Eric Topol Profile picture
physician-scientist, author, editor https://t.co/AWqrOxpoZP
Antone Johnson Profile picture eDo Profile picture BlackeyedSusan28 Is Fully Vaccinated Profile picture Sadie Profile picture Dr Bob 'God created science,doctors, vaccine' Profile picture 228 added to My Authors
22 Sep
New large dataset of US Medicare (age 65+) population subgroup: 2.7 million Pfizer; 2.9 million Moderna vaccinated, w/ ~30,000 breakthrough hospitalizations, via claims 🧵main findings
@Humetrix humetrix.com/powerpoint-vac…
1. Definite waning of protection vs hospitalization for those 5-6 months out from vaccination (odd ratio 2.5X at 6 months) Image
2. No significant difference of waning for Pfizer vs Moderna for protection from breakthrough infections Image
Read 8 tweets
20 Sep
Delta can be daunting to contain.
The situation in Singapore with over 1,000 new cases today and yesterday, 80% of total population fully vaccinated, 1 of top 3 countries in the world, is an important indicator of the challenge.
Singapore’s booster campaign for people over the age of 60 began Tuesday, 14 September
The primary schools shifted to online reuters.com/business/healt…
Read 4 tweets
18 Sep
A @CellCellPress commentary yesterday entitled "Keeping Pace with the #SARSCoV2 Variants" states
"The evidence so far suggests that effectiveness against hospitalizations and symptomatic illness is highly preserved against Delta" cell.com/cell/fulltext/…
I'm calling it out. /1
For several weeks dating back to July, we have seen protection of vaccination for symptomatic infections drop down from >90% to <40% in Israel which was refuted, attributed to poor analysis, Simpson's paradox, and many other objections to @IsraelMOH reports /2
Those reports were since corroborated by others including @KPSCalResearch, @PHE_uk. Qatar and many other. But they were ignored and denied. /3
Read 8 tweets
15 Sep
3 new @NEJM papers today on @Pfizer/@BioNTech_Group vaccine
1. 3rd shot (Booster) in over 1.1 million Israelis, age ≥ 60, > 12 days later
19.5-fold reduction in severe illness
nejm.org/doi/full/10.10…
2. 6-month follow-up of the original placebo-controlled trials (adult + teens; > 44,000 participants) showed gradual reduction in efficacy vs symptomatic infections from 96% (fully vaxxed) to 83% (> 4 months)
nejm.org/doi/full/10.10…
3. Small 3rd shot-> Neutralizing antibody study vs Wild-type and Delta by age group, showing significant increase immune response not much affected by variant or age
Read 4 tweets
15 Sep
The @Pfizer @US_FDA booster documents fda.gov/media/152161/d…
reviews all data on effectiveness (VE) vs infection
—waning immunity not related to Delta, just a matter of time, 6% reduction of VE every 2 months
—restoration to 95% VE by 3rd shot
—recommends booster for all age 16+
The (Pfizer) bottom line, w/ antibody % safety data in this 53 page report.
Their case is not made sufficiently for all age groups, predominantly relying on infections, not protection from severe illness, which exists now for age ≥ 60
That may change with ongoing follow-up data.
Little evidence of difference in booster effect by age or variant (WT/Wuhan vs Delta/DA)) difference for neutralization assays. Substantial increase on this log-scale NT50 plot across the board.
Read 4 tweets
14 Sep
Let me be clear about the evidence on 3rd shots. It is unequivocal for Pfizer's vaccine, given w/ 3 week spacing. In people over age 60, there is significant reduction of effectiveness (VE) vs hospitalizations and symptomatic infections at 5+ months after primary vaccination. /1
And that Israel's data shows that VE vs severe illness is restored by a 3rd shot for those age ≥ 60.
The duration of the restored VE can be debated, but likely several months, at minimum. /2
It's not the "general population" but there are over 70 million Americans age ≥ 60. They should not be sitting vulnerable while infighting takes place /3
nytimes.com/2021/09/13/hea…
Read 8 tweets
13 Sep
A new @TheLancet viewpoint by an international panel on boosters: "To date, none of these studies has provided evidence of substantially declining protection against severe disease." …s-jbs-prod-cdn.jbs.elsevierhealth.com/pb-assets/Lanc… But that'll change w/ this week's @NEJM Israel report, Pfizer💉, age >60
This is where I disagree w/ the panel. Many studies on reduced efficacy have been published in the media & preprints. Waiting for "robust data" that is adjudicated by the eminent authorities is not how it works. The public wants to know, has a right to know, and that builds trust
Read 4 tweets
10 Sep
3 new @CDCMMWR reports today provide very strong reassurance of vaccination benefits vs Delta and point toward a potential edge of @Moderna_tx for real-world effectiveness washingtonpost.com/health/2021/09… by @bylenasun and @JoelAchenbach
The data from 13 US jurisdictions to show some increase in breakthrough cases during Delta but, at the same time, increased gradient of benefit for vaccination and very little rise in the fully vaccinated for hospitalizations or deaths
cdc.gov/mmwr/volumes/7…
The Table from the report on vaccine effectiveness from 9 state analysis for reduction in emergency department, urgent care, and hospitalizations
cdc.gov/mmwr/volumes/7…
Read 4 tweets
9 Sep
What's good and not good about @POTUS's new Covid plan
Good: major 💉mandates for 17 million health care workforce, Fed & private co employees. Discounts on rapid home tests.
Not Good:
—No data mess fix
—No Green Pass: air, rail, public transport; access to many activities
—No free, ample supply of rapid home tests, medical-grade masks to all households. 35% off a $10+/test is unhelpful
—Lack of frequent (qd or qod),free testing for all schools
—No mention of priority to get a universal #SARSCoV2 vaccine or nasal vaccine
—Fuzzy ?? booster program
—Continued lack of recognition of Prior Covid to = 1 dose of vaccine (important for Green pass/CDC cards)
—A vaccine-centric, lack attention to data deficiency, soft package that is not the aggressive "path out of the pandemic" that we need now.
Read 4 tweets
6 Sep
Looking for any favorable signs?
Hospitalizations are coming down a bit.
Case growth has flattened (log scale)
Test positivity is coming down w/ testing up.
Hoping for descent from Delta soon. ImageImage
These indices preceded the holiday weekend but pervasive pessimism prevails. Image
Maybe you'll believe @trvrb with this elegant analysis
Read 4 tweets
4 Sep
Pediatric covid hospitalizations by state fully vaccination per cent, past 30 days
time.com/6092446/pediat… by @Jamie_Ducharme @TIMEHealth
Florida, an off-the-chart outlier
Kentucky, not shown on the graph, with 49% vaccination rate, now at peak pandemic, with this really sad and eminently preventable school struggle
The 2 CDC reports from yesterday on kids in the Delta wave show the importance of vaccination in adults, at the state level, to help protect kids from infections, emergency department visits, and hospitalizations
Read 4 tweets
3 Sep
Not only has the data to support potential use of Ivermectin been exceptionally weak from small studies, but now 2 of the studies most cited have been shown to be fraudulent, one from Egypt and now this one from Argentina
Despite the lack of evidence, why did @joerogan and so many take Ivermectin? Remember the emergency podcast to "save the world"? And that it was "99 percent effective" and "the pandemic would end in a month" but it was being suppressed by a conspiracy.
quillette.com/2021/07/06/loo…
If you are interested in the truth about Ivermectin's dataset and the fraudulent issues, I highly recommend the 3-part series by @GidMK, culminating in today's on the Argentina study
Read 4 tweets
1 Sep
Just published @NEJM
Breakthrough infections in health care workers before and during the Delta wave
mRNA Vaccine effectiveness vs symptomatic infections dropped from 94% to 66% [95% CI 49,77]
"Our data suggest that vaccine effectiveness against any symptomatic disease is considerably lower against the Delta variant and may wane over time since vaccination"
The breakthrough attack rate went from pre-Delta 0.25/100,000 to Delta 5.7/100,000 in fully vaccinated (23-fold)
Here's the link to the report
nejm.org/doi/full/10.10…
which aligns to what I have been highlighting w/r to reduced mRNA vaccine effectiveness in the Delta wave vs *symptomatic* disease
Read 5 tweets
31 Aug
New @PNASNews
Exposure maps of airborne transmission and the flaws of models and current guidelines that have given a consistent and gross underestimate of infection risk
pnas.org/content/118/37…
Effect of sneezing at different temperatures and humidity %, time to evaporation
Humidity makes a difference
Here effect of sneeze at 68° Fahrenheit, 50% relative humidity
Read 4 tweets
28 Aug
An important new study from Qatar on waning of the Pfizer vaccine's protection against symptomatic infection at 6 months to <50%, with preserved effectiveness vs hospitalization, adds to a growing body of consistent evidence for this dichotomy
medrxiv.org/content/10.110…
This week's Kaiser Permanente @KPSCalResearch report from >3.3 million people showed a decline of Pfizer vaccine effectiveness against infections to 53%[95% CI 38,65] at ≥4 months yet preserved 93% VE against hospitalizations papers.ssrn.com/sol3/papers.cf… @KPSCALnews
A new @CDCMMWR in health care workers for both Pfizer and Moderna vaccines cdc.gov/mmwr/volumes/7… found a decline to 66% effectiveness against infection, 75% of which were symptomatic
Read 4 tweets
28 Aug
First mover disadvantage

Waning immunity, 3 week dose-spacing, insufficient population vaccinated, and other factors contributing to this unexpected outcome.
Dose-spacing immune response data, 1 potential factor
This phenomenon remains unexplained. If the main driver is simply waning immunity, these countries that are 3 months behind Israel may subsequently manifest this problem.
Read 4 tweets
23 Aug
A notable difference between Israel and UK in their Delta waves ft.com/content/23cdbf… by @jburnmurdoch and @nikasgari @FT Image
And a graph of higher rates of breakthrough over time in Israel Image
Not just waning --> infections Image
Read 5 tweets
19 Aug
New large UK study confirms attrition of @Pfizer vaccine effectiveness vs Delta infections over time bloomberg.com/news/articles/… "By roughly 4 1/2 months after the 2nd dose, Pfizer’s shot will probably be about on par with Astra’s at preventing infections with a high viral burden"
Reminder (for the nth time) these data have nothing to do with effectiveness vs hospitalizations and death, which has been shown to remain high in multiple studies
More details of study here (@Reuters):
1 more point, since the UK gave @Pfizer at 3-4 wks and 8-12 wks dosing schedules:
"The study also suggested that the time between doses did not affect effectiveness in preventing new infections" but unclear if this pertains to Delta infections or overall standard.co.uk/news/uk/delta-…
Read 4 tweets
18 Aug
Step-by-step, towards a pan-coronavirus vaccine. This one via individuals with the original SARS (in 2003) getting a #SARSCoV2 mRNA vaccine, neutralizes all variants of concern and more @NEJM @NUSingapore @dukenus nejm.org/doi/full/10.10…
We keep getting closer to discovering /defining antibodies that will take down the entire beta coronavirus family, which can be used as a template for universal vaccines. I don't understand why we are futzing around with variant-specific vaccines when this could be #1 priority?
Here's another one, discovery of SARS2-38 mAb, a broad neutralizing antibody vs all the variants of concern. 3rd such study this week, all providing momentum towards a pan-coronavirus vaccine
cell.com/immunity/fullt… @ImmunityCP
Read 4 tweets
18 Aug
3 new @CDCMMWR reports today on mRNA vaccine effectiveness (VE): (1) Nursing home residents; (2) 21 hospitals; (3) New York State.
They show some reduction vs Delta infections, to as low as to 53% in study (1), and well-preserved VE vs hospitalizations
cdc.gov/mmwr/
The Nursing Home resident report
cdc.gov/mmwr/volumes/7…
The 21 hospitals on 18 states report
cdc.gov/mmwr/volumes/7…
Read 5 tweets
16 Aug
It wasn't supposed to work this way.
Cases got down to zero in June after one of the most aggressive vaccination campaigns in the world.
Then came Delta.
There is little evidence of waning immunity to the original strain at 6 months medrxiv.org/content/10.110…
In contrast to what is becoming clear with Delta
The waning/vulnerability may have been made worse by the 3-week dosing schedule. In countries using 8-12 weeks (e.g. UK, Canada) vaccine effectiveness vs infections is ~80% to date. Beyond 6 months, VE vs infections has dropped in Israel, Qatar and in US studies w/ 3-week spacing
Read 4 tweets