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Eric Topol Profile picture
@EricTopol
Jan 18, 2022 • 6 tweets • 3 min read • Read on X
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New data mRNA vaccine 4th dose
timesofisrael.com/israeli-trial-…
—HCW, 154 Pfizer, 120 Moderna, + control group
—Increase in antibodies > 3rd dose
—Little effect on Omicron cases
—No data yet for ? severe disease, memory B/T cells, higher or more durable protection
—Uncertain benefit/need
Last week @UKHSA published their new data on Omicron and 2 dose vs 3 dose vaccine effectiveness (VE) vs infections assets.publishing.service.gov.uk/government/upl…
In people w/o prior Covid, the booster approximately doubled VE, the 62% isn't bad (point estimate)
But
It falls off pretty fast, this vs Omicron (and Delta) symptomatic infections. So an important unresolved question is whether the 4th dose helps prevents this attrition of VE over time vs symptomatic infection and severe disease
Israel has given a 4th dose to well over 500,000 people (of 9 M population)
abcnews.go.com/International/…
Testing is aggressive (>8X US/capita) but this graph of their Omicron wave isn't encouraging vs infections with 3rd booster rate 54% (US 24%), 2-shot vaxx 64% (US 62%)
Last point, which I cannot emphasize enough:
3rd shot protection vs Omicron hospitalizations, severe disease, death is remarkably high, about as well preserved as 2 shots vs ancestral strain, and a very different look compared with VE vs infections
assets.publishing.service.gov.uk/government/upl…
Further highlighting this dichotomy in Israel
Impact of cases vs impact on severe disease/hospital or ICU admits/death
ourworldindata.org/covid-metrics-…

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More from @EricTopol

Eric Topol Profile picture
Nov 13
New @NEJM
A whopping (~90%) reduction of progression to Type 2 diabetes with tirzepatide (GLP-1 drug, dual receptor) vs placebo in a randomized trial of >2,500 participants with obesity, absolute reduction of 10/100 treated

by @AniaJastreboff and collaboratorsnejm.org/doi/full/10.10…Image
In other GLP-1 new publications today
—Country-wide Sweden reduced hospitalizations for alcohol or substance abuse with these drugs
jamanetwork.com/journals/jamap… @JAMAPsych
—Concerns about discontinuation
jamanetwork.com/journals/jama/… @JAMA_current Image
Other new anti-obesity drugs in the pipeline, one that also increases energy expenditure
@NatureNV nature.com/articles/d4158…Image
Read 4 tweets
Eric Topol Profile picture
Nov 13
A dedicated issue of @ScienceTM on #LongCovid
—Sex-specific differences, with perspective by @VirusesImmunity and @SilvaJ_C
—Insights for therapies @AndreaCoxMDPhD
—Deconvoluting "Osler's Web" @MichaelPelusoMD @DeeksSteven @DrMaureenHanson @SaydahSharon
—+RECOVER Trial, Lyme diseaseImage
Image
Image
science.org/toc/stm/16/773
Where we have failed to date: finding an effective therapy. That has to change
science.org/doi/epdf/10.11…Image
Read 4 tweets
Eric Topol Profile picture
Oct 19
An elegant @Nature study by @AkassoglouLab has illuminated our understanding of the role of fibrin (component of blood clots), #SARSCoV2, and brain inflammation in Covid and #LongCovid.
This discovery and more in the new Ground Truths podcast, with transcript, key figures (such as as the one below) and citations. Open-access. Link in my profile.Image
Image
A clip from our conversation. Unknowingly, @AkassoglouLab was gearing up for understanding this complex pathophysiology for many years before Covid hit
For treatment, it's not just as simple as preventing fibrin clots. It's isolating the pro-inflammatory action of fibrin, targeted by the antibody
Read 4 tweets
Eric Topol Profile picture
Oct 9
Covid and increased risk of major adverse cardiovascular events (MACE) 3-years out

2-fold increased for any severity of Covid
~4-fold increase for Covid requiring hospitalization
"a coronary artery disease equivalent"
interaction with non-O blood types
@uk_biobankahajournals.org/doi/10.1161/AT…Image
"A major finding from our analyses was that the risk
of MACE among the subset of hospitalized COVID-
19 cases without known CVD (ie, primary prevention
patients) was comparable to (or even slightly higher than) the risk in patients with CVD, PAD, or diabetes but without COVID-19."
"one of the first examples of a gene-pathogen exposure interaction for thrombotic events"
I think it's the first one documented, likely others to be unraveled
Read 4 tweets
Eric Topol Profile picture
Aug 2
New US Covid genomic surveillance
The KP.3.1.1 variant is on the move to become dominant, more of a challenge to our immune response than KP.3 and prior variants (especially without new KP.2 booster when we need it for high-risk individuals) Image
It's the deletion 31/31 that makes the KP.3.1.1 spike different, but otherwise 2 mutations away from KP.2 (R346T and Q493E) Image
Buckle up; this wave isn't over yet d/t KP.3.1.1's emergence
Read 4 tweets
Eric Topol Profile picture
Jul 21
The new boosters (vs. KP.2) should be available the first week of September. It takes ~90 days make them from the FDA decision on June.

But it didn't have to be that way.......1/5nbcnews.com/health/health-…
We've known about KP.3's marked growth advantage since April and could have made the call then to make the new booster. That would have been aligned well with the current wave (available in July) 2/5 erictopol.substack.com/p/are-we-flirt…
Image
But the FDA has tried to force fit Covid into an annual shot like flu, even though all data tells us it doesn't follow an annual pattern. Even the CDC acknowledges this now
3/5cdc.gov/ncird/whats-ne…
Read 5 tweets

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