What the early omicron data means: get boosted.

"BNT162b2+infection" are people infected in 1st wave, then Pfizer-vaxxed (2 shots). They have better neutralization of omicron than only Pfizer-vaxxed .

A RNA boost 6mo after your last shot bumps Ab levels by 10x. You may need it.
Some details: The 100x higher antibody levels of the infected+Pfizer vs Pfizer here is somewhat artifactual. The vax-only are ony 12 days post-vax. That's well before peak antibody response at 3-8 wks post-vax. OTOH the infection+vax are 27 days post-vax, so near peak protection.
Previous studies saw only a 2–10x difference in Ab levels between infection+vax and vax. So the 100x difference here is likely from the vax-only being sampled before their response is mature.
thelancet.com/journals/lanmi…
Anyway, omicron requires 40x higher antibody levels for neutralization compared to original strain (today's result). By comparison, Delta required 4x more.
Boosting is able to give you 2x more antibodies than needed to protect 90% against Delta disease. As omicron requires 10x higher titres to get the same protection as Delta, that means it won't be possible for current vax+boost to provide 90% protection against omicron.
Still, the more Abs the better the protection vs omicron. Boosters also likely bring in additional naive B and T cells to serve as memory cells for an omicron challenge. So boosters, so long derided in the media as not necessary, turn out to be very useful indeed.
Here's a nice study comparing 2xPfizer ("fully vaccinated") to 3xPfizer ("boosted") to infection+2xPfizer. In panel A are nAb titers. Gray is vs Delta, red Omicron.

3xPfizer as good as infection+2xPfizer.

No need to travel back in time to get infected before your vaccine now.

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More from @michaelzlin

7 Dec
First results of mAb testing on omicron: looks good for sotrovimab. GSK and Vir say no loss of activity v compared to previous strains reuters.com/business/healt…
Sotrovimab reduces deaths and hospitalizations by 79%. It requires just one 30min IV infusion. It's a very good drug. It's been approved in the US since May. The craziest thing in this crazy epidemic? UK's MHRA only approved it 4 days ago. bmj.com/content/375/bm…
That's AFTER it approved molnupiravir, which is only 30% effective (and there's some skepticism about that), needs to be taken over 5 days, and creates mutated virus, and whose interim trial results were only reported in October, final results in late November.
Read 11 tweets
2 Dec
I've been getting 2 questions a lot:
1. If I'm J&J and I boost with Moderna/Pfizer, do I need a 2nd dose of Moderna/Pfizer?
2. If I'm J&J and I boosted with Moderna/Pfizer once, when should I boost again?
Answers:
1. Congrats, you've chosen wisely to boost your J&J with Moderna or Pfizer. After 1 shot of either, you'll have more antibodies than people after 2x Moderna or 2x Pfizer
2. After you've boosted your J&J with Moderna or Pfizer, you're good for at least 6 months (vs Delta)
Now the evidence. We all remember the NIH-sponsored heterologous boost study that measured antibody levels in people who got each of the 3 vaccines in the US, boosted by a single dose of any of the 3 vaccine types (9 combinations).

pubmed.ncbi.nlm.nih.gov/34671773/
Read 28 tweets
26 Nov
B.1.1.529 (nu) is bad news. It has an unusually high number of mutations.

And my (and Haseltine's) stated concern about molnupiravir accelerating evolution of SARSCoV2 is being discussed now.

The former makes me even more concerned about the latter.

Merck claims there isn't a higher rate of viral mutations in molnupiravir clinical trial participants. But (1) this logically contradicts its stated mechanism of action and (2) we need to see the data to know the confidence level of this statement
edition.cnn.com/2021/11/23/hea… Image
Specifically, how could molnupiravir (Lagevrio) work by causing mutations in SARSCoV2, but when Merck sequences virus from patients taking molnupiravir they see no higher rate of mutations. Is the drug working or not?
sciencedirect.com/science/articl…
Read 65 tweets
24 Nov
I'd like to wrap up tweeting about vaccine boosters, because I prefer to provide scientific analysis in on controversial or misunderstood issues, not to repeat what's already known.

And now it's clear that boosters were/are needed and were/are useful.

A mini-thread
There were disparate reasons for anti-booster arguments, making for an odd hodgepodge of forces denying booster efficacy or need across the political spectrum. These included:

1. Denial of booster need/efficacy in the US to signal dediction to health outside the US (sadly...
...in the way it was communicated, some similarities to the playing it down by the former guy)

2. Reluctance by certain political or media favorites (not using the E word here) to be the bearer of inconvenient news, or to change a position formulated before Delta
Read 19 tweets
23 Nov
Speaking of motivated reasoning, last clause in pink box is a scientifically dubious interpretation.

Sisonke2 is a trial to give Sisonke1 participants (single-dosed J&J) another J&J dose as booster.
Gets worse after you click through. Really, no safety support? Trial organizers would actually withhold medical treatment if you have issues? I'm sure that's not what they meant, as it would be extremely unethical. So why use threatening words that imply it? Image
It's in reality a bit of a nonissue for safety, as there is *more* data in support of the safety of a Pfizer boost for J&J than of a J&J boost for J&J. So bringing it up is not scientifically valid either, and it seems to brought up only as a way to scare people away from Pfizer.
Read 4 tweets
23 Nov
One could say the ability to adapt one's beliefs in response to new evidence is 1 of 2 essential characteristics of a scientific mindset. The other one is the ability to use theory to formulate new hypotheses.
arstechnica.com/science/2021/1…
If you then think experts should have a scientific mindset (and I'd suggest you should, or you'd just have someone who's only right when they're lucky, and wrong other times), then you'd want your experts to change their position when presented with evidence that contradicts it.
Interestingly using theory to back a hypothesis and adapting beliefs to data are in tension: if you hold on to an incomplete/outdated theory too strongly, you can fail to accept new data. This is indeed a major contributing factor to scientific debate.
Read 6 tweets

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