Thread by @gretchemaben

Let's learn about "Viruses, Variants, Vaccines, and Virulence: The Present and Future of COVID-19"!  #CHEST2021 1/

First up is Dr. Shazia Jamil (@MdShaziajamil) with "Alpha, Beta, Lambda, and Delta: The Epidemiology of COVID-19 Variants"! #CHEST2021 2/

Understanding the terminology #CHEST2021 3/

Evolution of COVID-19 genome sequencing #CHEST2021 4/

A genetic lineage is a family tree. #CHEST2021 5/

The Pango nomenclature system is a rule-based system for naming SARS-CoV-2 genetic lineages. #CHEST2021 6/

A genetic clade tracks how a virus bounces around various geographical regions. #CHEST2021 7/

GIASID is an initiative that promotes rapid sharing of data from viruses. #CHEST2021 18/

SARS-CoV-2 variants naming #CHEST2021 19/

The S protein has a fundamental role as a target for vaccine development, antibody-blocking therapy, and for small molecule inhibitors. #CHEST2021 20/

Evolutionary perspective of SARS-CoV-2 variants #CHEST2021 21/

The D614G mutation made the virus more infectious, but not more severe. #CHEST2021 22/

The alpha variant was identified in Great Britain in 9/2020. #CHEST2021 23/

The alpha variant is more transmissible and deadly. #CHEST2021 24/

The beta variant was detected in South Africa in 12/2020. #CHEST2021 25/

The beta variant is highly transmissible but not more severe or deadly. But it was more resistant to the vaccine. #CHEST2021 26/

The lamda variant was found in 12/2020 in Peru. #CHEST2021 27/

The delta variant is the predominant variant in the U.S. It was found in India in 10/2020. #CHEST2021 28/

The delta variant is very infectious and is more severe. #CHEST2021 29/

The delta plus variant has an additional mutation that leads to enhanced immune escape. #CHEST2021 30/

The best step to curb mutation is to minimize the spread - vaccinate, distancing, masks, etc. #CHEST2021 31/

Non-pharmacologic interventions to minimize COVID-19 spread. #CHEST2021 32/

Next up is Dr. Ryan Maves (@RMavesMd) with "Vulnerable Hosts Monoclonals and Vaccine Strategies"! #CHEST2021 33/

There are a number of factors that can make someone "high-risk." #CHEST2021 34/

The incidence of graft loss and adverse renal and cardiac events in transplant patients is higher in patients who had COVID-19. #CHEST2021 35/

Patients with stem cell transplants have a much worse mortality rate when they had COVID-19. #CHEST2021 36/

The vaccines lead to a dramatic decrease in mortality! #CHEST2021 37/

Vaccine efficacy has been decreasing since the emergence of the Delta variant. #CHEST2021 38/

That said, there is still sustained high protection against hospitalization in most groups, although there is a significant reduction in protection in clinically vulnerable groups. Some of this declining efficacy is due to time and some due to the delta variant. #CHEST2021 39/

Strategies for prevention include nonpharmacologic measures (like masking/social distancing, crowd avoidance), plus vaccine adjustments and monoclonal antibodies. #CHEST2021 40/

A 3-dose primary vaccine series is used in high-risk populations because this study showed that solid-organ transplant recipients had a decreased rate of seroconversion after a 2 dose series. #CHEST2021 41/

In this study they showed improved seroconversion with a 3rd dose in solid organ transplant recipients. #CHEST2021 42/

This RCT found that a 3rd dose increased COVID protection in solid organ transplant recipients. #CHEST2021 43/

Boosters address waning serologic response. Controversies include equity and limited data. #CHEST2021 44/

You need to give vaccine boosters to a ton of young people to prevent a hospitalization, but that number goes down in older people. There may be an additional benefit of limiting spread, though. #CHEST2021 45/

Current booster recommendations #CHEST2021 46/

Early data suggest that monoclonal antibodies decrease the risk of hospitalization in high risk patients with mild to moderate disease. #CHEST2021 47/

Who should be offered monoclonal antibodies? #CHEST2021 48/

So where are we now with monoclonal antibodies?  #CHEST2021 49/

Summary - What are we doing today? #CHEST2021 50/50