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Michael Lin, PhD-MD 🧬 Profile picture
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18 Oct, 5 tweets, 2 min read
Yes and that's why saying the only important goal of vaccines is to prevent hospitalizations and deaths is counterproductive. That protection isn't 100%, so you need the reduction in transmission (herd-ish immunity) that protection from cases provides, and the higher the better
Just like everything else in this pandemic, we need all the help we can get. Trying to turn away some good things like case protection to "simplify" the message just complicates it, because then you end up twisting facts into logical pretzels

Much simpler: everything helps. See?
Which means I agree with this
But not this. R0>5 for Delta means R0=1 with 80% vaccination only if VE = 100% against transmission, and it's not. VE against cases is only ~85%, if boosted, on average.

You need 100% vaccination to take off the masks, especially indoors in the winter

Funny that those two posts just happened to be at the top of my timeline, one after the other

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Michael Lin, PhD-MD 🧬 Profile picture
19 Oct
Turns out there were 2 studies last week comparing J&J + J&J booster to J&J + Pfizer booster! One was NIH, as most know. The other is from Singapore and it looks like a solid study too.

Most interesting: they looked at T cells too, not just antibodies!

medrxiv.org/content/10.110…
We see again that J&J+Pfizer gave higher antibody levels and neutralizing activity than J&J+J&J, and similar to Pfizer+Pfizer. Note wide range of interdose intervals (43-71d for J&J+J&J, 11-180d for J&J+Pfizer) but Ab levels actually quite tight.
While antibodies are the first line of defense and what block you getting infected, it's essential to have T cells for avoiding late complicatinos. It's widely proposed that the Ad vaccine of J&J may elicit more T cells.
Read 13 tweets
Michael Lin, PhD-MD 🧬 Profile picture
19 Oct
🎉🎇🙂 Wonderful news! @US_FDA will allow mix & match boosters!

As the linked article below says, booster freedom helps local health officials. And it's also the right thing scientifically, especially for #JnJers

This is the happiest I've ever felt from a FDA decision!
I had some hope FDA might do this, after Dr. Marks' said in Friday's VRBPAC meeting that they'd like to know what info was needed to approve mixed boosters, and some VRBPAC members replied that the "Mix and Match Booster Trial" results were clear enough

nytimes.com/2021/10/16/us/…
I'd learned from repeated lack of action not to hope too much. Gathering info on the benefits of heterologous boosts for #JnJers and seeing it tossed aside for various nonreasons made me feel like Sisyphus rolling a stone

So this news is like Sisyphus finally cresting the hill
Read 24 tweets
Michael Lin, PhD-MD 🧬 Profile picture
13 Oct
Finally the study we've all been waiting for on mix&match boosters.

Results: J&J starts at 6-15x lower antibodies than Pfizer/Moderna. It's boosted 56x by Moderna, 5x by another J&J.

Clearly Moderna is the better booster for #JnJers

All as predicted

medrxiv.org/content/10.110…
Note J&J starting at 6x lower abs than Pfizer and then boosted 5x by a 2nd J&J dose means J&J x2 gets you to where Pfizer "fully immunized" people were to begin with. That pretty much proves what many of us have been saying: J&J should have gone for a 2-dose vax to begin with.
Also a J&J booster is also not as effective in raising antibodies for Pfizer and Moderna recipients as a Moderna booster.
Read 41 tweets
Michael Lin, PhD-MD 🧬 Profile picture
7 Oct
This Lancet study has Pfizer VE vs Delta infections trending to ≤50% at 6 mo. VE drop seems to accelerate between 3 and 6 mo

Thus shouldn't wait beyond 6mo past your last shot to get boosted if you or household members are at risk

thelancet.com/journals/lance…
Earlier wasn't clear if VE decay was linear, exponential, or sigmoidal. Now it's looking sigmoidal.

The Israel data also looked sigmoidal but many worried about sampling bias (not sure if MOH ever shared if VE was calculated vs matched demographics)

The earlier Oxford study didn't go past 3 mo, so we didn't get a good idea of what might happen at 6 mo. Error bars widened in both directions so it looked pretty straight in the 0-3mo time window.

Read 8 tweets
Michael Lin, PhD-MD 🧬 Profile picture
4 Oct
Did @nytimes just bury the scoop?

"A study by NIH suggests that Moderna’s vaccine works better as a booster than a second shot of J&J."

This appears to be the first mention of results from the NIH J&J+Moderna trial that Fauci said just finished.

nytimes.com/2021/10/04/us/…
Another interesting mention: if boosters for J&J are authorized only after 6mo, J&J can continue to market the vaccine as 1-shot.

Not sure where that policy came from (maybe related to some guidance regarding vaccine durability for EUA application?)
But I've been wondering what the proper "statute of limitations" is for vaccines. That is, how long until you don't have to consider which other vaccines you are getting for that antigen?
Read 4 tweets
Michael Lin, PhD-MD 🧬 Profile picture
4 Oct
Gottlieb on CDC:
"Couldn't mount the logistical response we needed"
"It just wasn't in the capacity or ethos"
"Backward looking mindset"
"Uncomfortable surfacing information that's partially predictive"
"Uses their own bespoke datasets"
Listen from 1:00

finance.yahoo.com/video/wsj-opin…
I usually take a pass on anything labelled WSJ editorial, but this discussion avoids politics and is just about how to better respond to new pandemics.
Essentially Gottlieb confirms my impression of CDC: a plodding nontransparent organization that prefers to tabulate their own data over more abundant information in the public sphere, and doesn't have the will or ability to rapidly formulate preventive policy
Read 7 tweets

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