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Dr Satoshi Akima Profile picture
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28 Nov, 12 tweets, 6 min read
It takes 3 shots to be fully vaxxed. If you’re double vaxxed, you’re only partially vaxxed. The EU won’t even let you in
If it takes 3 shots to be fully vaxxed, then Australia is only 1.6% fully vaxxed. We've already been overtaken by Canada, who announced their 3rd shot later. To avoid future lockdowns, we've got to get to +50% by winter. Table by @covidbaseau covidbaseau.com/vaccinations/ Image
The evidence is clear. If we get everyone triple jabbed by winter, we have an excellent chance of averting lockdown. Follow the Israeli example. DO IT NOW!—don't start after we end up in another lockdown crisis
The effect of the 2nd shot starts to wane 2-3 months afterwards. But you really only start to see a surge in breakthrough cases after around 6 months. This data is for the Moderna vaccine, but you can see the sudden jump in case after June nejm.org/doi/full/10.10… Image
Once the 3rd shot goes in, immunity levels are not just restored but go above where they were after the second shot. This is true for all vaccines, whether Pfizer, Moderna, or AstraZeneca. This is why we should only give vaxx passports to the triple-vaxxed Image
The good news is that the 3rd shot wanes more slowly than the 2nd and might last 9-10 months. By the time we are due for a 4th shot, we should have variant-specific boosters ready. Pfizer and Moderna are working on Omicron-specific updates now timesofisrael.com/pfizer-booster…
Terminology: you can call the 2nd/3rd/4th shots “boosters” if you want. You can see waning after the 1st shot, especially with a 10-week gap between 1st & 2nd shots. But vaxx passports should only be granted to those who've had 3 shots Image
To get everyone fully vaxxed with 3 shots, we need to open up access to the 3rd shot after 3-4 months. As with Hep B shots, a 2-shot regime is suboptimal—both for the developed and developing world
No sooner had I spoken, the UK (notoriously conservative though they are) has approved access to the third dose after 3 months. This effectively renders it a 3 shot vaccine similar to Hepatitis B. Other countries can be expected to rapidly follow suit
And again, the CDC in the US has followed suit in opening access to 3rd shots in all adults—however only after 6 months. Expect this to be brought forwards both in the US as elsewhere to fall in line with the UK position cdc.gov/media/releases…
There we go, it's not just me. Others are straight out saying the same thing.
I may have spoken too early. I assumed that the 4th shot will be an Omicron-specific booster, but if it is delayed, we may be forced to #Gigavaxx by boosting with a fourth shot beforehand to mitigate any drop in efficacy vs. Omicron Image

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More from @ToshiAkima

Dr Satoshi Akima Profile picture
29 Nov
There’s a lot of #Hopium being shared over #Omicron saying that because info is incomplete that therefore “it’s just a mild cold”, “viruses always become more harmless over time”, “let’s all get infected”. But we know more than many admit
Once again, alarm signals about increased transmissibility (in Delta this mean higher viral loads and increased hospitalisation rates). Lack of perfect evidence of harm is hardly grounds for Faith in #Omicron being the Saviour attenuated live viral vaccine some claim it is
Omicron already exhibits mutations that were predicted to increase infectivity through enhanced binding to ACE2. There are *NO* known genetic features predictive of it turning into a cuddly live attenuated viral vaccine against COVID (the virology equivalent of Santa)
Read 8 tweets
Dr Satoshi Akima Profile picture
20 Nov
Unsolicited Review: Castle Grade N98 respirator. This gets a recommendation from me. TGA approved making it suitable for HCWs. It is comfortable and reusable. Ideal for Australian HCWs who suffer PPE burns from N95 masks, while upgrading aerosol protection castlegrade.com.au
Initial concerns included that I am not fit-tested by work, but as soon as you put it on you can tell there is reduced air leakage around the mask edges vs. a fit-tested N95. That means ZERO fogging of glasses. The tight seal pushes the air through the front of the respiratory
The acid test is whether I'd wear it working on COVID duties despite not being fit-tested. The answer is YES. There is obvious reduction in air leakage around the mask edges. It would be difficult for work to object to me wearing a TGA approved N98 respiratory instead of an N95
Read 16 tweets
Dr Satoshi Akima Profile picture
20 Nov
Another cycling day today. 50km done wearing a KF94 mask all throughout the ride (only removed to drink water). The trick to avoiding having it fog up your glasses is to push it as high on the bridge of your nose as possible.
During my work N95 fit testing, I was instructed to push the N95 mask as high up as possible. A KF94 is smaller so it causes it to sit above your chin, but this encourages exhaled air to be expelled from the bottom—not the top, fogging up the glasses
I was also instructed to carefully mould the nose bridge wire so that it fits the contour of your face. It's best to do this in front of a mirror. This further improves the fit, reducing leaks of air upwards, fogging up your glasses.
Read 6 tweets
Dr Satoshi Akima Profile picture
19 Nov
The answer is that it doesn't matter. Masks, social distancing and lockdowns are NPIs not drugs. It's enough signal that everyone gets masked and the burden of proof is on those who want to demask to provide level 1 evidence it won't cause excess mortality/morbidity.
The burden of proof to come up with evidence to substantiate their position falls on those who propose the potentially unsafe course of action. With novel drugs, that falls on the prescriber/manufacturer of the drug. With NPIs it is the de-prescriber of precautionary measures
There is no level 1a+++ evidence for the efficacy of lockdowns, handwashing, or social distancing for COVID. That is not grounds for de-prescription of these precautionary NPIs. The burden of proof falls on those who wish to de-prescribe them to prove it won't increase mortality
Read 6 tweets
Dr Satoshi Akima Profile picture
19 Nov
If Australians wish to avoid further disruptive lockdowns, we must find alternative NPIs to take their place. The evidence is clear: universal mask mandates are the best solution. They probably work even better than lockdowns or social distancing while keeping the economy running
The only reason to reject masks is that we love lockdowns. That's what's going to happen if we don't find a better alternative. Now we know #COVIDisAirborne we can use this insight to find more mode-of-transmission specific NPIs other than crude lockdowns
Anyone who rejects masks is an agent of chaos who secretly wishes more lockdowns upon us for the purpose of stirring social unrest, then harnessing it for their crazed populist cause. Gallows and all Image
Read 6 tweets
Dr Satoshi Akima Profile picture
18 Nov
Masks are 2x more effective than social distancing according to a new BMJ systematic review. This isn't the first systematic review to come to such conclusions. That it is mechanistically plausible based on COVID's airborne mode of spread makes it highly credible #COVIDisAirborne
From a Cochrane review dated 6th Jul 2011: "Surgical masks or N95 respirators were the most consistent and comprehensive supportive measures. There was limited evidence that social distancing was effective" cochranelibrary.com/cdsr/doi/10.10…
The information found in that 2011 Cochrane review formed a springboard for the South Koreans to develop aerosol-mitigation based systematic biosecurity defence protocols that are the envy of the world
Read 5 tweets

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