Michael Lin, MD PhD 🧬 Profile picture
Feb 2, 2022 11 tweets 5 min read Read on X
This study flew under the radar (only 1 news article): Omicron antibodies in participants of the NIH mix and match trial

Results: 3xRNA ~ 2xRNA+JJ ≥ JJ+RNA >> JJ+JJ

JJ+JJ ends up 10x worse than 3xRNA

medrxiv.org/content/10.110… @PaulSaxMD Image
Also confirms JJ is a poor booster for JJ, for either "original" D614G or Omicron. Image
Above, the JJ+Pfizer looked about 2x worse than 3xPfizer. Confidence intervals are wide, but another underreported Omicron study found JJ+Pfizer was ~3x worse than Mod+Mod+Pfizer. So this effect size seems consistent.

Great graphics BTW

medrxiv.org/content/10.110… Image
The difference between JJ+RNA and 3xRNA was bigger in the @BalazsLab study. I believe those patient samples may have been more heterogeneous. Regardless JJ+RNA is consistently lower than 3xRNA.

cell.com/cell/fulltext/… Image
Returning to the second paper by the de Vries lab, they also looked at B and T cell responses to original spike, over time after "full vax" (1xJJ or 2xAZ or 2xRNA)

No surprises: we see again that the 2-dose vaccines have higher Ab levels at 1mo than at 6mo.

Peak Mod>Pfiz>AZ>JJ Image
For those who might have just read press releases or news articles that reiterate press releases, yes JJ (Ad26COV2S) Ab levels go up and then stabilize between 2mo and 6mo. But the whole time it is below the levels of 2xRNA (mRNA or BNT), so there's no net advantage of 1xJJ.
How about T cells, which some people thought would be an advantage of adenovirus (Ad, vectored) vaccines? As measured by IFNgamma release, they're worse for 2xAZ (ChAdOx) or 1xJJ (Ad26COV2s) vs 2xRNA (mRNA1273).

White circles = selected for in-depth analysis Image
They also looked at unboosted Ab levels against Omicron. This is a measure of breadth of the response. You can see convalescent sera and Moderna had the most Omicron neutralization (look at #'s above), everything else similarly poor. Image
And they also looked at T cell responses across strains. Again Moderna much better than everything else. Little differences across strains (because T cell epitopes are from anywhere in the protein, and not subject to the same selective pressure) Image
So the de Vries study is remarkably consistent in showing Moderna to have the broadest B cell responses, and the strongest B and T cell responses. It does seem like the most protective of the vaccines, and Modernites also get to enjoy a 3rd shot of their choice (4 if they are IC)
And finally the de Vries study, like the Balazs study, is a joy to read because of the excellent graphics. Everything is consistently labelled, well organized, and color-coded, and there's a cartoon of the experimental process. You hardly ever have to look at the legend. 🙏👏👏

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More from @michaelzlin

Sep 3
New study in JAMA: azelastine antihistamine nasal spray reduced occurrence of COVID19 and common cold by 67% in a placebo-controlled (but small) study.

Azelastine in the US is sold OTC as Astepro, just $10 at CVS (with coupon). Note it's not the more common steroid nasal spray Image
Azelastine is generic now, and this was an academic study. Little interest by companies to test off-patent drugs. It was done in Germany (zero interest by US to do COVID-19 research now)

Trial was n=450 split into azelastine and placebo groups. That's large by academic standards
Subjects took azelastine 3x/day for 8 weeks. SARS2 antigen testing was done 2x weekly by study personnel, so not self-reported which is good. Those with symptoms but SARS2 negativity were tested for other viruses. Solid study.

SARS2 rate 2.2% treatment v 6.7% placebo, p = 0.02 Image
Read 20 tweets
Aug 19
People have been asking about the SARSCoV2 (COVID19) vaccine outlook so I'll summarize as best as I can. But overall, the current situation is chaotic and in constant flux, and if FDA is trying to apply consistent criteria then they haven't shown it yet
Right now there are 4 vaccines from 3 companies covering 2 technologies with FDA approval in some form or other. The approvals are for different age ranges and risk categories. In addition each August or September new formulations have to be reapproved, kind of like influenza.
The vax are Comirnaty (Pfizer), Spikevax (Moderna), mNEXSPIKE (Moderna), and Novaxovid (Novavax). The first 3 are RNA, the last is protein. HHS.gov shows who qualifies for each, but hasn't been updated with mNEXSPIKE. Must be the DOGE cuts hhs.gov/coronavirus/co… Image
Read 22 tweets
Jul 6
In case you think cameras can detect cars or people ahead of them through the glare of the sun, or that AI has learned to react to ambiguous situations with the, well, intelligence of humans, read this Image
It's a frightening and sad story (a grandmother was killed) and I'm surprised to find out about it only now.

There's clear evidence from the Tesla's own cameras that no kind of image processing can beat glare (and that FSD lacks all sense of caution)
bloomberg.com/features/2025-…
Glare happens when light rays from the sun get scattered by water or dust in the air at every lit location to new directions. That means air between an object and the camera can scatter sunlight toward the eye or camera.
Read 7 tweets
May 18
FDA has granted regular approval to the Novavax vaccine. What does this mean? A lot of things, all good.

1- It proves Novavax has met efficacy and safety criteria to merit approval outside of the emergency use situation.
Novavax is safer than the RNA vaccines, but ironically the RNA vaccines received full approval earlier than Novavax. That meant Novavax was the only COVID vaccine which vaccine skeptics could incorrectly claim was not safe enough to receive regular approval.
2- Novavax will get to participate in annual booster updates on the same terms as the RNA vaccines. This year's advisory committee for booster strain selection has already been scheduled.

3- All health insurers should now cover Novavax.
Read 14 tweets
Apr 18
"Novavax had 1.7 systemic symptoms compared with 2.8 in Pfizer recipients. In total, 43.8% of Pfizer vaccinees reported at least one symptom of moderate or higher grade, compared with 24.2% of Novavax"

@RobertKennedyJr in case you didn't know. It's also more broadly protective. Image
This is the 2nd controlled study to show about half the side effects rate for Novavax vs Pfizer.

Of the 3 covid vaccines, Novavax is the only one still on EUA. Happens it's the smallest of the 3 companies and hasn't hired ex-FDA staffers.

Article below.
cidrap.umn.edu/covid-19/novav…
FDA had a deadline of April 2 (this month) to decide on regular approval for Novavax, and reportedly was going to, except Peter Marks resigned the day before. Sadly he didn't sign the approval before he left. Was different for Pfizer and Moderna, who got early review and approval
Read 9 tweets
Mar 25
Our NIH grant to discover coronavirus antiviral meds was terminated today.

With this grant, we had developed a better SARSCoV2 inhibitor than Paxlovid, and we recently discovered an improved drug that looks better than Pfizer's own second-generation inhibitor. Image
This is part of a complete elimination of COVID19-related research, including on long COVID.

The rationale given is that the pandemic is over.

In reality, people are dying of COVID at several times the rate of flu, and still getting long COVID.

arstechnica.com/health/2025/03…
This goes against RFK Jr's stated intention to concentrate on chronic disease.

Long COVID is a bad chronic disease to get, and there are reports of long COVID cases getting better immediately after treatment by protease inhibitors such as the ones we are improving.
Read 9 tweets

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