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Michael Lin, MD PhD 🧬 Profile picture
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Jun 29 • 12 tweets • 4 min read
Fauci should be questioning not only FDA and CDC guidance but also Pfizer's claimed 2% rebound rate
One recalls @Bob_Wachter's spouse also did not find the rebound mild and indeed progressed to PASC
Seems only sensible to hypothesize that the rebound rate is higher in those who are more susceptible to disease progression, who have weaker immunity. These are the same people Paxlovid will help the most but it seems we can't rely on Paxlovid alone; we need better vaccines.
Notably Fauci was double boosted just a week before infection; he was as protected as he could be with currently approved vaccines. Emphasis on currently and approved.
B cell repertoire narrows as we age; this is why older people need n+1 vaccine shots to get the same antibody levels as n shots for younger people. So when we ask a Wuhan vaccine to produce B cells that neutralize Omicron through somatic hypermutation, we reach B cell limits.
So we need vaccines that allow targeting a broader array of epitopes (maybe Novavax) and that are closer to existing strains.

And I think Fauci needs to have a talk with Offit.
On the same day: real life vs idle behavioral theorizing on @statnews
And may be time for a trial in high-risk omicron patients 5 days Paxlovid + 5 days placebo vs 10 days Paxlovid. Can't compare to no treatment for ethical reasons.
Meanwhile Pfizer's standard NDA of Paxlovid should be sent back because it's entirely based on unvaxxed pre-Omicron results
pfizer.com/news/press-rel…
BTW this means Fauci's MD (or himself) prescribed Paxlovid off-label (label requires starting within 5 days of first symptoms). But rules do not allow this for EUAs.

This, after all the grief CDC/FDA gave #JnJers wanting a 2nd shot off-label (and who still can't get a 3rd)
Unfortunate timing on that headline from 2 days ago

Coming down with bad rebound COVID-19 after taking 4 vaccine doses and Paxlovid definitely doesn't sound like a waning pandemic

I just happened to notice it and thought it was an old story but alas no
washingtonpost.com/magazine/2022/…
How's that waning going?

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More from @michaelzlin

Michael Lin, MD PhD 🧬 Profile picture
Jun 29
Critical news on rebound rates on Paxlovid and molnupiravir revealed last week

The MOV rate is scary and disproves Merck's claim that MOV kills the virus efficiently. It means mutated viruses are transmitting in 8% of cases, just when you don't expect it

This was the kind of study we asked Merck to do, or FDA to require them to do. They refused. Now it's done by academics, and supports my fear that not all the mutated viruses are dying. That makes 5% of MOV patients stealth incubators of SARSCoV2 variants

washingtonpost.com/outlook/2021/1…
In one of my tweets I said the Phase 2 Sci Trans Med paper made a claim that virus was eliminated in 5 days, when its own data showed RNA positivity in 7.5% of patients 1 mo after MOV and 6% of patients progressed to hospitalization in Phase 3. Image
Read 17 tweets
Michael Lin, MD PhD 🧬 Profile picture
Jun 28
Live blog of #VRBPAC meeting by @HelenBranswell and @matthewherper

First interesting info is that VE for BA2 hospitalization ("what we should care about" since we gave up on stopping disease) is at best 71% after 3 doses. Far worse than the 95% that we had to original strain Image
@HelenBranswell @matthewherper Live blog link, thx to Helen and Matthew for condensing the important points: statnews.com/2022/06/28/tra…
And in the biggest shocker of any VRBPAC I've seen, Novavax showed up. We're used to them not being invited to the party.

And not only did they show up, they actually presented new data on Omicron including BA1 BA2 and BA5.

And it was very impressive data too

h/t @doctorvasan Image
Read 22 tweets
Michael Lin, MD PhD 🧬 Profile picture
Jun 27
A @nytimes article quotes a couple of scientists favoring BA4/5 boosters over BA1-2. But with BA2 not dead yet, it would be selected for by a BA4/5-only booster. So best booster may be BA2+BA4/5. We'll see if anyone brings up that idea at VRBPAC tomorrow.
nytimes.com/2022/06/27/us/…
But Moderna and Pfizer only have data for BA1 boosters. For a booster to be ready by sometime in September, they'd need a go-ahead and promise of purchase in early July. For that to happen a few unprecedented things would have to occur:
VRBPAC would have to play the role of a variant selector, which they've never done. Doesn't seem like the group you want deciding for 320M Americans. They only serve part time and records show some of them lack detailed knowledge of virology, immunology, or COVID19 vax results.
Read 10 tweets
Michael Lin, MD PhD 🧬 Profile picture
Jun 22
Reposting this table on relative VE against detected disease or infection of the original RNA vaccine son original vs Omicron (originally posted April 5)

The Omicron here is BA.1. Things get worse for BA.4 and BA.5, which is why we want some Omicron booster soon
VE of original vax (2 or 3 doses) to different variants can be related to relative neutralizing activity, such as at science.org/doi/10.1126/sc…

You can see 3x Pfizer does okay on BA.1 and BA.2, but worse on BA.4/5.
And while avg nAb levels on BA1 and BA2 look okay after 3x Pfizer, it's variable. This is because those nAbs are produced by mutation of memory B cells expanded by Wuhan vax; this is a random process and many won't be so lucky, which is why VE for BA2 isn't as high as for Wuhan.
Read 11 tweets
Michael Lin, MD PhD 🧬 Profile picture
Jun 21
Remember how some scientists wrote a letter of concern about how Sputnik trial data reported in Lancet looked too perfect to be real?

Yesterday @K_Sheldrick and colleagues published a statistical analysis concluding the data are indeed fictitious
Concerns were first raised in 2020:

cattiviscienziati.com/2020/09/07/not…
Then reiterated in 2021:

thelancet.com/journals/lance…
Read 6 tweets
Michael Lin, MD PhD 🧬 Profile picture
Jun 19
Wasn't just CDC; a certain famous virologist said the same. Seemed policymakers were so bedazzled by trial results they forgot that immune responses wane

Hence dropping masks and variant vaxxes in favor of July 4 2021 COVID freedom bash

Wonder why nobody's warnings got through
Because I remember where the receipts are:

Famous virologist:
And famous PH official, now COVID19 czar (the "largely true" part is largely untrue):
Read 4 tweets

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