1/ How can the SARS-CoV-2 virus evolve?

- To become more transmissible (e.g. the Alpha & Delta variants)
- To evade immune responses (e.g. the Beta & Gamma variants)
- To become more virulent

nytimes.com/2021/10/12/hea…
2/ There are limits on how infectious a virus can become. But have we reached that limit with SARS-CoV-2? We don't know.
3/ The SARS-CoV-2 virus can also evolve to escape our immune responses.

Fortunately, we are protected by multiple branches of our immune system.
4/ After vaccination, breakthrough infections may serve as immunity boosters, teaching our immune systems to recognize the shifting, mutating virus.
5/ HYBRID immunity (vaccination followed by infection) may be our best immunity against the SARS-CoV-2 virus.

That said, I DO NOT RECOMMEND intentionally exposing yourself to SARS-CoV-2 infection after vaccination. At least not yet. We need more data.

science.org/doi/10.1126/sc…

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Keep Current with Céline Gounder, MD, ScM, FIDSA

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More from @celinegounder

13 Oct
1/ PRE-PRINT results on NIH's mix & match COVID vaccines study:

medrxiv.org/content/10.110…

2/
Matched (same) vaccine:
⬆️neutralizing antibody levels 4-20x

Mixed (different) vaccine:
⬆️neutralizing antibody levels 6-76x
3/ Best boosts?

Based on neutralizing antibody titers at day 15 after boost:

After Moderna:
Moderna > Pfizer > J&J

After J&J:
Moderna > Pfizer >>> J&J

After Pfizer:
Moderna > Pfizer > J&J ImageImage
Read 8 tweets
11 Oct
1/ Study of ~9M people in NYS
medrxiv.org/content/10.110…

May: NYS adopted CDC guidance for fully-vaxxed
June: end of NYS’ state of emergency (⬇️mask-wearing, distancing etc)
July: CDC recommended mask usage for fully-vaxxed based on transmission levels
July: Delta became dominant
2/ COVID vaccine effectiveness vs HOSPITALIZATION:

Among 18-49 year-olds:

Pfizer/Moderna: >90%
* except June with 87% for Moderna

J&J: >90%
* except June with 54%

* related to behavior? (see #1)
3/ COVID vaccine effectiveness vs HOSPITALIZATION:

Among 50-64 year-olds:
Pfizer/Moderna: >90%
J&J: 87-93%

STABLE OVER TIME.
Read 8 tweets
11 Oct
2/ WE NEED THE SERENITY TO ACCEPT THE THINGS WE CANNOT CHANGE:

COVID is here to stay.
SARS-CoV-2 cannot be eliminated.
The virus will become endemic (i.e. ongoing community transmission).
3/ ...THE COURAGE TO CHANGE THE THINGS WE CAN:

Maximize use of testing, ventilation, & air filtration.
Tailor based on individual risk.
Masks in some settings.
Support caregivers.
Paid sick leave.
Better treatment/care for long COVID patients as well as disability benefits.
Read 5 tweets
9 Oct
1/ Black pastors are preaching God's word & public health.
They're working to save the souls & lives of their flock.

nytimes.com/2021/10/09/nyr… Image
2/ Only 55% of Black New Yorkers have received at least one vaccine dose.

Black & Brown people have good reason to doubt the government & health system:
justhumanproductions.org/podcasts/s1e68…
3/ Vaccination rates are even lower among young Black New Yorkers:
Only 48% between 18 and 44 have gotten at least one dose of COVID vaccine

And only 30% of Black Americans under 40 attend a Black church.
Read 4 tweets
9 Oct
1/ Facebook whistleblower @FrancesHaugen joined @WSJPodcasts in Part 6 of the Facebook Files:
wsj.com/podcasts/the-j…
2/ Some highlights:

at 8:30

Vaccine disinformation is being targeted at these groups, too:

justhumanproductions.org/podcasts/s1e72…

justhumanproductions.org/podcasts/s1e74… Image
3/ at 10:50

Top 10 Facebook threats to democracy AND public health:

hate speech
misinformation
harassment
impersonation
voter suppression Image
Read 7 tweets
8 Oct
1/ New @NEJM paper from Qatar on Pfizer vaccine effectiveness vs SARS-CoV-2 infection, severe COVID, or death from COVID.

nejm.org/doi/full/10.10…
2/ The study population included Qatar *residents*.

Note that 90% of people in Qatar are economic migrants from South Asia and other countries.

🤔
3/ Vaccine effectiveness vs INFECTION:
- Peaks at 78% ~1 month after 2nd dose of Pfizer vaccine
- Declines over time
Read 10 tweets

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