SARS-CoV-2 is here to stay but COVID-19, as it’s name suggests, has an expiration date.
Post immune (esp💉💉💉) SARS-CoV-2 infection is nothing like COVID-19.
May 2022 be the year we vaccinate the entire 🌎, boost those who need it & banish naive COVID-19 to the annals of history Infection ≠ disease & vaccines are our best way to decouple infection from disease. We will never eradicate SARS-CoV-2 but post-immune SARS-CoV-2 infection isn’t necessarily COVID-19. The next few months will be rough, but in 2022 we will transition to post pandemic life.

Important tip on rapid antigen tests (RAT) for Omicron. In the last 2 days a few of my patients have tested RAT negative when collecting only nasal samples but positive on throat + nasal samples. See video for instructions on how to collect a good sample. Tips in following tweets

https://twitter.com/abbydietitian/status/1476610989126832132

First collect a throat sample. Stand in front of a mirror in a well lit room. Open 👄 wide, stick out 👅& say ahhh. You’ll see an arch at the back. Swab the tonsils, sides of arch & back of throat behind the arch (10 secs). Avoid touching 👅& 🦷
Next use same swab in👃tweet 👇

If Omicron carries the reinfection risk that available data suggest, then I’m concerned that ~35% of India population (<18) is ineligible for vaccination: ~500 million Indians!
Some estimate that ~50-70% <18 already been infected, but Omicron variant changes the implications
1/ Susceptible implies possibility of infection (& therefore contribution to transmission)
Vulnerable implies likely to have severe disease / poor outcomes if infected (🏥☠️)
Indians < 18 will likely be susceptible to infection due to Omicron variant, but most wont be vulnerable
2/

India has vaccine supply to vaccinate the eligible population with 2 doses, offer 3rd doses for elderly (60+), highly vulnerable population & exposed front line workers and contribute to global vaccine equity.

Here’s some back of the envelope maths

1/ India has capacity to manufacture 300 million doses per month.

~65% of 1.4 billion Indian are 18+ & eligible for vaccination, ie, ~900 million people x 2 doses
~1.8 billion doses

We have administered 1.24 billion doses

~560 million doses left to go

2/

timesofindia.indiatimes.com/india/india-to…

I’m not trying to be alarmist but a devastating 3rd wave due to Omicron is possible. That doesn’t mean it will happen. I don’t know enough about Omicron to say, but I do know that having a VOC wild card in the mix raises enough concern to scale preparedness on a war footing. Anyone saying wait to be certain before reacting is a fool who has learnt nothing despite 2 years of suffering consequences of delayed response. Move fast even when uncertain. Scaling down response if wave doesn’t come is easy, scaling up response when it comes is impossible.

How bad will an Omicron wave in India get?

Uncertain. Here’s how I think about this:

A)
What percent of the population is vulnerable to severe outcomes due to Omicron variant:
- virus transmissibility, virulence, impact on vaccines
- host immunity & protection it affords
1/ B) How much surge capacity does our system have?
- to reduce transmission : testing, tracing, isolation, quarantine, indoor air quality, N95s
- to reduce deaths
Hospital beds : hospital beds, ICU, meds, O2, non burnt out health staff
2/

If you own a business where customers come into a poorly ventilated indoor space, please do yourself, your staff & your customers a huge favor.
Install a low cost HEPA filter based air cleaner & a CO2 sensor. This will prevent far more infections that a sanitizer dispenser.
1/ The air cleaner will remove virus laden aerosols thus reducing the risk of airborne transmission of COVID-19.
The CO2 sensor will let you know if there are too many people in the space and help you manage numbers. If CO2 is high, you can add more air cleaners to make it safer.
2/

.@daraobriain is a legend 😂

Scientists explicitly warn about novel coronavirus spilling over and going pandemic for years.

No one listen. It happens.

Obviously the people who were warning about it and working to stop it get blamed.

If this pattern holds up, climate scientists are in for a rough one! Warning as early as 2007

journals.asm.org/doi/10.1128/CM…

New AIIMS/WHO study shows very high seroprevalence in India. Assay used detected total anti-RBD antibodies. This has very important implications for India’s COVID-19 vaccination program.
Many Indians (sero positive) will be adequately protected w/ 1 dose of COVISHIELD. A 🧵
1/

https://twitter.com/DevanSinha/status/1405678971610611712

The receptor binding domain (RBD) is the critical part of SARS-CoV-2 Spike protein that allows it to infect our cells. Most neutralizing Abs target the RBD. This study shows a large % of Indians have been exposed to the virus and have anti-RBD antibodies.
2/

Herd immunity wont protect you: #COVIDisAirborne

80% of your network is vaccinated. They form a ring of immunity around you, they reduce your chance of contact with an infected person.
But virus is airborne, so it floats right over that immune ring and gets you

A thread 🧵
1/ When a substantial number of people are vaccinated COVID-19 cases will drop, we will even contain the pandemic. But that doesn’t mean unvaccinated people are safe!

Imagine you work in an enclosed office without ventilation or air filtration. No attention to indoor air quality
2/

Interesting...
Look at B.1.617.2 in March 21 in Delhi and J&K. Real time genomic epidemiology would have saved us a world of hurt. H/t @VidurMahajan1

Reduction in Ct values suggests an actively growing epidemic @michaelmina_lab @jameshay218 @mlipsitch et al paper linked below
1/

https://twitter.com/medrxivpreprint/status/1400511717264740352

Real time genomic surveillance would have picked up on B.1.617.2 spreading in March and if policy makers responded appropriately we could have saved so many lives... need to start sequencing and analyzing in real-time. Need to integrate epi and clincal data like UK PHE
2/

In this thread I’m going to commit the cardinal scientific sin of oversimplification to try and explain vaccine, neutralizing antibodies and protection from infection/sickness/hospitalization/death

The numbers used here are to explain a concept and aren’t necessarily to scale
1/ Let’s imagine the virus can be killed by bullets.

These bullets are neutralizing antibodies - antibodies that neutralize (kill) the virus.

A few bullets will prevent death/hospitalization, more bullets will prevent illness, a lot of bullets may even prevent infection.
2/

Provided COVAXIN single dose efficacy is >70%, models support delaying COVAXIN 2nd dose except for 65 years +
We should have had quality Ph3 data and real world data on COVAXIN by now. Unbelievable that we’re still doing guess work.
🧵
1/ Modeling study helps us understand lives saved with delayed second dose of Covaxin.

Assuming vaccination rate of 0.3% of population / day. The total cumulative mortality on day 180 is seen to be lower as below depending on efficacy. Makes sense if efficacy >70%
2/

Here’s a plan to get India 10-20% extra COVISHIELD vaccines doses overnight!

How could this be possible? Read on to find out.

🧵 1/

Antibody Responses After a Single Dose of ChAdOx1 nCoV-19 Vaccine in HCWs Previously Infected with SARS-CoV-2 medrxiv.org/content/10.110… A study found that HCWs who had recovered from COVID-19 up-to 11 months prior responded incredibly to a single dose of AstraZeneca vaccine (COVISHIELD).
They had neutralizing antibodies against wild type virus but also neutralized P.1 & B.1.351 (immune escape variants)!
2/

If we have to wait till June for COVOVAX, Indian regulators should hang their heads in shame.
They gave COVAXIN an EUA without any efficacy data or Ph3. Novavax has efficacy data from Ph3 in U.K. and Ph2 in SA. Ph3 in USA and Mexico underway. 1/

https://twitter.com/adarpoonawalla/status/1355421280539791360

Indian regulators literally rewrote the rules for COVAXIN citing hypothetical superior efficacy against variants. What a load of BS (BOGUS science). They made up the restricted EUA in clinical trial mode BS. But a vaccine with 85%+ efficacy in Ph3 against B.1.1.7 is too risky! 2/

Let me just try to preempt all the BS (bad science) we will hear about hypothetical superiority of COVAXIN against variants vs Novavax. A thread 🧵 1/ Novavax is proven efficacious against OG COVID-19 and B.1.1.7 in a Phase 3 clinical trial in U.K. We should soon have the data in a preprint / peer reviewed publication. The confidence in the results will increase as more cases occur. 2/

Mumbai’s sero-prevelance study - detailed report with technical details : tcs.tifr.res.in/~sandeepj/avai… @CT_Bergstrom @mlipsitch @cmyeaton @nataliexdean @apoorva_nyc @velumania 1/ 2/Study period: 14 days in July 20.
Areas selected:Three wards (R-North, M-West and F-North) in Mumbai were chosen based on: (a) City and Suburban areas (b) East, West and North areas and (c) representative of areas with low to high prevalence based on reported cases on 02/06/20

Those of us following #RECOVERYtrial know it’s one of the most important clinical trials for COVID-19, not just for its potential to identify new therapeutic options but also to temper the excitement over unproven therapies. 1/

https://twitter.com/swapneilparikh/status/1264810177913651201

My thoughts on the RECOVERY trial PRESS release on mortality benefit for COVID-19 with dexamethasone.
RECOVERY trial is a large randomized controlled trial with multiple arms. 11k+ patients and multiple treatments being evaluated. See image for therapeutics under evaluation. 2/

@ShamikaRavi We explored the possible effect of the monsoons on transmission SARS-CoV-2 in #TheCoronavirusBook. Influenza does activity does spike in the monsoon and post monsoon period in tropical countries. 1/ @ShamikaRavi Possible reasons: clustering of people indoors with increased social contact, high RH + precipitation and decreased solar radiation can prolong viron stability, lower vitamin D levels may play a role. 2/

@ICMRDELHI conducted a seroprevalence study across India. In this study, they tested people for antibodies against SARS-CoV-2. Those testing positive have already been infected (with or without symptoms). Seroprevalence studies indicate what % of the country has been infected 1/ The study had 2 parts. The first part, which has been completed, looked at the % of the general population that has been infected. The second part is ongoing and is looking at the % of the population in hot zones that has been infected. 2/