccinated people can transmit with mild breakthroughs- However, transmitting at equal rates seems counterintuitive.
What I don't think anyone is disputing/ debating is the need to get eligible adults who are unvaccinated, vaccinated. You are seeing conversation turn towards vaccine requirements for federal employees, Facebook, Apple, other tech companies requiring vaccines. We need to increase
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See a lot of despair this morning after CDC announcement yesterday re: high viral loads with delta so transmission risk from vax'd & agree that this virus gives us so many twists & turns and so disappointing. But wonder if this helps about the mysteries nytimes.com/2021/07/30/bri…
Or changing one's expectations with delta away from #covidzero but seeing that we have made much progress in our fight against this terrible virus; defanging the virus with the vaccines so that in areas of high vax, hospitalizations & cases more uncoupled politico.com/news/magazine/…
Please read @ashishkjha analysis of slides which reminds us of high vax effectiveness against disease & please read this- antibodies take bit of time to make from memory B cells but they do kick in, bring down transmission. T cells prevent severe diseases
Good summary from WaPo on day's issues 1) waiting on CDC data on vax'd and viral load (we will likely need culture for deeper dive); 2) masks @CarlosdelRio7 "putting toothpaste back in tube"; 3) plummeting UK cases: delta-driven natural immunity+ vax washingtonpost.com/politics/2021/…
In terms of UK cases falling despite easing lockdowns, not surprising. Delta is a hurricane- if finds vaccinated's nose, will boost immune response if asymptomatic; finds unvax'd adults FAST & tragically causes deaths or natural immunity if non-severe cnbc.com/2021/07/28/uk-…
Of note,- I'm sure CDC has data on viral loads with delta & will tell us. Delta has higher viral load, different beast than alpha. But is a PCR-determined viral load in a vax'd person with immunity (Abs/T cells in nose) as infectious as in unvax'd? Do we need culture to tell??
Spoke to @fayeflam at Bloomberg last week of how vaccine memory should be long. There are many papers on this but I wanted to give you the 4 most interesting ones in this thread in my opinion. podcasts.apple.com/us/podcast/32-…
So, we all love this paper showing the vaccines generate memory B cells (even in the lymph nodes with biopsies) although La Jolla and other places had already shown memory B cell formation in blood in other studies nature.com/articles/s4158…
So you have memory B cells and see a variant in the future? Even if your antibodies wane (which they will, not a glitch but natural for the immune system), you have the blueprint to make more from memory B & those antibodies will ADAPT to the variant medrxiv.org/content/10.110…
Wanted to explain what @CDCgov did today in terms of masking guidelines & why I think made sense. They did not say everyone mask- they said mask according to community transmission rates + vaccination rate in your community. I, @syramadad@ashishkjha wrote washingtonpost.com/outlook/2021/0…
this article in Washington Post a long time ago saying look at community transmission rates + vaccination rates as metrics of when to lift restrictions (we used a hospitalization metric of <5/100K because case rates can become uncoupled from hospitalizations at higher vax rates)
So, what did the CDC do today? They released this MMWR article saying just that- decide on masking on vaccination rates + community transmission rates. Why? Because we aren't where we wanted to be with vax rates in US by this time & we have the delta. cdc.gov/mmwr/volumes/7…
In this critical time of delta circulating, we need clean data on 1) what % admitted to hospital are unvaccinated; 2) if vaccinated, is it breakthrough or asymptomatic with universal screening; 3) if vax'd, need CT of PCR test or some way to know viral load
This article explains concept of viral load and how to determine from PCR cycle threshold (if that is the test hospital is using); rapid antigen is another test using lateral flow assay washingtonpost.com/outlook/2021/0…
If delta higher viral loads explaining transmissibility, 1) Asymptomatic breakthrough, low viral load: You fought the virus, brought it down & vax success, can't spread 2) Symptomatic breakthrough: Need to know if viral load high enough to transmit 3) Severe breakthrough: Boost
Reason viral load (VL) becomes so important now is due to delta. So much more transmissible with those studies showing higher VLs. Those vax'd may get some in nose, will strengthen your immune response to fight it off so need to know if VL stays low washingtonpost.com/outlook/2021/0…
Then for a mild breakthrough infection after vax, is that when an antiviral like molnupiravir comes into play - best to stop viral replication early for mild disease (severe disease mediated by innate immunity which is why we use steroids)
And then severe disease of course prevented by vaccination which everyone very convinced of at this point with what we have seen from delta. So, working on getting vaccination rates up is of utmost importance as outlined well here @apoorva_nyc nytimes.com/2021/07/25/hea…