Michael Lin, MD PhD 🧬 Profile picture
Associate Professor of Neurobiology & Bioengineering @Stanford ☘️🧪🦠🧠🌈🔬📖🇺🇲🌏 Molecular engineering for voltage, viruses, and SARSCoV2. Fan of facts.
Postcards of the Hanging(s) Profile picture The Holocron, the CDC is really dumb Profile picture Jörg Honegger Profile picture Paul Leo Profile picture S. Diamond-Myrsten Profile picture 9 added to My Authors
Jan 13,
Two years too late. Okay, it was the former guy then, so just 1 year too late for this administration.

I recommended household distribution of small packs of masks in March 2020.

Image Korea and Taiwan did that for their citizens. Taiwan gave out a few free medical masks per week per person. Korea allowed purchases but limited per person and price-controlled.
nytimes.com/2020/04/01/opi…
Read 6 tweets
Jan 11,
Making a new COVID-19 metathread for 2022.

Previous 2020-2021 COVID-19 metathread is below

2022.01.01. Recommending the 3M Aura as a speakable, breathable, comfortable, affordable N95 mask.
Read 6 tweets
Jan 11,
Some Omicron trends that we can now definitively see:
• Case hospitalization and fatality rates (CHR, CFR) in SA, Denmark, UK, Australia, US
• A guess at true infection hospitalization and fatality rates (IHR, IFR)
• Omicron peaking in many regions of the US This follows a previous thread where we inferred from early SA data that the CHR was lower for Omicron than earlier waves due to prior immunity and lower virulence, and it would be similar in the West. (But still bad news due to very high case # s)
Read 25 tweets
Jan 7,
Since my analysis concluding 3 shots are required for the broad response needed against Omicron, and that #JnJers will need 2 shots of RNA, others like former Surgeon General @JeromeAdamsMD have reached the same conclusion 16M Americans are stuck in pre-Omicron limbo. We just need to admit J&J was like one shot of RNA, so they were behind 2xRNA-vaxxed and should be allowed to catch up. (And a 2nd J&J is not as good due to immunized clearance of the adenovirus vector)
Read 4 tweets
Jan 6,
On-the-ground look at Omicron from the Marin County PH officer.

- Cases peaked 2 wks ago
- 18/19 hospitalizations non-ICU (most don't even need O2, some asymptomatic)
- Older vaccinated well protected

Not sure Omicron truly done here but still...

sfgate.com/coronavirus/ar… Image As @Merz mentioned Marin is one of the highest-vaxxed counties in CA. However it's not particularly young. The experience is "anecdotal" anyway but the PH officer relates it to past experience in the same location. It may serve as an example of what high vax rates can achieve.
Read 5 tweets
Jan 3,
While our attention was diverted by Omicron, FDA approved the viral mutagen molnupiravir (MOV) on the last business day before Christmas. The same time, Merck published that MOV doesn't reduce virus levels in the first 3 days. So patients will be shedding mutated virus for 3 days I wrote in the Washington Post pointing out that widespread use of the drug increases the risk that we will create new immunoevasive variants. This could come from Delta; it may not be milder like Omicron. Since my piece is no longer browsable, I post it here as a public service
Read 7 tweets
Jan 1,
For a new year tried out a new mask, the 3M Aura N95 mask. Wow what a night and day difference. Didn't realize a mask could be this comfortable. Most amazing thing: speech comes through clearly.

My colleague @AbraarKaran is correct: CDC should be pushing better masks like these These are $3 each and worth it. You can buy a 3pack (or 10pack) and rotate between them. On the 3 days off you let the mask air out to evaporate odors and let any viruses in them die off. More info on this thread.
Read 13 tweets
Dec 31, 2021
Going to wrap up 2021 with an optimistic thread.

If we can avoid creating worse variants with molnupiravir, COVID19 can finally become like the flu in 2022.

1/n
The SA experience, mirrored in Western countries so far, suggests Omicron IFR is an order of magnitude lower than previous variants. This is due to preexisting immunity and lower virulence of Omicron.

2/n
nytimes.com/2021/12/30/wor…
Read 24 tweets
Dec 31, 2021
More evidence a booster helps prevent you from catching Omicron. We knew that already from Pfizer but this study looks at risks within households, which is useful info as it provides an absolute rather than relative risk in a common situation
The chart ET posted is confusing, as it normalizes to the "fully vaxxed" state. Leaving aside the heterogeneity of this population (vaxxed at different times, and includes some unknown % with the less effective 1-shot J&J), normalizing to unvaxxed would be better. So I redid it.
Read 8 tweets
Dec 30, 2021
Thanks Dr. Hildreth for speaking out on the dangers of molnupiravir to "the health of the world". We need more people with foresight and integrity like you and @RickABright speaking up Drs. Hildreth and Bright were inspirations for my essay on the risk of molnupiravir creating immunoevasive strains.
Read 5 tweets
Dec 29, 2021
Reordered the COVID19 meta-thread by date.

2020.03: Introducing the #coronadeck, explaining what we knew about SARSCoV2 based on its 80% identity to SARSCoV1. Discussed evidence for masks. This was back when CDC and WHO were saying they were ineffective.
2020.04: On why SARSCoV2 disease should have been called simply SARS2 or vSARS or even simply SARS, rather than the meaningless COVID-19.
Read 29 tweets
Dec 27, 2021
ICYMI, on 12/23, the last news day before a long holiday break, FDA approved the viral mutagen molnupiravir as an at-home COVID19 drug. It sounds worrisome because it is. I wrote in the @washingtonpost that immunoevasive variants could arise from its use.
washingtonpost.com/outlook/2021/1… If molnupiravir gives rise to enhanced mutants of SARSCoV2, it will prolong the pandemic and cause countless deaths and needless suffering. Yet it's only 30% effective in preventing hospitalization, similar to generic antidepressant and far worse than the 89% of other antivirals.
Read 32 tweets
Dec 23, 2021
Would you prefer (1) we get back to normal activities sometime, or (2) we make new vaccine-evading coronaviruses continuously, suffer widespread breakthrough waves, and wear masks forever?

If you chose #1, then know this: Merck's molnupiravir should not be approved. Molnupiravir is, to put it in clear terms, a potentially dangerous and virus-enhancing drug. It is not an effective antiviral medication outside of the confined conditions of cell culture and hamster cages. I'll explain below.
Read 135 tweets
Dec 22, 2021
I've been meaning to reveal some exciting results from my lab's SARSCoV2 protease inhibitor research. With FDA approval of Pfizer's Paxlovid today, it's a good time to finally share our good news as well.

We've developed not 1 but 2 inhibitors with activity superior to Paxlovid. This work began in March 2020 when we hypothesized the HCV protease inhibitor boceprevir could serve as a template for the creation of orally dosable SARSCoV2 protease inhibitors. We announced initial results from this work in September 2020.
Read 5 tweets
Dec 22, 2021
👍🙂💊SARSCoV2 protease inhibitor Paxlovid approved as the first pill for preventing severe COVID19 i the US.

This is great news, as it prevents hospitalizations by 89% in high-risk patients with SARSCoV2 infections.

And I'm obligated to point out that we were the first to invent a SARSCoV2 protease inhibitor with the essential elements later found in Paxlovid (we showed our drugs in 9/2020, Pfizer announced Paxlovid in 4/2021)
Read 10 tweets
Dec 17, 2021
Finally, what we've been waiting for: age-controlled data on Omicron severity, courtesy SA health ministry.

Across all ages, deaths among hospitalized pts are 2/3 lower in Omicron wave.

If more mild cases are admitted, this # goes down, but doesn't seem likely that's the reason Image Source:

h/t @b_chinnian5
Read 33 tweets
Dec 14, 2021
An important study just posted from @BalazsLab

Findings are good for Pfizerites and Modernans but sobering for #JnJers

#JnJers even after boosting have lower neutralizing antibodies against Delta and Omicron vs 3x Pfizer

I'll discuss implications

🧵

Study design is excellent. Relevant vaccine statuses were tested in parallel: {Moderna, Pfizer, J&J} x {distant vax, recent vax, infection+vax, boosted vax}. Assay was pseudovirus neutralization. Color-coded images explain everything. Image
Read 35 tweets
Dec 13, 2021
ICYMI: Another reason not to take #molnupiravir is mutagenesis of the patient DNA hasn't been ruled out.

We've already ruled *in* viral mutagenesis.

The push to approve molnupiravir feels like Challenger-style "go fever".

Sanity needs to prevail.

nytimes.com/2021/12/13/hea… When we discovered boceprevir has activity against SARSCoV2, we contacted Merck and let them know, because it was their drug and we figured they could modify the compound for even better activity.

Boceprevir activity below, also published by others.
biorxiv.org/content/10.110…
Read 8 tweets
Dec 8, 2021
What the early omicron data means: get boosted.

"BNT162b2+infection" are people infected in 1st wave, then Pfizer-vaxxed (2 shots). They have better neutralization of omicron than only Pfizer-vaxxed .

A RNA boost 6mo after your last shot bumps Ab levels by 10x. You may need it. Some details: The 100x higher antibody levels of the infected+Pfizer vs Pfizer here is somewhat artifactual. The vax-only are ony 12 days post-vax. That's well before peak antibody response at 3-8 wks post-vax. OTOH the infection+vax are 27 days post-vax, so near peak protection.
Read 7 tweets
Dec 7, 2021
First results of mAb testing on omicron: looks good for sotrovimab. GSK and Vir say no loss of activity v compared to previous strains reuters.com/business/healt… Sotrovimab reduces deaths and hospitalizations by 79%. It requires just one 30min IV infusion. It's a very good drug. It's been approved in the US since May. The craziest thing in this crazy epidemic? UK's MHRA only approved it 4 days ago. bmj.com/content/375/bm…
Read 11 tweets
Dec 2, 2021
I've been getting 2 questions a lot:
1. If I'm J&J and I boost with Moderna/Pfizer, do I need a 2nd dose of Moderna/Pfizer?
2. If I'm J&J and I boosted with Moderna/Pfizer once, when should I boost again? Answers:
1. Congrats, you've chosen wisely to boost your J&J with Moderna or Pfizer. After 1 shot of either, you'll have more antibodies than people after 2x Moderna or 2x Pfizer
2. After you've boosted your J&J with Moderna or Pfizer, you're good for at least 6 months (vs Delta)
Read 28 tweets