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Michael Lin, PhD-MD 🧬 Profile picture
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21 Oct, 4 tweets, 2 min read
Um yeah
You mean high yield like this? Heard a few public health people quoted saying it wasn't necessary or that it would be harmful.
Probably an unrepresentative minority, but they seem to get a lot of airtime.
nejm.org/doi/full/10.10…
But actually it was masks the OP was complaining about: "there is a time and place for them".

Right, like now?
Don't understand why the WaPo (an organization I highly respect) keeps on publishing the same opinion piece by Joseph Allen every month. Or is it every week?

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Michael Lin, PhD-MD 🧬 Profile picture
21 Oct
Okay since everyone is asking about which booster to get, I decided to think about it quantitatively and arrived at some general conclusions.

1. If you're J&J or Pfizer, boost with Pfizer or Moderna (the 50mcg booster dose)
2. If Moderna, boost with any depending on your risk...
This supercedes anything I might have said earlier. Reasoning is as follows.

The NIH mix & match booster study tested all combinations in a neutralizing antibody assay where a level of 100 IU50/mL correlates with 91% protection pre-Delta

Preprint link
medrxiv.org/content/10.110…
If you're going to boost, seems might as well try to get to 90% protection again. We adjust for Delta requiring 4x higher antibodies to neutralize (consistent finding across many vaccines, some may remember). That makes 400 IU50/mL, the blue line below
Read 15 tweets
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
18 Oct
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
Read 5 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

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