Tuesday COVID meeting updates this week (been holding these ever since the onset of the pandemic)

#1

In a series of 70 consecutive COVID deaths reported at a large Kerala hospital, 69 were unvaccinated, one had received 1 dose vaccine.

That was 98.6% unvaccinated, May-Sept

1/
This data is powerful evidence that vaccination has made a significant reduction in the severe outcomes of delta.

Remember, these are vaccines based on the old Wuhan strain of the SARS-CoV-2 virus.

Yet they are protective against delta variant.

This is hard evidence.

2/
This is real-world evidence that vaccine protection (against severe disease, mainly cell mediated immunity) kicks in with the first dose itself.

In fact we know from lab studies that T cells arrive by day 10 after the first dose.

Let me explain the immunology.

3/
After the initial “excitement” (introduction of components of virus by vaccination), a few of these T cells retire and become memory cells that live in the tissues and elsewhere.

Retirement also occurs in B cells (antibody factory), where a few live ~forever as memory cells.

4/
These memory cells of B & T cell genre sniff out the earliest presence of the virus if & when an infection occurs. They make sure that a strong, systematic, prompt response is mounted.

That is how organ damage is prevented. It doesn’t matter what variant it is, see the data.

5/
Many people panic when they hear words like “neutralising titer drops by 40 fold” etc. That is why we must look at the big picture.

Let’s not forget the same “drop of neutralising titre” was the worry of the world ever since delta arrived.

6/
We doctors are carefully monitoring the situation to look for any changes in trends.

So far there is no cause for any alarm with vaccines failing.

(Asymptomatic breakthrough infections are expected within a few months after vaccine, that is not the same as severe disease)

7/
Will post other updates later.

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More from @RajeevJayadevan

9 Dec
Immunology simplified

A map of our immune response to viral infection shared by @papaphone2002

I have added (in red) the role of the much-discussed neutralising antibody, thread👇

Our immunity team has so many more players, who cannot be fooled by the virus.

Here’s why

1/5
Please note the diagram only presents an outline, not the whole thing.

Neutralising antibodies form only a tiny fraction of our TOTAL antibody response. Most antibodies are produced AFTER the attack occurs, helping eliminate virus.

(Labs measure Ab’s ALREADY in circulation)

2/
In other words, neutralising antibodies aren’t everything.

And, importantly, a “loss of neutralisation” (‼️🔴alarmist language that lab researchers love to use while describing their work to a clueless public) doesn’t mean “we have lost against the virus”.

3/
Read 15 tweets
8 Dec
Discussed a few aspects of vaccination among children in India with @snehamordani @IndiaToday
Link to 24 minute video of the panel discussion 👇

Read 4 tweets
8 Dec
The Denmark puzzle

Two months ago, 74.4% population were fully vaccinated. Cases were on a low baseline. Denmark “removed all restrictions” on September 10.

A big wave took off in early November.

Omicron was detected recently.

1/5
A high % vaccination coverage does not stop waves. The pandemic has a cyclical pattern. The sooner we acknowledge that, the more realistic our approach will be. Vaccination will help reduce risk of severe disease & death by a big margin, and also lower the risk of infection.

2/
In any country there will be large numbers of people who are not previously exposed to virus or vaccine. They will be more represented in future waves, along with some reinfections and breakthrough infections.

Reinfections are almost invariably mild or asymptomatic.

3/
Read 6 tweets
8 Dec
The big picture on Omicron

Early studies now out comparing Omicron and Delta.

One liner: All is not lost; hybrid immunity performs the best.

This work is from @sigallab Sweden where they checked neutralisation of omicron VS delta VS old virus using serum from 34 people

1/16
They find what is already known: that people respond differently to the infection.

That is, there is substantial variation in the profile of immune response between individuals.

Which means: we can’t generalise for one person. That is one thing we need to understand.

2/
This graph shows all 34 people’s neutralising values

In plain English it means how did each of their serum (sera) did against: 1. Old virus
2. Delta
3. Omicron

The y axis is pseudovirus neutralisation titer. Higher value means the sample is effective at higher dilution.

3/
Read 14 tweets
7 Dec
Theoretical prediction of the effect omicron mutations on monoclonal antibodies by @jbloom_lab

Authors believe that this combination of mutations located on the RBD could potentially reduce the effect of monoclonal antibodies targeting that area of the virus.

See thread👇

1/5
This study is based on the apparent individual & additive effect of mutations based on a computer model of the RBD.

They did a computational method called “deep mutational scanning” which is used to study multiple mutations at once.

It is however not a biophysical model.

2/
Authors conclude

“Sites 484, 446 & 417 are the biggest drivers of this antigenic change, although other mutations also contribute. Mutations at sites 346, 378, 444 & 504 could make it worse”

3/
Read 6 tweets
6 Dec
Why a more transmissible variant can cause more deaths than a more lethal (but less transmissible) variant.

Short thread👇

1/4
Transmissibility and immune escape are different. The first is the ability to enter cells.

The latter refers to the ability of the virus to infect someone who had prior infection or vaccine-induced immunity.

The combination of the two traits does not work in our favour.

2/
Broadly speaking, Alpha was more transmissible, beta had immune escape, delta had both. We are awaiting the true picture of omicron.

This new research shows how a transmissible virus is dangerous, more so when it also has immune evasive capability.

3/4

sciencedaily.com/releases/2021/…
Read 4 tweets

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