👉Clinical and in vitro evidence suggests urgent reassessment of @WHO's Therapeutics and COVID-19 Living Guideline on monoclonal antibodies is needed. ➡️Out today @TheLancet from @TheCrick and @UCLHresearch, work led by @MaryYiWeiWu ::
thelancet.com/journals/lance… ... a 🧵1/n @WHO @TheLancet @TheCrick @UCLHresearch @MaryYiWeiWu The 16 Sept 2022 update to the WHO Living Guideline switched to “strongly recommending against” the use of the only 2 monoclonal antibodies available globally – a sudden change from their 14 July 2022 guidelines which “conditionally recommended” their use. 2/n

Preprint: Less than half of adults with #COVID19 caused by #Omicron BA.1 or BA.2 would self-isolate if they followed current @NHSEngland guidelines, despite high viral loads. New findings from the @UCLH_Research & @TheCrick Legacy study and @LSHTM - medrxiv.org/content/10.110… 🧵1/n Legacy is a prospective cohort study of healthy adults undergoing regular occupational health screening for SARS-CoV-2. We sent out alternate day swabs by courier and a symptom e-diary to participants reporting COVID-19 infection since July 2021. 2/n

It’s not all Spike! 👉Emergence of novel subgenomic mRNAs in SARS-CoV-2. Sharing our latest preprint with work led by @Artisplicer, showing effectively the coronavirus analogue of entirely new promoters and splice sites emerging in the genome 🆒 biorxiv.org/cgi/content/sh…🧵 1/n This process is a hallmark of coronavirus evolution and adaptation to new hosts, and we are seeing it in real-time… It’s also reminiscent of eukaryotic gene evolution via exon shuffling and duplication of promoter and regulatory elements. 2/n

Why not all doom and gloom? ➡️Broad immune response after 3x vax tackles Omicron in @TheCrick / @UCLHresearch Legacy study of 620 samples from 364 participants. 💡 READ ON... Out @TheLancet, by @MaryYiWeiWu, @dremmacbw, @EdjCarr et al. thelancet.com/journals/lance… 🧵 1/n Two doses doesn’t provide nearly as much neutralisation vs. Omicron, especially for Oxford/AstraZeneca recipients. Titres wane, and for 2xPfizer, ~half have no quantifiable neutralisation vs Omicron after 3 months (but nearly all still neutralise Alpha and Delta) 2/n

Urgent correction is needed to the many breathless (re)tweets this evening relaying news that antigen Lateral Flow Tests work against "the" Omicron variant

https://twitter.com/CiesekSandra/status/1464925734741368837?s=20

... significant diversity apparent in Nucleocapsid gene (detected by LFTs) in Omicron... 1/n thanks to urgent sequencing work by @Tuliodna and South African colleagues that was not visible at all just a few days ago.⏩ SO: we need to know the genome sequence of that Omicron case's N gene before drawing conclusions about LFTs efficacy in "the" Omicron variant... 2/n

If you don't watch InfoWars (yes, that one) regularly, you might have missed my star turn in the antivax world. To cement the academic cliché, I wrote a Guardian piece about it... theguardian.com/commentisfree/… ... and thought I'd put a few more thoughts here 🧵 1/n First the apparently obligatory summary. Get vaccinated. Now. Take the afternoon off. Even if you had COVID before. The vaccines are safe. 2/n

6x reduced antibody neutralisation vs. Delta variant in @TheCrick / @UCLHresearch Legacy study of 106 Oxford-AstraZeneca 1/2-dose vaccinees. 💡Interesting picture emerging, read on! @TheLancet, by @dremmacbw, @MaryYiWeiWu, R Harvey et al. thelancet.com/journals/lance… 1/n After 1 dose, wide distribution becomes clearer when you ask people if they have had COVID. Suggests Oxford/AZ vaccine is very good at boosting existing immunity, like mRNA: science.sciencemag.org/content/372/65… (So NO antivaxxers, the vaccine doesn’t ‘destroy’ your natural immunity🤦) 2/n

Significant loss of antibody neutralisation vs live B.1.617.2 SARS-CoV-2 variant (-5.8x, akin to B.1.351) in @TheCrick / @UCLHresearch Legacy study of 250 (!) Pfizer-BioNTech 1/2-dose vaccinees, out today @TheLancet, by @dremmacbw, @MaryYiWeiWu et al. thelancet.com/journals/lance… 1/n Increased age & time since 2nd dose correlated with reduced virus neutralisation across all strains tested. Not a surprise, but given low starting titres vs B.1.617.2, more of a concern to see neutralisation “dropping off”, significantly. Boosters more likely to be needed 2/n