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1 Aug, 18 tweets, 6 min read
Let’s talk about Provincetown. There has been a lot of discussion about a recent COVID outbreak in Barnstable County, MA which is where P-town is located. Why all the excitement? And what does it mean for you?
1/
 cdc.gov/mmwr/volumes/7…
Provincetown was once a whaling port and Portuguese fishing town, but it morphed into a party mecca many years ago, and with mask mandates ended and everyone ready to party after a year of lockdown, I’m pretty sure this past 4th of July was a wild scene
2/
There was a COVID outbreak centered on Provincetown. About 3/4s of the Massachusetts population has been vaccinated. About 3/4s of the people testing positive (346/469) were fully vaccinate. 5 people were hospitalized, 4 of whom were fully vaccinated
3/
5 hospitalizations in 469 cases is about 1%. The US has had 35M reported cases of COVID-19 and 2.4M hospitalizations (about 7%), but in the 18-49 year old group likely to be partying in P town its only about 1%
cdc.gov/coronavirus/20…
4/
Taken at face value, these number say that in the Provincetown outbreak the vaccines didn’t provide significant protection against either infection or serious COVID-19 leading to hospitalization. That’s bad. What happened?
5/
One big issue is exposure dose. In animal studies, we know that inoculation dose alters the clinical course of disease. Ferrets given a low dose of SARS-CoV-2 shrug it off. Those given a high dose get sick and shed virus
6/
 nature.com/articles/s4146…
Being exposed in a crowded bar with lots of shouts and singing is pretty much the worst case for COVID-19 exposure risk. It’s likely that the Provincetown partiers got a high inoculation dose
7/
 cdc.gov/mmwr/volumes/6…
The Delta variant was also circulating and accounted for 90% of the cases. Delta is associated with high levels of viral shedding in both unvaccinated and vaccinated people.
8/
 medrxi.org/content/10.110…
The Delta variant also partially escapes vaccine induced antibody immunity
/9
biorxiv.org/content/10.110…
Another factor to consider, in January 2021, before vaccines were widely available, about 1 in 4 Americans were seropositive from previous SARS-CoV-2 infection. By July, it was higher. For those partiers who hadn’t been vaccinated maybe much a higher.
10/
 jamanetwork.com/journals/jaman…
What Provincetown may have shown is that immunity acquired through pervious infection and immunity acquired through vaccination are both about equally effective or ineffective against delta
11/
The apparent decrease in effectiveness of the vaccines in the Provincetown outbreak is likely due to multiple factors: high inoculation dose overwhelming immunity, partial immune escape of the Delta and comparison to a group that already had significant immunity
12/
Where do we go from here?
1) Get vaccinated
2) Don’t to crazy shit
3) Continue to mask up and use NPI measures
13/
Get vaccinated. They work. The UK has extensive data showing the vaccines are effective against the delta variant. These are remarkably safe and effective drugs. Use them!
14/
 nejm.org/doi/10.1056/NE…
Pandemics don’t end like flicking off a switch. It will be sporadic waves of infection that become less frequent and less severe. It’s already been more than a year. It likely will be at least another
15/
Continue to mask up and use NPI measures. Get good masks (N95/KN95/KF94/FFP3) to protect yourself as well as others. Learn how to be sure your mask fits. Avoid crowds and risky environments, especially crowded bars with poor ventilation
16/
Don’t do crazy shit. Even if you’ve been vaccinated, if you’re exposed to a really high dose of virus, it could make you sick even though you may be immune to lower dose exposures. Sorry, COVID parties are just a really bad idea
17/
But here’s the really complicated part, in the end, we probably do want to get out and get low level exposure to emerging variants to update and boost our immunity. That’s how we as a population learn to live with SARS-CoV-2
18/fin

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More from @statesdj

David States Profile picture
9 Jul
We’re thinking all wrong about the variants. The prevailing narrative is that each new variant comes to dominate because it’s more transmissible than previous variants. A better view may be that it’s immune escape driving viral diversity
1/
If it was just transmissibility, older viruses would continue to spread, even if somewhat more slowly, but that’s not what’s happening. Older variants are declining in absolute case count suggesting that there is competition between variants
2/
 ncbi.nlm.nih.gov/pmc/articles/P… Image
How can variants compete with each other? Immune escape. A variant that evades the immunity induced by a different variant can continue to spread while spread of the old variant is limited to only hosts who have not been infected or vaccinated
3/
Read 19 tweets
David States Profile picture
5 Jan
@trvrb @LongDesertTrain @CT_Bergstrom Perhaps influenza (or any endemic virus) isn’t a good model. It depends on availability of susceptible hosts. A highly transmissible variant in one season would deplete the pool of available hosts in the next so endemic pathogens stabilize at moderate levels of transmission 1/
@trvrb @LongDesertTrain @CT_Bergstrom OTOH SARS-CoV-2 is in a transient phase and has yet to become endemic. ~All naive humans are susceptible so the immediate selective pressure is to maximize transmissibility
2/
@trvrb @LongDesertTrain @CT_Bergstrom Once SARS-CoV-2 has become endemic, maybe it will tend toward lower transmissibility, but we’re not there yet. Globally aren’t we still well under 50% seropositive? But likely there are subpopulations approaching herd immunity levels of infection/immunity
3/
Read 6 tweets
David States Profile picture
10 Dec 20
Some push back on the notion that NIH spent hundreds of billions of dollars on basic research and therefore owns mRNA vaccine technology and has “march in” rights to dictate the use of pricing of this technology @RESachs @Dereklowe
1/
The fundamental contract underlying academic publication is that you publish your findings in return for recognition of priority, but once you have published others are free to use and build on your work. It’s practice established in the time of Newton and honored ever since
2/
No question mRNA vaccines draw on much basic molecular biology and would not have be possible without the work of Avery, MacLeod, Hershey, Chase, Nirenberg, Jacob & Monod, Sanger, Mullis, and many others. These scientists have received many well justified accolades and honors
3/
Read 11 tweets
David States Profile picture
3 Jun 20
Despite the catchy headline, the mandate of the CDC is far broader than pandemics, and the problems at the CDC precede COVID-19. But yes, the response to the COVID-19 pandemic was deeply flawed and systemic
1/
 nytimes.com/2020/06/03/us/…
Vaccination is a key public health responsibility, and the US does well on influenza vaccination of the elderly, but we are middle of the pack on childhood vaccination rates
2/
 data.oecd.org/healthcare/inf…
The Obesity Epidemic has been a disaster. Remember back when Surgeon General Luther Terry took on big tobacco and won? Big food not so much
3/
 thelancet.com/journals/lanpu…
Read 6 tweets
David States Profile picture
28 May 20
Let’s talk about Fall Semester. Colleges and universities have to make some big decisions soon
1/
And it won’t affect just students. For example, the University of Michigan #GoBlue has 46,000 students but it also has 25,000 faculty and staff. While students may be mostly young, many faculty and staff are in vulnerable age groups
2/
 cupahr.org/wp-content/upl…
There’s also real meaning to “university community”, schools are densely linked social networks with multiple paths linking students, e.g. classes. Eliminating large classes can reduce but not eliminate the potential for epidemic spread
3/
 osf.io/6kuet/
Read 18 tweets
David States Profile picture
21 May 20
Epidemiologists and economists say we need millions if not tens of millions of tests/day to convince people it's safe to re-open the economy, e.g. this Harvard study estimates we'll need 20 millions tests per day ethics.harvard.edu/Covid-Roadmap
1/
Nobel Laurette Paul Romer’s @paulmromer simulations say we need to test everyone in the US every two weeks, or about 25 million tests per day paulromer.net/covid-sim-part…
2/
The most sensitive and specific tests for COVID-19 use quantitative RTPCR. We have about 1,000 instruments each able to run about 1,000 RTPCR tests per day for a national capacity of about a million tests per day.
3/
Read 20 tweets

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