No one seems to know what BA.2 means for the world. I'm not aware of any studies on it, but I hope they come out soon. It seems apparent BA.2 will become dominant everywhere before long—as it already has in Denmark.

🧵 of graphs comparing BA.1 & BA.2 in various countries
1/16
Of all the countries with decent genetic surveillance, Denmark has the highest proportion of BA.2. 2/16
According to the Outbreak numbers compiled using @GISAID data, January 12 was when BA.2 surpassed 50% of all cases in Denmark, with 480/955 cases. 3/16
A similar conclusion was reached by @JosetteSchoenma, who's assiduously tracked BA.2 prevalence in Denmark (and elsewhere) and was pointing out its significance before anyone else. 4/16
The fact that Denmark has the highest level of Covid cases per 100,000 of any country in the world and the highest percentage of BA.2 of any country with decent sequencing data is probably not a coincidence. 5/16
The UK BA.2 numbers are far lower than in Denmark at the moment but are clearly on an exponentially increasing trajectory. It's only a matter of time before BA.2 becomes dominant there. 6/16
According to @OliasDave, BA.2 is doubling every 4 days (as a percentage of all cases) in the UK, meaning it could become dominant there in about three weeks. 7/16
Genetic surveillance outside of Denmark & the UK is far less comprehensive. The graphs therefore noisier & the trends less consistent. Still exponential increase in the proportion of BA.2 seems universal. Sweden and Norway are in the 10-15% range & exhibit similar trends. 8/16
Belgium and the Netherlands are both around 5% BA.2 with exponential increases underway. 9/16
Germany's data is pretty sparse after January 7, but there are hints of an early exponential increase in BA.2 there. 10/16
Finally, there have only been 47 sequences of BA.2 detected in the US, 17 of them in Arizona. But there can hardly be any doubt we'll see large increases in BA.2 prevalence throughout the US in the coming weeks. 11/16
Some have claimed that BA.2 is no different than BA.1 and nothing to worry about. It could turn out that way, but it seems far from certain. BA.2 has 70 mutations significantly more than the 53 of BA.1. 12/16
BA.1 and BA.2 share a set of mutations, but their mutations differ a great deal as well, both spike and non-spike. outbreak.info/compare-lineag… 13/16
One Denmark report said there was "no evidence" of increased severity from BA.2. This may turn out to be right, but it reminds me of the early declarations that there was "no evidence" Alpha or Delta were more severe. Evidence takes time to accumulate. 14/16
We can hope BA.2 won't seriously change things for the worse, but to assume it is nothing to worry about seems extremely unwise. Similar assumptions have not worked out well for us in this pandemic.

Interesting tidbit from @bicidiario here. 15/16
See this great thread by @PeacockFlu for more info on BA.2. 16/16

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More from @LongDesertTrain

Jan 9
1/6 Important new study from Japan finds that with Omicron, infectious viral loads peak 3-6 days after symptom onset/diagnosis.

So many people are ending isolation & returning to work & school at peak infectiousness. Thanks, @CDCgov.

h/t @gianlucac1
niid.go.jp/niid/en/2019-n…
2/6 They looked at 21 cases: 19 vaxxed, 2 unvaxxed, 17 symptomatic, 4 asymptomatic. For the symptomatic, viral loads (by PCR Ct value) were much higher on days 3-6 after symptom onset than days -1 to 2. Furthermore, many samples still had high viral loads on days 7-9.
3/6 This is very different than what we'd seen with previous variants. Studies by @LucaFerrettiEvo, @DiseaseEcology, & others showed that peak infectiousness previously occurred the day before symptom onset & fell fairly rapidly thereafter. medrxiv.org/content/10.110…
Read 8 tweets
Jan 9
Hard to believe Walensky said this out loud—apparently intentionally.

I'm pretty sure if Trump had said this, all the major media would've been in an uproar for days or weeks—and rightfully so. Why is this not a major story? Has she apologized?
I thought this was a joke tweet, but I followed the link, and there it is, on page 5 of the CDC's 152-page list of "Conditions contributing to deaths involving COVID-19" through Dec 5, 2020: bird fancier's lung.
Reminder that there are people out there who have 4+ comorbidities entirely because they had Covid & never got better. If Omicron kills one of them, what fraction of a "healthy death" is their life worth?

50%?
25%?
10%?

Someone needs to ask Walensky.
Read 4 tweets
Jan 8
1/6 One remarkable but overlooked aspect of this already incredible case of long-range airborne transmission is that the index case was *asymptomatic* through the entire period. He had zero symptoms yet infected 3 people living in an entirely separate room across a hotel hallway.
2/6 ICYMI, this happened in a quarantine facility in New Zealand where cameras, genetic sequencing, frequent testing, & a controlled environment make the direction of transmission indisputable. Definitely worth reading the whole paper (it's not too long).
3/6 I still see Covid denialist claptrap claiming asymptomatic & presymptomatic transmission doesn't happen. This was partly fueled by an extremely flawed 2020 meta-analysis that somehow passed peer review & was published in JAMA. Breakdown below:
Read 8 tweets
Jan 2
1/ Monica Gandhi is living proof that, if you tell people what they want to hear, you will never lack for an audience, nor will you ever run out of major media outlets eager to disseminate your tripe—even if you've been embarrassingly wrong again and again and again.
2/ Gandhi has been minimizing the continuing threat of Covid and campaigning against mitigations and testing for many months now. She literally used the phrase "Delta variant, delta shmariant," at the end of an interview in late June. slate.com/technology/202…
3/ In the same interview, Gandhi's determination to purvey hopium, no matter the facts, led her to make the following remarkable—and false—statement about HIV. "I knew something else from HIV, which is that a virus can't keep on mutating forever."
Read 14 tweets
Jan 1
NYC Mayor Eric Adams, just before he pushed into a crowd of out-of-towners raucously celebrating the New Year: “It’s just great when New York shows the entire country how we come back." (1/5)
"Mayor-elect Eric Adams promised that New York City would soon lead the nation by example." (2/5)
Kindergarten teacher Jennifer Gaitan, while celebrating in Times Square: “In 2020 & 2021 we all had these high expectations, now we have to let come what may... It was my moral imperative to be here."

"Moral imperative"

Meanwhile... (3/5)
Read 5 tweets
Dec 30, 2021
1/7 Very important thread from an Indiana pulmonary/critical care doctor. Your choice to gather in large groups to celebrate New Year's Eve could mean someone else's death. If that sounds like hyperbole, read & share this thread. Indiana hospitals are operating on a knife's edge.
2/7 We are all potential links in the Omicron transmission chain—even those who've been infected and/or triple-vaccinated. Omicron spreads unlike anything we've seen. Even the triple-vaccinated are potential superspreaders.
3/7 Testing beforehand is better than nothing, but it is no guarantee that there will not be rampant transmission at your gathering, even if every single person tests negative.
Read 7 tweets

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