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Krutika Kuppalli, MD FIDSA Profile picture
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Jan 31 • 4 tweets • 6 min read
New data out today from #Denmark demonstrating that #Omicron #BA2 is more transmissible than #BA1 and has immune evasive properties reducing protective effect of #vaccination

Full 🧵👇
1/ medrxiv.org/content/10.110…
- Of 8,541 primary household cases with #Omicron, 2,122 were #BA2
- There were 5,702 secondary infections among 17,945 potential secondary cases
- In households with #Omicron, secondary attack rate was
29% - #BA1
39% - #BA2
2/ Image
- compared to #BA1, #BA2 associated with ⬆️ susceptibility of infection in
#unvaccinated (OR 2.19)
fully #vaccinated (OR 2.45)
#boosted (OR 2.99)
- ⬆️ transmissibility from #unvaccinated cases in #BA2 houses compared to #BA1 (OR 2.62) (Not seen in vaxd or boosted)
3/ Image
What does this indicate?
- #BA2 appears to be more transmissible than #BA1
- #BA2 may have immune evasive properties that reduces protective effect of vaccination (but does not increase transmissibility from vax'd with breakthrough infection)
- More studies and is needed
4/

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More from @KrutikaKuppalli

Krutika Kuppalli, MD FIDSA Profile picture
Jan 10
Latest @WHO #TechnicalBrief on #Omicron
Overall risk remains very high & threat depends on

1⃣Transmissibility of #variant
2⃣How protective vaccines & prior infection are
3⃣Virulence of variant
4⃣Understanding of dynamics & uptake PHSM

Full 🧵👇 (1/)
who.int/publications/m…
Epidemiology (1)
-#Omicron has large growth advantage over #Delta - grows significantly more than Delta in countries with community transmission
- Evidence that immune evasion contributes to rapid spread
-Wk 52, global weekly #COVID19 incidence ⬆️ 71% compared to prior wk
(2/)
Epidemiology (2)
-Study from HK found #Omicron infects human bronchus tissue faster and better than #Delta
-#UK study found Omicron outcompetes Delta in experiments using cells derived from human nose, but not seen in lung derived cells
-Growth advantage in upper resp tract
(3/)
Read 17 tweets
Krutika Kuppalli, MD FIDSA Profile picture
Jan 1
This narrative is exactly what I was worried about👇

We still don’t know #Omicron causes less severe disease but has become so politicized leaders say it only causes a “sore throat” without thinking of the immediate & long term (post #COVID19 condition #LongCovid) effects
#COVID19 and #Omicron most certainly does not only cause a “sore throat” we are seeing ⬆️⬆️ numbers of ICU admits and hospitalizations.
Yes some may have mild disease (thank you #vaccines) but these people can still transmit and put others (ie immunecompromised) at high risk.
The strain this is putting on healthcare systems and workers is tremendous.

Procedures that are non-emergent like cardiac catheterizations, biopsies, & other important surgeries are being postponed. This may lead to delays in diagnosis of things like cancer & adverse outcomes.
Read 5 tweets
Krutika Kuppalli, MD FIDSA Profile picture
Dec 30, 2021
💯agree with @jabarocas - in the past 24 hours 5 healthcare worker friends in different parts of the #US have been diagnosed with #COVID19.
At this rate as hospitalizations ⬆️ there will be an ⬆️ shortage of HCW's- who will care for patients & what will it look like a🧵
1/
✅The provider: patient ratio ⬆️⬆️⬆️
✅Patients wait longer for things like water, ice, food, & meds as nurses are stretched caring for more patients
✅The lab is stretched thin so bloodwork takes longer to return
✅Radiology is busier so it takes longer for an X-ray
2/
✅Physicians have less time to spend with patients and families because they have more individuals to see
✅There is less time to critically think about patients as HCW's are in triage mode trying to meet patients needs (I understand this is concerning, but is reality)
3/
Read 5 tweets
Krutika Kuppalli, MD FIDSA Profile picture
Jul 30, 2021
Here is a link to the @MMWR with the data from the #Provincetown outbreak which led @CDCgov to change their recommendation on #Masks due to the #DeltaVariant

Here is a🧵highlighting the important points
1/
cdc.gov/mmwr/volumes/7…
-There were 469 cases of #COVID19 in Barnstable, MA in July 2021
- 346 (74%) cases in fully #vaccinated
- #Sequencing in 119/133 (89%) specimens confirmed #DeltaVariant
-274 (79%) with breakthrough infection were symptomatic
-4/5 hospitalized were fully #vaccinated

2/
-Ct value similar in fully vax'd (127) vs. those not (84) (22.7 vs 21.5)
-Most cases in males (85%); median age 40
-Time from vax completion -> infection 86 d (6-178 d)
- Vax as cause for breakthrough
#PfizerBiontech (159,46%)
#Moderna (131,38%)
#Janssen (56,16%)

3/
Read 6 tweets
Krutika Kuppalli, MD FIDSA Profile picture
Jul 30, 2021
Here is some of the @CDC data that was looked at and published by @washingtonpost to make the recommendations to re-implement #masks earlier this week

Note that the #DeltaVariant is MORE transmissible than
- MERS & SARS
- Ebola
- Seasonal Flu and the Flu of 1918
- Smallpox
1/
#DeltaVariant associated with lower Ct value in breakthrough cases, longer duration of Ct < 30, and higher risk of re-infecton
2/
Breakthrough cases of #DeltaVariant have ~ 10 fold increase in viral load compared to alpha or other lineages
3/
Read 7 tweets
Krutika Kuppalli, MD FIDSA Profile picture
Apr 14, 2021
1/
Information regarding the six patients who have developed CVST after the #JohnsonandJohnson #CovidVaccine
- All were white females
- Only one was on oral contraceptives
2/ Clinical features of the patients
3/ Location of CVST
Read 8 tweets

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