A thread well worth reading on the new variant:

Highlights:

Omicron does not originate from Delta but ancestor from mid 2020

Maybe accumulated mutations for >1 yr before detection (perhaps) or accelerated development in immune compromised individual that couldn’t clear it

1/
The constellation of mutations suggest it is likely more immune evasive…

(but how much more is difficult to say - particularly with Vax plus the large number of exposures to Delta over the past 6+ months, our immune systems may be getting sufficiently trained)

2/
Many of the mutations that are accumulated have been seen among variants that have a more difficult time being neutralized by our immune response. And among variants that are more infectious.

More data is needed to confirm the latter.

3/
A lot of people are asking if the mutations will render it undetectable to tests.

A majority of the mutations are in Spike protein. Both rapid tests and PCR tests generally detect one or more different proteins. So tests (rapid and PCR) should all still work!

4/
That said, there is an S gene dropout for some of the PCR tests. This is a silver lining that makes it easier to detect. If you see two genes positive and S negative on PCR, then good chance it’s Omicron today.

5/

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More from @michaelmina_lab

27 Nov
🧵 Why some vaccines stop transmission & others don’t:

Vaccines that stop transmission are often against viruses that replicate internally first and only then transmit (like measles). So if the vaccine stops internal replication, it stops transmission.

For COVID vaccines…

1/
For vax against upper respiratory viruses like SARS2, these viruses often don’t require “internal” replication. They just land in the nose, replicate locally & transmit on. So the vax can block “internal” replication and thus stop disease separate from stopping transmission

2/
The immune response in the upper respiratory tract is somewhat distinct from response in lungs, blood, lymph, etc.

Most vaccines create a multitude of layers of protection that can block a pathogen in lungs, blood, lymph, without offering the same in the nose/mouth/throat

3/
Read 5 tweets
27 Nov
On Omicron spread:

Vaccines keep ppl out of hospital - their most important attribute

However, vax’d can be infected & transmit. Yes, vax slow spread but by no means does vax mean you can’t be infected & spread

This is critical to acknowledge as we try to limit Omicron spread
If public health officials fail to appreciate & acknowledge clearly that vaccinated can in fact acquire and spread the virus and that this is not rare, I fear ppl will continue to believe they can’t spread if they are vax’d and do less to limit spread of Omicron where it exists.
I am 100% for vaccination. I just want public health to be transparent about what vaccines do well and don’t do well so ppl are fully informed.

For too long messaging said transmission among vax was rare. This then caused confusion and loss in confidence in the vaccines.
Read 4 tweets
24 Nov
🧵 When the goal is limiting transmission, timing of tests is everything

If you wait days for positive results before isolating, the time spent waiting must be factored in to the “effectiveness sensitivity” of a test.

Time is always ignored as a test metric. This is wrong

1/
If people are infectious for 6 days and you have to wait 2 days for results, then for every 3 positive people detected, you miss the equivalent of an entire infection Bc the sensitivity while waiting is 0%.

This means the “effective sensitivity” cannot break 67%. But worse…

2/
What’s particularly bad but also ignored is the **0% sensitivity** while awaiting a lab PCR result is for everyone - even people who are at absolute peak virus titers and immediate isolation is most important. For these people, rapid tests detect >95% - with immediate action

3/
Read 6 tweets
24 Nov
This is honestly some of the most idiotic messaging I’ve seen this entire pandemic.

Come on Ireland - seriously?

Surely, You can do better.
Have rapid tests ready at home

If wake up symptomatic, use a rapid test. If pos, you have COVID. Done

If neg and think you may have COVID, check again later that day with a rapid test, or go get a PCR.

But if you have symptoms w COVID, rapid tests will detect vast majority
What is Fianna Fáil?
Read 4 tweets
21 Nov
🧵 I want to comment on what I was referring to👇

When we say “pandemic of the unvaccinated”, it is stigmatizing & inaccurate - this is a pandemic of a virus that is disproportionately afflicting unvaccinated

I urge us to consider root causes of why so many are unvaccinated

1/
I have spent many years speaking w vaccine hesitant ppl and not once have I found someone choosing to not vaccinate out of spite

It is nearly always out of a combination of love and fear and confusion about who to trust.

In this pandemic, we have lost the trust of many…

2/
The US has bungled the response to this virus in nearly every way pre-vax.

There have been many times when the public health decisions have had to be walked back. “We” have made many mistakes.

Yet we assume that everyone should auto-trust public health decisions

3/
Read 9 tweets
20 Nov
🧵 When ppl give anecdotes about public health efforts not working - please proceed cautiously

It is rare that public health success makes headlines or goes viral Bc success in public health almost always represents the absence of anything interesting.

Bias is tough to spot

1/
Imagine for example if a vax failure in a single person was the only times vaccines made headlines. We’d think they didn’t work. But this is why we have trials - to ensure that we put any Vax failures into proper perspective and measure rates of success vs failure

2/
The same goes for anecdotes around tests, for example:

The White House Rose Garden outbreak made headlines and made everyone think that tests don’t work.

What was not discussed were the hundreds of WH events w no outbreaks owing exclusively in that WH to testing.

3/
Read 4 tweets

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