Vaccines prevent deaths.

Audit of 281 COVID-19 deaths in Ernakulam showed that 98.2% of the deaths occurred among those who had not been (fully) vaccinated. i.e. only 1.8% of deaths were fully vaccinated.

@RajeevJayadevan Quoted in The Hindu today.

thehindu.com/news/cities/Ko…
🔺All deaths among the fully vaccinated, occurred in people older than 60.

The current vaccination coverage in adults is 68% (1 dose) & 24% (2 doses)

We can say the % of fully vaccinated is 24%, yet deaths in that category was only 1.8% - that is 92.5% lower than expected.

2/
These figures from death audits aren’t enough to calculate vaccine effectiveness.

But when we compare with current vaccination coverage, we get an idea of how much lower the deaths are among the fully vaccinated.

1.8% (observed rate) is 92.5% lower than 24% (expected rate*)

3/
*To explain the math, let’s imagine the vaccine has zero effect (i.e. same as water).

In that case, (theoretically) out of every 100 deaths, 24 would have had full vaccination. (Because that’s the current vaccination coverage in adults)

4/
But when we looked at 100 actual deaths, we found that the % of fully vaccinated was only 1.8%, and not 24%.

The more effective vaccine is, the lower that % would be.

e.g. A mildly effective vaccine might turn up a death % of 12%. We got as low as 1.8%, which is very good.

5/
Note: by definition, this is not “effectiveness”, but it gives an idea.

Similar observations are also regularly reported by individual doctors from across the region.

In summary, it is good to get data on the ground that vaccines are preventing severe disease & deaths.

6/6

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More from @RajeevJayadevan

17 Sep
Past infection did not provide additional protection from breakthrough infections.

ICMR study on 614 healthcare workers, half of whom each got covishield & covaxin.

Breakthrough infection rate was 13% in those with & without past infection.

1/6

assets.researchsquare.com/files/rs-88876… Image
Breakthrough infection rate is not provided for type of vaccine. Only overall number is given (13%, 81/614)

Antibody levels are seen to drop with time as expected.

Peak antibody levels are lower & the decline faster for covaxin, but this does not imply lower protection.

2/
The reason why a lower antibody level does not mean lower protection is that there are multiple components in the immune system that provide protection. Not all of them are measurable.

Besides, the study does not provide data that lower antibody level led to more infections.

3/
Read 7 tweets
16 Sep
Multiple issues with the widely quoted NEJM Israel study on boosters

Long thread👇

1. Authors report a lofty reduction in infections & severe cases by a factor of 11.3 & 19.5 in the primary analysis, where rates are compared between boosted & non boosted groups.

But ...

1/
2. In secondary analysis, this factor is down to 5.4. Secondary analysis compares rates within the SAME group, by timeframe. This is more believable not only because comparison is within the same group, but also because we know higher antibody levels reduce infection rates.

2/
Note: secondary analysis is available ONLY for infections, not severe cases.

In other words, we do not yet know if this 5.4-fold reduction in ‘infection’ will translate to reduction in hospitalisation/death later.

3. No mention of number of people who were hospitalised.

3/
Read 12 tweets
13 Sep
Detailed graphical representation of the story of the US elementary school teacher who infected 12 of her masked students by reading aloud without mask.

Lessons:

1. Multiple factors have to be in place to prevent outbreaks

2. Aerosol spread infects people both near & far

1/ Image
3. Masks did not protect the children from getting infected.

4. The teacher was unvaccinated, and had attended social gatherings.

5. She developed mild “allergy” symptoms which she chose to ignore (this could happen to anyone: wisdom is easier in hindsight)

2/ Image
6. Children in the next classroom also got infected, showing how far aerosols can travel

7. This also shows physical spacing is of limited value (think cigarette smoke in a room, spacing doesn’t change how the smoke spreads or smells)

3/
Read 6 tweets
28 Aug
Natural infection provides greater protection than (Pfizer) vaccination

Large study from Israel compared 3 groups of people

1. Past infection
2. Pfizer-vaccinated individuals
3. Those who had both

Please see WHOLE thread👇

1/
Large cohort of 673,676 vaccinated, 62883 past infection, & 42,099 vacc + past infection. The groups were matched to exclude confounding.

They looked at remote & recent past infection separately. Those who were infected in 2021 had greater protection than 1 year ago.

2/
The vaccinated group had a 27-fold greater risk of SYMPTOMATIC breakthrough infection compared to natural infection. The risk was 13-fold for ALL breakthrough infections.

A single dose of vaccine further increased the level of protection for those who had past infection.

3/
Read 14 tweets
18 Aug
The reason why children are easily able to get rid of the SARS-CoV-2 virus is due to a super-efficient innate immune system in their airways, as was hypothesised earlier (not from ‘less ACE2 receptors’).

Innate immunity is our “rapid response unit”.

1/4

nature.com/articles/s4158…
Innate immunity refers to those defence mechanisms that are the “first responders”- even before an exact ID of the attacker is known.

Adults respond less efficiently.

As a result, there is an imbalance between the various departments of our immune system, which isn’t good.

2/
SARS-CoV-2 virus is super-replicating, and turns off our innate immunity early (interferons are part of this) to aid the “stealth factor”.

It is harder to do so in children - who have a hyper-alert system that outperforms adults in the 1st 4 days of infection, authors find.

3/
Read 4 tweets
18 Aug
Enhanced spread of Delta variant might not be due to “immune escape”, but rather from more efficient cell-entry mechanisms & improved replication (processing of spike protein).

P681R mutation could be the key.

Research from University of Texas.

1/4

biorxiv.org/content/10.110…
Researchers tested out a “Frankenstein” delta variant fitted with an alpha spike, and found that this hybrid virus was even less efficient than the alpha itself.

P681 mutation enhances the S1-S2 furin cleavage process. This improves entry into the cell.

2/
P681R also helps during processing of spike protein within the cell.

Both these factors effectively mean that the virus can not only enter, but also multiply efficiently.

This translates to enormous numbers of viruses found early during infection, and thus greater spread.

3/
Read 4 tweets

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