COVID Update: The marvels of science are slowly but surely taming this virus.

Vaccines are helping mute the effects of Omicron. And now Paxlovid, approved by FDA under EUA, ushers in a new era of the pandemic. Patience & caution still required. 1/
For almost everyone, vaccines make dying from COVID extremely unlikely. Delta increased the need for a booster. Omicron increases it further if you want to avoid even a mild infection.

But the main point is vaccinate the globe & the country & fewer will lose their lives. 2/
Still, in the US at least, this leaves 130 million people who aren’t vaccinated, the majority of whom are eligible.

This isn’t a failure of science. The vaccine is very well tolerated & production scales nicely. But it is a vulnerability nonetheless. 3/
The refusal of many to get themselves vaccinated falls directly on the backs of nurses, doctors & medical staff. And it puts people who can’t get vaccinated at some risk.

But increasingly, thanks to science, it is the unvaccinated who are most at risk of serious illness. 4/
Enter Paxlovid, which can be given orally 3-5 after infection, and reduces serious illness by 88%— and believed effective against Omicron.

This drug, and a class of even better ones which are sure to follow, will soon render COVID even less dangerous. 5/
The drug inhibits viral replication and has been approved for those at serious risk 12 and older.

The US has purchased 10 million treatments, but will begin with only 200k in January, with the full order delivered by September. 6/
The ramping of supply & the choices it creates begs a number of interesting & even ethical questions and not all the questions about the drug are answered. 7/
Why the low supply to begin with?

Two reasons. First while many factories can produce, it takes a while to ramp this type of chemistry. I’m no expert in this type of pill production but others who know more will I’m sure opine. 8/
Second, unlike vaccines, the anti-virals are being distributed much more equitably globally from the outset.

One could argue that those countries with the least amount of vaccine should be given the highest priority for Paxlovid. 9/
If this means the US needs to wait, given the abundance of vaccines in the US, that would seem appropriate from a life saving standpoint & just. Wealthy nations benefit as reducing replication also reduces chance for mutations to form. 10/
It raises the question of how to think about the use of the treatment in the US while volume builds.

Should the treatment be used disproportionately to protect unvaccinated people? Or does this reduce the likelihood of more vaccinations? 11/
Consider the numbers. 200,000 in all@of January is the amount of total cases we are currently experiencing in a day.

While this will improve dramatically throughout the year, it means the anti-viral isn’t for everyone who tests positive. So who is it for? 12/
But with 40,000 dying each month, if the right people are targeted 200,000 & growing can cut that number down meaningfully. 13/
First priority would be people with organ transplants or who are immunocompromised & to whom the vaccine don’t help very well.

Older people in assisted living & people with co-morbidities are also a priority. 14/
But unvaccinated people are dying at a rate 13x vaccinated people. Undoubtedly to save the most lives, the therapy would go disproportionately to unvaccinated people. 15/
Paxlovid and the drugs which follow are likely to change the course of how we think about COVID & what feels safe to do when they’re widely available.

In the meantime, the drug should reduce suffering & death as much as possible. 16/
Paxlovid will be distributed through states and from there presumably to local health departments, hospitals & pharmacies.

There will also be a direct allocation to community health centers. 17/
Adapting to a world of oral anti-virals will take time and also bring with it unanticipated issues & unforeseen consequences.

Will it’s effectiveness wane over time as some are concerned? Will new variants alter the effectiveness? 18/
This is what progress feels like. Slow to happen. Requiring more patience than we have. Incomplete. Raising ethical questions. Still leaving uncertainty.

All of that. Big don’t let those things get in the way of seeing this breakthrough as a giant step towards normal./end

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More from @ASlavitt

21 Dec
COVID Update: The good case for what’s happening with Omicron is getting signs of scientific support. 1/
What could be good about a new variant that blankets the population and has mutations that make it far easier to spread & harder for many vaccines to keep up with? 2/
Certainly it’s rapid spread will stress already stressed Hospital systems. That’s NOT good.

Very encouraging to see President Biden will announce today the military personnel & FEMA will be deployed to help. 3/
Read 21 tweets
18 Dec
COVID Update: A setback is a setback. And we’ve had 3 setbacks with vaccine testing this week.

But all of those setbacks remind me of how blessed we have been so far by science and the people who monitor safety.

One setback, announced yesterday, is the change of position from the CDC on Johnson & Johnson’s vaccine. 2/
J&J’s vaccine was flagged and pulled from the market temporarily in the Spring when reports of several blood clotting issues arose.

Many criticized the decision for causing doubt & disruption of vaccines at a critical moment after it was ultimately put back on the market. 3/
Read 23 tweets
16 Dec
COVID Update: Three groups of Americans will face Omicron in 3 very different ways.

Those who can
Those who can’t
And the biggest group— those who can but haven’t

17% of Americans have gotten boosted, a dangerously low number with a virus which doesn’t respect prior infection or those with 1 or 2 doses. 2/
23% of Americans either aren’t eligible for boosters (17%) or eligible for the vaccine (6%).

That’s 75 million Americans who are basically counting on the rest of us to stay safe through no choice of their own. 3/
Read 12 tweets
16 Dec
COVID Update: Omicron will peak in the US in the third wave in January according to a consensus of 10 scientists we interviewed. 1/
So far Omicron is doubling every 2-4 days, extraordinarily fast. People with prior infections or have been vaccinated but not boosted are right in the path of the spread.

This makes the spread 2-3x as fast as Delta. 2/
Even with a limited understanding of the severity of Omicron, it feels like this implies some concerning news and some better news (it’s all relative at this point😕). 3/
Read 21 tweets
13 Dec
COVID Update: Vaccine boosters appear to double the effectiveness of vaccines against Omicron.

But with only 14% of the country boosted, we should brace for a tough winter. 1/
Studies in the UK and SA are coming back with a consistent finding.

Prior Delta immunity is not preventing Omicron. Re infection rates are at least triple Delta.
2 Pfizer vaccines (presume same for Moderna) have a 30-40% efficacy against Omicron. 2/
Some good news. In both cases (prior immunity & 2 vaccines), studies are showing T cell response (our line of defense that prevents more severe illness in the lungs) continues to work against Omicron. 3/
Read 20 tweets
12 Dec
COVID Update: At a time when most scientists are concluding an additional mRNA vaccines is needed, a Republican senator wants to go the other direction.

His idea? Prior infection should count as immunity. 1/
Roger Marshall from Kansas thinks the country should officially recognize prior COVID infection as the equivalent of being vaccinated when considering a vaccine requirement.

He’s not alone but he’s wrong in so many ways. 2/
Roger also recently said this:

“The people that have thus far not gotten the vaccine are not going to do it until this White House acknowledges natural immunity.”

He’s calling for a sort of protest? Wut? 3/
Read 21 tweets

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