Yes, Colin Powell died of a breakthrough infection. That is why boosters are recommended for people at high risk for severe COVID-19.

Yes, that means vaccines aren’t 100% effective.

No, that doesn’t mean that vaccines are 0% effective.
Every death from COVID is a preventable tragedy. As long as prevalence is high, even some vaccinated people will be infected & a small percentage of those will become very sick. An even smaller percentage will die. But the vast majority of deaths are in the unvaccinated.
So get vaccinated AND wear masks AND try to limit exposure to people outside your household AND rapid test if you can get them AND try to improve indoor air quality AND use caution.

But don’t think this means vaccines don’t work. They work very well, just not perfectly.
Get vaccinated. It’s still the single most important and effective thing you can do to reduce your risk of dying from COVID or giving COVID to someone you love.

Vaccines work.
And also please see this wonderful thread on the topic.

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More from @angie_rasmussen

14 Oct
This has now happened a second time: an Ebola outbreak has occurred due to transmission from a persistently infected person of a virus that has barely changed in years.

This hints at an unknown and completely novel persistence mechanism for an RNA virus.
virological.org/t/oct-2021-evd…
This Ebola virus diverges from the most closely related genome by only 6 nucleotides. That virus was sampled from a deceased EVD patient in July 2019, meaning that in over 2 years, this virus has barely changed.

Which is really, really weird.
RNA viruses famously have a very high mutation rate, The RNA-dependent RNA polymerase (RdRp) that copies the viral genome can't proofread & correct "typos" during replication. Thus, you can count the typos—mutations—as a measure of evolutionary time if you know the mutation rate.
Read 10 tweets
24 Sep
Much respect for Dr. Gilbert but I don’t agree with this. Viruses don’t always become attenuated (less virulent). When they do, it’s because there is an evolutionary selection pressure driving it. No such pressure exists for SARS-CoV-2.
An example of this type of selection pressure would be a virus that is so virulent, it kills its host before it can be transmitted to another one.

A virus is essentially a machine programmed to make more viruses. To do that, it needs to be spread to new hosts.
So variants that are so virulent they kill a host before that host can pass it along, that is under negative selection pressure. The more virulent viruses won’t be passed on. But attenuated variants will. They are under positive selection.
Read 8 tweets
21 Sep
Fellow J&J recipients: big press release out on impact of boosters. While the confidence intervals are huge, there’s evidence that boosting with a 2nd shot (of J&J) increases effectiveness.

jnj.com/johnson-johnso…
We need to see the full dataset but hopefully when it’s examined in detail, it will support a recommendation for those who got J&J to get a second shot. All the data (for any COVID vaccine) suggests there’s substantial benefit to boosting.
And I’m not sure where we are at with J&J supply, but last I saw, there wasn’t a lot. ACIP/FDA should consider recommending heterologous (mix and match) boosting with a mRNA vaccine. There’s data with AstraZeneca + mRNA that supports the safety of this approach.
Read 4 tweets
17 Sep
Yesterday my spouse said that we need to be both extra careful and hopeful. We can’t get in a car accident or appendicitis or anything that would require hospital care. There’s simply no capacity because of COVID.

I wish this had happened earlier but better late than never.
On July 11, all restrictions were lifted. I mostly go to work or run essential errands. I always wear a mask despite being fully vaccinated. We’ve gone out for dinner or drinks a handful of times and sat outside each time. Yet everywhere (except work) the scene is the same.
The majority of people are unmasked. Last Friday I picked up a bottle of wine. I was the only masked person in the long TGIF line at the liquor store. Distancing was not observed at all. A person in front of me merrily told another customer she was stocking up for a party.
Read 6 tweets
2 Sep
My excellent colleague @akelvinlab has this right: we will have more variants as long as SARS-CoV-2 continues to replicate.

Also worth pointing out that we don't know much yet about C.1.2, but we do know that it's not "mutating faster." That wouldn't even necessarily be bad.
C.1.2 is an emergent lineage of variants, meaning it's actually a cluster of several different variants. Here's the preprint describing it, by @CathrineSch07 and colleagues:
medrxiv.org/content/10.110…
Misinterpretation of panel C in the above figure led to 🚨MUTATES TWICE AS FAST 🚨 insanity a few days ago. That's wrong.

The amino acid substitution rate (new mutations that result in a change in a protein) is on par with other emerging variants.
Read 19 tweets

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