For those asking when this is going to end:

Once >6 mo kids can get vaxxed, then only those with weaker immunity need boosters on occasion. <6mo old would count on lower prevalence to reduce risk

What we could really use: greek alphabet soup vaccines

nytimes.com/2021/08/18/hea…
For #JnJers, working on bringing some attention to the issue
Record-number of eye-rolling comments in this article: nytimes.com/2021/08/18/hea…

“Feeling sick like a dog and laid up in bed, but not in the hospital with severe Covid, is not a good enough reason,” Dr. Gounder said.
How about protecting your unvaccinated kids or your elderly (yes even vaccinated) parent this winter? Would that be good enough? Not everybody has selfish reasons here.
Dr. Hanage: “A third shot will add to skepticism among people yet to receive one dose that the vaccines help them.”

100% wrong. Public health officials revising recommendations shows they adapt to the situation, which engenders confidence that policy is up to date.
Just amazing that some people still insist that vaccines must be spoken of as perfect, even if it means completely changing their definition of perfect along the way. If you stick to argument by shifting your reasons and definitions, it is you who loses credibility.
Not sure if anybody noticed the own-goal: 'But not all immunocompromised persons will respond to an additional dose of vaccine,” Dr. Gounder noted. To protect these vulnerable individuals, everyone around them should be vaccinated and should continue to wear masks, she added.'
Let's see... immunocompromised may still not mount a great response to the booster (although studies show some do, definitely a net gain). So those around them need to be vaccinated! But didn't she just say the vaccinated should be okay with getting sick (and contagious)?
"We never meant unsinkable to mean it wouldn't sink. The ship still has efficacy as a habitat for sea creatures, so it does what we expected it to do eventually."
"If we now boost the number of lifeboats on the Olympic, it might add to skepticism among the people who have never been on a ship before. Better to say everything has been working as designed. After all Titanic did keep people dry more than halfway across."
I'm clearly not getting a job in public health after this
Okay this analogy has legs

"Our unsinkable guidance was based on evidence of Titanic floating and lack of evidence otherwise. New science we have today suggests that on occasion this design can sink. But we shouldn't add lifeboats to Olympic as it may add to hesitancy to sail."

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More from @michaelzlin

15 Sep
1) The news has been reporting on this "expert" editorial opposing boosters.

Just read it. Shocked that anyone would use pre-Delta studies to argue against boosters now.

Plus blatant data destruction that I'll try to explain.

A complete Lancet fail.

thelancet.com/journals/lance…
2) The editorial takes the form of a metaanalysis of vaccine efficacy, but it's the worst statistical malpractice I've ever seen. Fortunately it's short (one figure of 4 panels), so hopefully we can get through it quickly and point out the major issues.
Panel A: What is this??? Studies are grouped by efficacy ranges of 50-80, 80-90, and 90-100 for disease, then their average efficacy for all disease and severe disease are plotted. Why??? I'll try to be polite but I'm upset by this. It's an insult to human intelligence.
Read 19 tweets
10 Sep
And there you go

New CDC stuy shows best estimate of J&J efficacy vs Delta hospitalization is 60%

This is worse than 80% for Pfizer and 95% for Moderna

cdc.gov/mmwr/volumes/7… Image
And before anyone complains the CIs are overlapping, that's a sophomoric complaint. Remember that's the 95% CI, and 95% is an arbitrary bar. Also there are other data that show J&J's lower effectiveness on hospitalization, such as below (pre-Delta)

Or the finding that J&J is only 71% effective vs hospitalization due to Delta, from South Africa

Read 15 tweets
8 Sep
The South African trial has finally revealed something about J&J effectiveness against Delta disease, and it is "about half".

No precise #, just a response to an interview question

Low protection and lack of clarity by trial organizers not surprising

bloomberg.com/news/articles/…
You may recall on August 6 the SA trial announced 71% effectiveness against Delta hospitalization, but didn't say anything about effectiveness against disease, which is the default metric and the one used if you are gonig to report only one number.
Some surmised that effectiveness against Delta disease must be very unimpressive, or else it would have been reported alongside the hospitalization numbers on 8/6 (which were already unimpressive).

This has been proven correct.
Read 15 tweets
31 Aug
🧵We discussed how mucosal antibodies function to block SARSCoV2 infection. A study on this just posted from my Stanford colleague Michal Tal and UToronto collaborator Jennifer Gommerman.

Interesting: RNA and J&J make Abs in saliva, but neutralizing levels only detected with RNA
2) First, as a reminder, the role of mucosal antibodies (thought mostly to be IgA, but we'll revisit that in a moment) is to block viruses, once they land on your mucous membranes, from entering your cells.
3) Second, here's the link to Dr. Tal's paper. Let's begin...
medrxiv.org/content/10.110…
Read 15 tweets
30 Aug
1) There was an ACIP meeting today, but nothing newsworthy happened. CDC briefing materials (as posted at cdc.gov/vaccines/acip/…) are limiting the ability of ACIP to independently and intelligently assess data.
2) Most concerning, CDC continues to withhold J&J data by omitting it entirely or lumping it together with the 10x larger Pfizer+Moderna data so it becomes a rounding error. No wonder ACIP is not able to make any recommendations specifically for J&J
cdc.gov/vaccines/acip/…
3) But the data exist, and is becoming increasingly in plain sight, showing higher case and hospitalization rates for J&J than for Pfizer and Moderna in the real world against Delta
Read 4 tweets
29 Aug
In a recent thread I posited that mechanisms of antibody production, viral resistance, and somatic hypermutation can explain why pre-Delta vaccines block most Delta infections but not peak virus levels once infected, yet still limit late disease.

Here I present the explanation…
Most neutralization of SARSCoV2 infection is performed by antibodies against the spike (S) protein, and the vaccines used in the US include only S and no other parts of SARSCoV2, so we'll concentrate on S as the antigen, i.e. the protein targeted by antibodies or T cell receptors
Your body has millions to billions of resting/naive B cells, each with an unique surface-bound antibody or immunoglobulin (Ig), just waiting to find their match to foreign particles. You also have T cells with unique T cell receptors (TCRs)
ncbi.nlm.nih.gov/pmc/articles/P…
Read 27 tweets

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