Nice interplay of threads from experts on a key question: what will the future of COVID bring? Nobody knows for sure, but @trvrb and @WhitneyEpi discuss some key factors on the viral and human/societal sides, respectively. Both 🧵's worth a read in full, but my tl;drs follow. 1/5
2/5 1st, @trvrb says:
- SARS-CoV-2 is here to stay
- more contagious at baseline than flu = prob larger annual infection footprint
- key unknowns that'll affect impact: rates of waning immunity & antigenic drift; severity of post-immunity infections (IFR)

3/5 @WhitneyEpi adds that human behaviors matter too for annual impact:
- will we modify behavior, esp during surges? how? how much?
- will we test? how much? in Sx or aSx?
- will we improve ventilation?
- will we boost vaccines? how often?

4/5 (I'm a bit more optimistic abt both waning immunity & severity of post-immune infections, once "full immunity" is established; & fairly pessimistic abt our appetite for societal mitigation going forward in the US - but I trust their insights more than mine on these points.)
5/5 One other perspective I'd add, as an ID doc: I'm concerned for implications of ongoing spread in the immunocompromised. Problem for flu, too, but I worry severity may be worse w/ COVID (maybe b/c of less lifetime exposure? all hunches). Need robust ppx (mAb's?) & Rx (orals?).

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More from @roby_bhatt

14 Oct
Long overdue 🧵 on a COVID study we preprinted last year, now out in JID. Co-led by @nialljlennon @gabriel_stacey @eric_lander, enabled by @BroadGenomics & @MassDPH

Key finding: shed viral load is independent of symptoms at time of testing (pre-vax)…

Back in Apr 2020, COVID overwhelmed our hospital in MA (I was on service & will never forget).

It also swept thru nursing homes, so @MassDPH tested ALL residents+staff of SNFs for COVID (back when tests were rare: big job w help from MA Nat'l Guard).
B/c of @broadinstitute's remarkable early scale-up of testing, >70% of these (>30,000 over 2+ mo) were run @BroadGenomics. @nialljlennon & @gabriel_stacey recognized an opportunity to study viral loads on their standardized platform; @MassDPH had queried symptoms (yes/no).
Read 17 tweets
1 Oct
Eyre et al (…) is a tour-de-force. Bravo!
- traced 150k contacts from 100k cases (! - NHS👏🏽)
- Pfizer vax'd index cases had ~5x (Alpha) or 3x (Delta) lower odds of spreading (this is beyond protection by preventing the index case to begin with)
🧵 1/6
- this despite similar cycle thresholds (Ct) in vax'd vs unvax'd index Delta cases, as others have shown
- Pfizer vax'd contacts had 16x (Alpha) or 10x (Delta) lower odds of being infected
- Ct is not infectivity
- Ct is not infectivity
- Ct is not infectivity
- #VaccinesWork
- they also saw waning, c/w other studies (incl imo the best studies, the post-hoc crossover analyses of mRNA RCTs). Here, they found 1.2x increased odds of transmission "for each doubling of weeks since 14 days after 2nd vax in index cases" (?), & 1.4x increase in contacts.
Read 11 tweets
29 Dec 20
At the risk of shouting into the void, 🧵 on papers from 2020 that most changed how I think abt COVID, as an ID physician-scientist. 280-char summaries + URLs for each. Thx to all authors & apologies for any omissions; this list is unofficial, personal, idiosyncratic, & LONG. 1/
2/ Early summary of 72,314 (hospitalized) cases from Chinese CDC, broken down by mild vs severe vs critical, early hint at CFR (overestimated b/c mild cases undersampled), & sharply age-dependent mortality. Also, risk to HCWs. Fig 1 (epidemic curve) key.…
3/ Another inpt obs cohort study from China 🙏🏽. Fig 2 shows prognostic biomarkers (lymphs, D-dimer, IL-6 – not CRP, despite my false memory). Watched (helplessly) a lot of these rise in worsening patients. Still wonder why we ordered so many, so often.…
Read 38 tweets
6 Aug 20
NEJM editorial argues that low sensitivity tests are problematic…

If the alternative is a perfect test, sure. But tests are still too scarce. We need more & faster tests; can sacrifice Se w/ clear communication

@michaelmina_lab @DanLarremore @RWalensky 🧵
From the editorial: "A big concern has been test availability, but test accuracy may prove a larger long-term problem."

I disagree w this framing: the two features are in direct tension. If we hold out for "perfectly" sensitive tests, we resign ourselves to less testing.
Great modeling studies from folks I tagged shows frequency/TAT are MUCH more impt than sensitivity:……

Even w/o repeat tests, even one 70% Se test catches far more than no test at all. (& those it misses probably shed less virus)
Read 9 tweets

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