Covid vaccines are essential and have had a profoundly positive impact.
There's controversy as to whether boosters will be useful for age <60.
New data highlights significantly less protection vs symptomatic infections and, to a lesser extent, hospitalizations /1
Summary of the recent data for vaccine effectiveness vs symptomatic infections. At 2 months, this was well over 90% for mRNA vaccines, but by 4-6+ months has declined to between 44-70%.
All ages.
Data for Pfizer, Moderna, and AZ /2
The Qatar data were just published @NEJM

Here are the ICATT data (age <65), presented at the recent CDC ACIP meeting /3
These are the recent studies for mRNA vaccine effectiveness (VE) vs hospitalizations. In early months post-vaccination, >90% would be expected. The decline is much less than vs symptomatic infections and more pronounced in age 65+ /4
Whether symptomatic infections are important to suppress, the 1° endpoint of the 💉clinical trials, is now the crux of the debate. These can be pretty severe, at the brink of hospitalization, & pose a risk for #LongCovid. There's also a risk for them to transmit, but it's low /5
Concern on this last point, #LongCovid, and this decision… by @StephArmour1 @felschwartz w/ @PeterHotez commentary /6

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More from @EricTopol

1 Oct
This could turn out to be one of the most important advances to counter Covid. Molnupiravir, a pill for 5 days (I'll nickname "M-pack") to markedly reduce hospitalization. Await details beyond press release, including safety… by @matthewherper @statnews
Molnupiravir is a broad spectrum anti-viral that achieves "lethal mutagenesis" of #SARSCoV2. Unlike remdesivir, it's a pill, it's not repurposed, had solid data from a Phase 2 trial supporting potency + safety vs Covid… @nature The mechanism of action 👇
The fact that the new clinical trial was stopped by the Data and Safety Monitoring Board early because of overwhelming efficacy, deeming it unethical to proceed, would be considered a Eureka moment in the fight against Covid
Read 6 tweets
28 Sep
Why are symptomatic post-vaccination covid infections, without hospitalization (H), important?
—they can be severe, on the brink of H
—they can result in #LongCovid
—they can transmit to others
—they were the primary endpoint of the vaccine clinical trials for efficacy
Inconvenient truth #1
The waning of vaccine effectiveness vs symptomatic infections for both Pfizer and Moderna across all age 20+ groups, presented at @CDCgov Advisory meeting last week… Image
Inconvenient truth #2
Transmission among fully vaccinated health care workers, with some asymptomatic individuals with higher viral loads than those with symptoms…
(not common, but it can occur) Image
Read 4 tweets
25 Sep
The waning of Pfizer and Moderna vaccine protection vs *symptomatic infections* over time in all age groups, slide presented at ACIP @CDCgov meeting by Sara Oliver MD…
(this was the primary endpoint for the pivotal trials to approve these vaccines)
Red=Delta (Green=pre-Delta)
It's still early into the period of waning, w/ frequency of exposures increasing over time.
Recall the UK (and other countries) decision to provide 3rd shots irrespective of vaccine to all age 50+ is at odds with FDA/CDC (Pfizer only, age 65+)
Meanwhile we have left the people who got a J&J vaccine stranded with comparatively very low antibody levels 2-6 weeks after dosing, while we've learned such levels are tied to protection…
I think that's now ill-considered.
Read 4 tweets
22 Sep
New reports @NEJM today support higher vaccine effectiveness (VE) of Moderna over Pfizer, with both providing strong level of protection
1. vs Symptomatic infection in health care personnel
96.3 vs 88.8% (see Table for 95% CI, slight overlap)…
2. ~6-Month Follow-Up of Moderna pivotal trial…
VE 98.2% vs severe disease (here VE = vaccine efficacy, with a placebo control)
Difference between protection, VE for symptomatic infections during extended follow-up of Pfizer and Moderna
Pfizer data…
Read 4 tweets
22 Sep
New large dataset of US Medicare (age 65+) population subgroup: 2.7 million Pfizer; 2.9 million Moderna vaccinated, w/ ~30,000 breakthrough hospitalizations, via claims 🧵main findings
1. Definite waning of protection vs hospitalization for those 5-6 months out from vaccination (odd ratio 2.5X at 6 months)
2. No significant difference of waning for Pfizer vs Moderna for protection from breakthrough infections
Read 8 tweets
20 Sep
Delta can be daunting to contain.
The situation in Singapore with over 1,000 new cases today and yesterday, 80% of total population fully vaccinated, 1 of top 3 countries in the world, is an important indicator of the challenge.
Singapore’s booster campaign for people over the age of 60 began Tuesday, 14 September
The primary schools shifted to online…
Read 4 tweets

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