maybe, just maybe, VAERS is being flooded with false reports from bad actors with ulterior motives?

So that's what I'm doing. Fully vaccinated I contracted Covid a week ago. Not pleasant. Isolating. And listening to the radio, to experts who say we're in 'the endgame', how well we've done, we can get back to normal. Er.. and wear a face mask if you're worried. (20)

And no one is accountable. Politicians say they follow the science. Advisers say Ministers must decide. No public inquiry, no resignations, a merry-go-round of Birthday Honours and George Crosses. Let's all forget about it and 'live with the virus'. Watch the football. (19)

The NHS staff get a pay cut. 1% rise with 2.5% inflation, a pay cut. They must understand there are other priorities. A new SERCO contract. A £250 million royal yacht. (18)

If more porters, nurses, doctors, care workers, bus drivers, factory workers must be infected and die, so be it. Because there is nothing we can do. We must 'live with the virus' and show the world how Britain knows best. (17)

Altruism must die. Because our banker health Minister is devoted to a dead, liberalist philosopher and screenwriter called Ayn Rand who once wrote a diatribe called 'The Virtue of Selfishness'. Do what thou wilt shall be the whole of the law. (16)

In the UK libertarian public health 'living with the virus' means that we must not compromise people's freedom to do what they like. If they prefer to cough and sneeze in a crowded train of commuters who must go to work, so be it. (15)

And no new G7 money is committed to Covax. And the main AZ franchise in India has its exports blocked. So Nepal, Bangladesh and the whole of Africa have virtually no vaccines. Tens of thousands die. Covax grinds to a halt. Cornwall superspreads. (14)

Yes, 95% plus of the money to develop the vaccines came from the public purse. But No we must protect the shareholders of big pharma companies. So a million people must die every month to sustain free markets. New variants must emerge so Big Pharma can make new vaccines. (13)

But the UK government already hosted a G7 meeting in Cornwall at which people hoped they will solve the global vaccine shortage. President Biden says share the patent with all countries so they can make the vaccine. Er... No say the UK, Germany and Canada. (12)

Vaccine escape science is ignored. Long Covid kept quiet. And its fine for 8.8 million children to be infected. Even though every other wealthy country is vaccinating them because benefits clearly outweigh the risks. No, lets give kid's vaccines to Africa say advisers. (11)

July 19 'freedom day' we shall have 50,000 cases per day say the leaders/advisers. But we can now 'live with the virus' because we are all vaccinated. Well, except children. And actually, only about half are fully protected with vaccines. Yes, admissions +deaths will go up. (10)

The third lockdown now ends in a staggered roadmap. Sir Patrick Vallance is alone in saying find, test, trace and isolate is crucial when case rates fall to low levels. In May cases fall to 1800 per day. But no changes r made to an ineffective system. So another wave begins. (9)

The £38 billion spent on consultants, cronys, private test companies, and an array of unapproved tests, is equivalent to ten years of funds for the whole UK public health programme. (8)

The vaccine arrived with a huge wave of nationalistic fervour. We are 'world-beating'. This time, luckily, the NHS stepped in to roll-out the vaccines. But local authorities and public health remained deprived of any financial support while £38 billion went private. (7)

But leaders/advisers stuck throughout to their belief that waves could not be controlled or suppressed. We could only have huge modelled waves and long national lockdowns until we got a vaccine. (6)

They refused to give any financial support to poor people in case "they gamed the system". So poor families had to game the test and trace system so they could keep working. Without 'national lockdowns' the virus just spread. (5)

Then our leaders/advisers set up a privatised, call centre public health system quite unlike anything the many successful Asian and other states did. And separate from our unfunded local public health teams. It couldn't possibly work. It didn't. (4)

We were forced into prolonged national lockdowns. Hugely damaging to livelihoods, the economy and mental health. None of the Asian states had national lockdowns, only local ones. Their economies had ten times less damage. (3)

Our leaders/advisers said you cannot suppress this virus. China and Vietnam did. Then they said these countries will inevitably face a huge second wave. They haven't - just smaller outbreaks that they jump on with good public health implemented by people on the ground. (2)

The story so far. About the failure of public health. Not masks. Look at the death rates in China (pop 1.4bn), Vietnam (100m), USA (340m) and UK (68m). Yes, you cannot see the death curves in the first two because they are so low. (1)

Here's the link to the article again Thanks @sophiescott2, @leonie_thorne and @NjbBari3

"Not allowing #COVID19 to circulate in Australia has already done a lot to help protect kids We've got excellent opportunity in Australia to learn from around the world - so many studies showing us what the risks are & also showing us great ways out of that situation

"With younger children <12, we know now they can get #COVID19 & can even die, however research still being done about whether vaccines are safe & effective for them It's important we let research & approval play out so we know about safety and efficacy of these vaccines for kids

"Vaccines for children likely to be part of solution Right now, #COVID19 vaccines in Australia only approved for ppl >16 & older. In US, UK & Canada, teens age 12 & up are already receiving them It's likely COVID-19 vaccines will eventually be approved for use in older children

"We want to keep kids at school as much as possible, so that (with these measures) school closures should only be very rarely necessary Now we know #COVID19 is airborne, we know that masks do help to limit transmission

"In situations when ventilation is difficult, such as bad weather, HEPA filters & other methods can help There's really good evidence coming in from around the world that HEPA filters are getting rid of aerosols in rooms, and that's what we need to be worried about #COVID19

"There are ways to protect children without vaccinations Rather than going straight for closing schools, we can look at having masks & look at ventilation in schools Carbon dioxide monitors are an easy way to work out if ventilation in classrooms is adequate #COVID19

"While full extent of the long-term effects of #COVID19 on kids is not yet known, experts are concerned "UK recently set up >10 specialised clinics to help kids w long COVID symptoms Data show 7-8% kids <16 report symptoms 12wks after COVID-19, UK's National Health Service says

"We now know...children transmit #COVID19, children do get sick from COVID, including long COVID, & they can die "Happens less than adults, but the risk is real "In the US alone, several hundred children have died from COVID & there is unknown number that will have long COVID"

#COVID19 & kids "Doctors say Australia needs to better protect school kids from #COVID19 through measures incl masks & vaccination" Thanks @sophiescott2 & @leonie_thorne @abcnews for informed & non alarmist article feat me & @NjbBari3 Thread #LongCovid #LongCovidKids

Much more detail in this thread for those who are interested. There are many things, like ventilation improvements, which will help, as well as vaccines for older kids & perhaps younger, if proven to be safe and effective in younger age groups

And follow these Australian docs & experts who've repeatedly made good calls on #COVID19 Compassionate, informed, visionary & trustworthy: @Globalbiosec @CrabbBrendan @profmiketoole @kate_cole_ @rajah_mich @drajm @venessb @YouAreLobbyLud

To be clear, I’m not talking about Australia but about other places, like UK, where this idea is forming Why we, one of the best #COVID19 performers, would want to emulate countries that have had such catastrophic outcomes is totally beyond me

As a pediatrician I'm going on record saying that allowing kids to be freely infected with a novel disease that has unknown long term consequences is the worst idea of 2021 despite being a pretty crowded field so far #COVID19

As a result it is going to take more than the sort of soundbite information we see in headlines to determine what is going on. As the Simpson’s paradox example illustrates, confounding can be a bear. Fortunately there are good people looking into these things in depth.

To be clear, I’m not arguing that one time slice of hospitalization numbers rules out waning or reduced efficacy against delta. I am trying to illustrate how VE calculated from aggregate numbers can be badly confounded and even trends from aggregate numbers can be misleading.

While I linked to him it in the second post and quoted from his blog subsequently, I want to again stress that this is @jsm2334’s observation. I came across it his blog. Please give him a follow for interesting and insightful COVID analysis.

7. As I mentioned, I have not spent enough time with the data to be 100% confident that this explains everything happening in Israel. That said, it does seem to be a strong alternative hypothesis to vaccine escape / waning, and merits serious consideration.

6. I believe it also explains the apparent drop in VE over time. When % vaxxed is low across the board, the association between being unvaxxed and being young is weak. As vaccine coverage increases to Israel levels, that association strengthens, driving the Simpson's paradox.

5. You may recognize this as an instance of Simpson's paradox. In this case, both cohorts have a much higher VE than the VE of the two cohorts aggregated together. This seems paradoxical, but results from the confounding described above.

4. This results are confounded by age. Irrespective of disease status most unvaxxed are young; irrespective of vaccine status most severe disease cases are old. This creates counterintuitive statistical result. VE overall is far lower than VE in under 50 or in people over 50.

3. Thanks also to @dylanhmorris who brought it to my attention, and @jbakcoleman and @BillHanage for discussion. The basic story is this: Looking at active severe cases in Israel we have 16.4/100K among unvaxxed and 5.3/100K among vaxxed. That looks like a mere 67.5% VE. But…

2. While I 've not spent enough time with the raw data to be willing to make absolute claims, I suspect this apparent decline may be an artifact; I think we can explain why; and I think this needs to be looked at seriously. @jsm2334 laid out the argument:

1. There has been lots of talk about recent data from Israel that seem to suggest a decline in vaccine efficacy against severe disease due to Delta, waning protection, or both. This may have even been a motivation for Biden's announcement that the US would be adopting boosters.

Another very compelling graph showing that, even in Israel with a massive outbreak, SERIOUS cases among vaccinated are very low (per capita) compared to vast number among unvaccinated. (All 60+ years of age). Pfizer vaccine has been VERY protective against serious disease.

Btw- VERY similar to findings in Israel. Quote Tweet(((Howard Forman)))@thehowie · 19 AugAnother very compelling graph showing that, even in Israel with a massive outbreak, SERIOUS cases among vaccinated are very low (per capita) compared to vast number among unvaccinated. (All 60+ years of age).

Connecticut Vaccine effectiveness in one chart 91% protection against ICU need. 80% protection against hospitalization. 86% of COVID patients in ICU are not fully vaccinated. Get vaccinated. Stay out of the ICU. Stay alive. Thank you for coming to my TED talk.

The U.S. is now averaging more than 900 Covid-deaths per day, the highest total since March.

6/6 Our study provides real-world evidence that heterologous ChAdOx/BNT immunisation with 10-12 week intervals is well-tolerated & elicits comparable immune responses as homologous BNT/BNT vaccination, with evidence of enhanced T cell reactivity.

5/6 These are the first interim results comparing immunogenicity of homologous BNT/BNT vs heterologous ChAdOx/BNT vaccination. Additional analyses on T cell responses and neutralisation are needed and currently ongoing...

4/6 Both homologous and heterologous vaccination elicited robust immune responses. Immunogenicity of heterologous ChAdOx/BNT boost was comparable to 2xBNT, with evidence of slightly increased T cell reactivity following heterologous booster vaccination.

3/6 Both regimens were well-tolerated and safe. Local reactions were frequently reported for all vaccines. Systemic reactions, incl. severe reactions, were most frequent following ChAdOx prime immunisation. Reactogenicity of BNT/BNT & ChAdOx/BNT boosters were comparable.

2/6 We report interim results of a prospective cohort study involving n=340 health care workers, comparing reactogenicity and immunogenicity of homologous BNT/BNT vs heterologous ChAdOx/BNT vaccination, at 3 and 10-12week intervals, respectively.

1/6 Our study comparing reactogenicity & immunogenicity of homologous (2xBNT/Pfizer) vs heterologous (AZ/ChAdOx +BNT) vaccination is available https://medrxiv.org/content/10.1101/2021.05.19.21257334v2… Great team effort @vmcorman #FlorianKurth #DavidHillus #TatjanaSchwarz #PinkusToberLau et al. @ChariteBerlin

This is the most important graph of the ‘third wave’. Thanks to @guardian for producing it.

As I didn't realize this thread would blow up, some additional clarifications: 1) My claim is based on my past analysis on the effectiveness of restrictions in the US: https://twitter.com/youyanggu/status/1397230156301930497… 2) Here is the original source which my Tweet was based from: https://businessinsider.com/uk-lifting-restrictions-increase-cases-euros-mystery-2021-8

To clarify, I am not anti-lockdown. If lockdown/restrictions work and the benefits are worth the trade-offs, then I'm all for it. I just haven't seen solid evidence of causal effectiveness & a thorough discussion of the trade-offs. I'm anti-bad science.

While cases in the UK reached similar levels as the Winter wave, deaths are less than 10% of the Winter wave. Unlike the fuzzy evidence on the effectiveness of restrictions, there is overwhelming evidence that vaccines are effective at reducing severe illness/death.

Many bad papers looked at these curves in 2020 & concluded that more restrictions is followed by a decline in cases, when the decline would've happened regardless. If we apply the same flawed logic here, one can say that the lifting of restrictions is followed by fewer cases.

It's interesting that some experts would rather question the accuracy of the data than acknowledge this reality.

People were worried cases would spike further when the UK lifted almost all remaining restrictions in July. The opposite happened. We must acknowledge that restrictions aren't all that effective in Western countries. (Except Australia, who just entered their 6th lockdown)

Most of those numbers are in the column, which focuses on a) the risk of the Delta variant to children under 12 and b) the 29% of Canadians who are not fully vaccinated. Brace yourself for more COVID-19 nastiness https://theglobeandmail.com/opinion/article-brace-yourself-for-more-covid-19-nastiness/…Quote Tweet

https://images.app.goo.gl/taGgu2hEGMEQBzfe7… You know what this yellow vaccination booklet is? It's the other name for #VaccinePassports. There is nothing whatsoever controversial about being able to show the vaccines you've had.

Dose 1 of 2 Progress ▓▓▓▓▓▓▓▓▓▓░░░░░ 68.5% Fully Vaccinated Progress ▓▓▓▓▓▓▓▓▓░░░░░░ 57.1% As of Wednesday, 14 Jul 2021. Note: percentages of 16+ population only. Data sources in bio. #CovidVaccine #COVID19 #COVID19Ireland

no it doesn't- it reflects the statistics of what, mathematically, has to happen as more and more people are vaccinated with a vaccine of less than 100% efficacy (as all vaccines are)

N serology at end of follow up could solve problem of bias from unobserved infectionsAnalyzing Vaccine Trials in Epidemics With Mild and Asymptomatic InfectionAbstract. Vaccine efficacy against susceptibility to infection (VES), regardless of symptoms, is an important endpoint of vaccine trials for pathogens with a hiacademic.oup.com

Baseline testing helps but doesn’t solve the problem if some infections undetected during follow up. So artifacts like this and heterogeneous frailty could contribute to estimates of waning in Pfizer RCT

Our amazing @SciBeh volunteers are launching on TikTok with messages about vaccine hesitancy: https://vm.tiktok.com/ZMdSt4fEm/ @Sander_vdLinden @roozenbot @adamhfinn @CorneliaBetsch @PhilippMSchmid @philipplenz6 @AnaSKozyreva

6/ A: continued... There is no data to support the use of drugs like hydroxychloroquine https://cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013587.pub2/full?highlightAbstract=hydroxychloroquine%7Chydroxychloroquin… & ivermectin to treat COVID. https://cochranelibrary.com/cdsr/doi/10.1002/14651858.CD015017.pub2/full… Vaccines are our way to the other side of this pandemic. We would be there if we used all the tools available.

5/ A: continued... In fact, the ODDS ARE that if they're NOT infectious disease specialists or epidemiologists, the odds are that these doctors in the media ARE SPEWING MIS-/DIS-INFORMATION. They should be disciplined by state medical licensing boards:

4/ A: continued... Doctors are allowed to tell the truth. There are doctors who are massive mis-/dis-information spreaders who don't tell the truth to patients, the public, or in the media.

3/ Q: "If doctors were allowed to tell the truth and treat their patients with therapeutics, we would not have hospitals full of sick people dying... What works? What will save lives? And it's not the vaccine." A: WOW. continued...

2/ Q: "If Mr. Doctor gives me a vial and says 'trust me,' I'll give you a vial, & you trust me." A: I'm Ms. Doctor. We study & train for YEARS—to earn that trust & to earn that privilege (a MINIMUM of 11 years after high school).

1/ PROFOUNDLY DISTURBING clips from a town hall with Arkansas @AsaHutchinson. Q: What's in the vaccine? A: Here are full ingredient lists: Pfizer: https://fda.gov/media/144413/download… Moderna: https://fda.gov/media/144637/download… J&J: https://fda.gov/media/146304/download…

3/ Most people who get Guillain-Barré syndrome RECOVER FULLY.

2/ Baseline rate of Guillain-Barré syndrome (i.e. not due to vaccination) is 3-6K cases/year out of 330M people in the U.S. (~0.001%). Often follows respiratory (e.g. influenza, CMV, EBV, Mycoplasma) or gastrointestinal (e.g. Campylobacter) infection, or HIV.

1/ J&J COVID vaccine linked VERY RARELY to Guillain-Barré syndrome (GBS). https://washingtonpost.com/health/2021/07/12/johnson-and-johnson-warning/… - 100 prelim reports of GBS out of 12.8M doses (0.0008%) - about 2 weeks after vaccination - mostly in men - mostly in 50+ years-old

Rest of the world watching closely: ‘In Scotland, estimated that 92.5% of adults would have tested positive for antibodies against SARS-CoV-2 on a blood test in the week beginning 12 July 2021’- is this enough to dampen transmission & protect under 12s from infection? Under 18s?

Yes, we now face a more formidable foe with Delta. The war has indeed changed. But the tools we need to win it haven’t. So let’s all take a deep breath. The vaccines are working just fine.

That’s why, for the unvaccinated, right now may be the most dangerous time of the pandemic. For the fully immunized, I cover what all the recent news means for you in the piece.

Even with Delta, the likelihood of severe illness if you’re fully immunized is still a small fraction of the likelihood for the unvaccinated. In other words, nearly every COVID-19-related death right now is preventable with vaccination.

Yes, Delta has shaved a few points off the vaccines’ ability to prevent symptomatic illness. But they still perform beyond our most optimistic projections at the thing that matters most: keeping people alive.

We always expected breakthrough infections. And as more people get vaccinated, we expect more infections in vaccinated people. Do you know someone who got Covid despite being fully vaccinated? Probably. Me too. But that doesn’t mean the vaccines aren’t working.

Misleading headlines and leaked slides added to everyones worry. Everyone is asking me: “I’m fully vaccinated…but do the shots still protect me?” Of course they do. The vaccines are incredible, but they’re not perfect. They never were.

I understand everyone’s concern. Delta cases are surging nationally. Some pharmaceutical companies say their vaccines hold up, while others are less sure. And in the aftermath of the Provincetown outbreak, hot vax summer started feeling more like hot mask summer overnight.

Are you fully vaccinated but worried about Delta? You’re not alone. In my latest for @TheAtlantic, I explain why everyone needs to relax. The vaccines are still working just fine.

time lapse of community prevelence from 7/1 to 8/1

Here is what happens when you open at 50%.Quote TweetBNO Newsroom@BNODesk · 6 AugMore than 1% of Florida's population tested positive for COVID-19 during the past 2 weeks https://newsnodes.com/us_state/FL

NYT FTWQuote TweetJennifer Berkshire@BisforBerkshire · 6 AugReplying to @JennBinisThis paragraph from today’s NYT almost killed me

ok, but I would have hoped that in an ideal public communication medium for science, people had megaphones that were commensurate with their skills and expertise, if there was variation among platform members at all. And I'd hope that users were calibrated re own expertise

This is such a recipe for disaster. I feel for parents & kids in TexasQuote TweetWFAA@wfaa · 6 AugOn Thursday, the Texas Education Agency released new guidance for schools on how to handle positive COVID-19 cases. More: https://bit.ly/3jkLzFi

More than 96% of US doctors have been fully vaccinated for COVID-19.

Vaccines work in a gif update: COVID19 cases versus vaccination rates in US states through time. The Delta variant effect can be seen clearly starting in July. States with lower vaccination rates are affected much worse.

10. Gray: 1. #Sisonke data shows there is good durability for the protection that the #JnJ jab provides: - Protection @ hospitalisation (65%) was the same 28 days after vaccination and 120 days after vaccination 2. Sisonke data shows, at this stage, no booster shot is required

9. Gray: Is the #JnJ jab safe? 1. #Sisonke data showed that the #JnJ vaccine is safe to use 2. Two rare blood clot events occurred among trial participants, but both cases have fully recovered 3. Sisonke will continue to monitor participants for 2 more years to assess safety

8. Gray: What about protection @ specifically Delta and Beta? 1. The #JnJ jab provided 67% protection @ hospitalisation as a result of infection with the #Beta variant 2. JnJ vaccine provided 71% of protection @ hospitalisation as a result of infection by the #DeltaVariant

7. Gray: What kind of protection did the #JnJ provide against hospitalisation and death in #Sisonke? 1. The JnJ jab provided 65-66% protection @ hospitalisation 2. The JnJ jab provided 91-95% protection @ death

6. Gray: 1. #Sisonke data shows the #JnJ vaccine provides protection against both the #BetaVariant and #DeltaVariant 2. The JnJ jab provides better protection against Delta than Beta, in other words vaccine efficacy for Delta is higher than for Beta

5. Gray: #Sisonke data shows the #JnJ vaccine provided 91-96.2% protection against death among #HealthWorker trial participants SA

3. Gray: #Sisonke researchers used three sets of data to analyse the study's results: 1. 2 sets of data from medical insurers were used and one set of provincial persal data 2. Today Gray is only reporting on two sets of data

2. Gray: 1. #Sisonke vaccinated 477 234 #HealthWorkers 2. 122 sites were used to vaccinate health workers

4. Gray: 1. #Sisonke ran from 17 February to 17 July (to collect data) 2. Researchers will continue to monitor trial participants for another two years to assess the durability of the protection that the #JnJ vaccine provides

[Thread] 1. Glenda Gray, co-lead investigator, #Sisonke: We now have results to show the #JnJ jab provides significant protection @ the #DeltaVariant in SA. What is Sisonke? The Sisonke study used the #JnJ jab to look @ the effectiveness of the jab among SA #HealthWorkers

More people have died of COVID in 2021 than in 2020. How are we in “a better place”?Quote TweetKate Sullivan@KateSullivanDC · 6 AugJen Psaki on the Delta variant: “This is not March 2020, or even January 2021. We're not going to lock down our economy or our schools because our country's in a much stronger place than when we took office.”

With test positivity > 22% you can imagine what the real case N is

If true, this indicates release for tomorrow will be a new single day record of 23,652. Will confirm after 5 pm todayQuote TweetWESH 2 News@WESH · 6 AugFlorida reports more than 134,500 new COVID cases this week, surpassing last week's high https://wesh.com/article/new-cases-covid-19-florida-surge-weekly-high/37246101?utm_campaign=snd-autopilot

And the role of luck, particularly in the early stages of an outbreak... 4/4

The subtle anchoring in the suggestion that the death of 0.2% of a population was a light outcome... 3/

The suggestion that some countries could use border closures in response to a similar pandemic... 2/

Reading with hindsight, some interesting details in this 2018 piece on the places that escaped the 1918 pandemic... 1/

Steep drop in UK cases is over. 7-day moving average now back to 26.7K/day and rising. To those who said that this was over, it is not. To those who said that lifting restrictions on July 19th would have no effect, it may well have had effect. Be humble. Too many unknowns.

US COVID Deaths Fully vaccinated (left) Not fully vaccinated (right)

3.5 billion people in have not had a single Covid Meanwhile, rich nations are: - throwing away expired vaccines - giving booster shots - offering lotteries to people who are hesitant - hoarding doses for next year 𝙃𝙊𝙒 𝙒𝙄𝙇𝙇 𝙏𝙃𝙄𝙎 𝙋𝘼𝙉𝘿𝙀𝙈𝙄𝘾 𝙀𝙑𝙀𝙍 𝙀𝙉𝘿?

So in sum, denominators matter! When scrolling past headlines, be sure to think about what denominators are in play 6/6

We calculate vaccine efficacy as (risk among unvaccinated - risk among vaccinated) / risk among unvaccinated so in this case, 89% (yay!) 5/6

What you need to do is look at the rates among the vaccinated and unvaccinated separately, and then compare them. Here 11% of the vaccinated got sick, 100% of the unvaccinated got sick. 4/6

In this scenario, 50% of the sick were vaccinated, but this is the wrong metric to look at! It is using the wrong denominator. It doesn't take into account that *90%* of the population is vaccinated (yay!) 3/6

More incredible support for the @VaccineEmoji today! Thanks to Dr. Faust, Dr. Cleavon, and hundreds of other people who have shared our posts This can happen if we keep pushing it! Pass this amazing emoji along

If you see something like x% of the sick/hospitalized/deceased were vaccinated, the *better* the vaccine uptake the *scarier* this number will seem! It is using the wrong denominator. For example, here is a scenario with 90% vaccination, 4 people got sick: 2 vaxed 2 unvaxed 2/6

I've seen a lot today about how effective the vaccines are; mistakes aside, lots of folks seem to be mixing up which denominators matter - good thing statisticians *LOVE* denominators 1/6

.@Comcast, one of the main sources of revenue for @FoxNews, doesn’t want you to see this ad.

Through COVAX, 1 million Johnson & Johnson doses arrived in Bolivia today.

Please — listen to the experts. 97% of those *hospitalized* from COVID-19 are unvaccinated. Over 99% of those *dying* from COVID-19 are unvaccinated. This is not political. It is not a hoax. I got my vaccine right away and you should too.

DeSantis - who signed a bill outlawing vaccine passports, blames “experts” for public distrust of vaccines, sells “Don’t Fauci My Florida” merch and was hesitant to disclose his own vaccination — wants you to know “vaccines are saving lives.”

"Among those aged 60-plus, early vaccinators are twice as likely to get infected. For those aged 40-59 early vaccinators are 2.1 times more vulnerable, and among under 39s they are 1.6 more likely to catch the coronavirus."

As there's a lot of "this is all EU politics" out there on AZ drug admission: some food for thought. I have deleted a lot of tweets on this. I will try to be brief, informative and neutral. (Thread)

“It's really important we don't situate vaccine hesitancy and low uptake of the vaccine as a problem of particular individuals or communities." @ProfKevinFenton joins the #DeepBreathIn podcast to talk covid vaccines and their uptake http://ow.ly/iIXf50DMtDE http://ow.ly/dAzS50DMtDF

There seems to be a concerted effort today by Fox's daytime news shows to promote the vaccines to its audience. Dr. Marc Siegel says "the Delta variant needs to be a wake-up call to get vaccinated." Anchor John Roberts then directs viewers to the government vaccine website.

Correcting a statistic I gave at the press conference today, 19 July. About 60% of hospitalisations from covid are not from double vaccinated people, rather 60% of hospitalisations from covid are currently from unvaccinated people.

Last night @SliderCuts & I discussed qq his 95k+ followers have about #COVID19 vaccines. Went on > 1.5 hrs in the end!! Pple have reasonable concerns that need to be heard and understood & happy to (hopefully) help address. Watch here https://instagram.com/tv/CLcu-UFB8Xy/?igshid=irvs1mlis0o9… @IndependentSage

CDC COVID tracker currently counts under 18 year old COVID deaths at 517 (based on 500k of >610k total deaths, so likely higher) https://covid.cdc.gov/covid-data-tracker/#demographics

apps.who.int/iris/rest/bitstreams/1358525/retrieve… just out from @WHO Guidance on conducting vaccine effectiveness evaluations in the setting of new SARS-CoV-2 variants INTERIM GUIDANCE 22 JULY 2021

Good news: vaccine hesitancy collapses Smart data analysis from @TheEconomist https://economist.com/graphic-detail/2021/07/24/the-right-and-wrong-ways-to-reduce-vaccine-hesitancy

The restrictions may be going, but the UK's Covid disaster will not be forgotten. (Sound on)

NEW: B.1617.2 is fuelling a third wave in the UK, with not only cases but also hospital admissions rising. Vaccines will make this wave different to those that have come before, but it remains a concern, and one that other countries will soon face. Thread on everything we know:

Democrats are now putting on masks — not because the vaccine suddenly stopped working — they’re wearing masks because it is a virtue signal of submissiveness.

this tweet is from a US senator who was educated at Princeton and Harvard Law School who won top speaker awards at both the 1992 US and North American debating championships...

And story here:

Informative thread here:

Over half of those who answered "wait and see" to @KFF's vaccine poll in January have now received the vaccine. So what changed their mind? - Seeing friends and family without side effects - Doctors and healthcare providers encouraging them https://kff.org/coronavirus-covid-19/poll-finding/kff-covid-19-vaccine-monitor-in-their-own-words-six-months-later/

Fox News has put in place a vaccine passport system for their employees. Pass it on.

This is what happens when your hospitals are over-run with cases. It affects everyone.Quote Tweet

Cower from this virus, or risk serious complications. It’s not a cold.

Please avoid a breakthrough infection with this virus. I believe breakthrough infections with Anosmia represent olfactory bulb damage and seeding I can't deny the neurovascular and neurological findings in preclinical models Please wear an N95 mask and do not remove it indoors

Me too Asha.

Why are we arguing over the same crap over and over?? Doctors have been explaining ad nauseam how and why masks work and why vaccines are safe and effective. At this point anyone “debating” these issues is either stupid or sadistic. I’m just exhausted

COVID19 vaccines are safe, effective, and lifesaving. Employer mandates can cut through the swirling misinformation on this topic and bring the pandemic in America to an end. Listen to the whole convo with @PJSkerret on @STATnews First Opinion podcast:

Employer vaccine mandates are ethical, effective, and will save lives. The health care industry should lead the way: care providers have a moral obligation to their patients, & remaining unvaccinated during a pandemic shirks their responsibility to do no harm.

States have tried million dollar lotteries and other incentives, yet only 1% of the population is being vaccinated each week. With cases surging across the US, the unvaccinated & partially vaccinated are increasingly at risk. In areas w/ low vaccination rates, deaths are spiking.

Masks are off, theaters and indoor dining are back: life seems to be returning to normal. But the highly transmissible Delta variant is spreading quickly, & we aren’t even halfway to a fully vaccinated population. It’s time for employer vaccine mandates.

In discussing future pandemic plans (as well as plans for COVID in coming months), it will be crucial to distinguish between what are genuine and perceived constraints - because it will be impossible to define what is optimal without this distinction. 9/9

As @hannahhec put it last March: "constraints may be real, but they may be moveable, either by the mobilisation of resources, or by updating the mental model about what is possible". https://channelnewsasia.com/news/commentary/covid-19-coronavirus-best-practices-singapore-success-strategy-12585706… 8/

There's also the question of scaled up testing regardless of symptoms. Places like China and South Korea did a lot early on, while others like Japan and Taiwan did relatively little (e.g. from last Aug: https://international.thenewslens.com/article/139685). Again, need to consider underlying reasons. 7/

Another topic is border measures - UK measures currently much stricter than most of Europe, but not as nearly as strict as some places as Asia Pacific. This constraint has shifted quite a lot - yet not fully in many countries. We should consider why. https://twitter.com/AdamJKucharski/status/1389940764587745281?s=20… 6/Quote Tweet

Stringency and sustainability can make big difference to outcomes. During the 1918 pandemic in US, the introduction of NPIs reduced impact - but they didn't remain in place for long and epidemics still ended with accumulation of immunity, e.g. https://pnas.org/content/104/18/7582… 5/

Adam Kucharski@AdamJKucharski·25 MayReplying to @AdamJKucharskiIn contrast, attitudes to duration/stringency of NPIs have shifted dramatically. Look back to Feb 2020 & prominent figures were raising human rights concerns about China lockdown. But by mid-March, countries had abandoned earlier perceived constraints: https://theconversation.com/what-we-learned-from-tracking-every-covid-policy-in-the-world-157721… 4/

It's worth reading these papers on the response in Taiwan (https://jamanetwork.com/journals/jama/fullarticle/2762689…) and Korea (https://jamanetwork.com/journals/jama/fullarticle/2765252…). Should more countries include these data-intense approaches in future pandemic plans? Or does reluctance to date reflect an immovable constraint? 3/

Some apparent local constraints have persisted throughout the pandemic. For example if you look globally, there are still notable differences in approaches to surveillance and quarantine... 2/Quote TweetAdam Kucharski@AdamJKucharski · 1 May 2020As many countries start to expand isolation and tracing efforts, it's worth highlighting a couple of important aspects of the response in places like Taiwan, Korea and Hong Kong: surveillance infrastructure and strict enforcement. 1/Show this thread

One thing that has hugely shaped countries' response to COVID, and which I don't think gets enough discussion: genuine constraints and perceived constraints. A thread... 1/

An update on the B.1.617.2 lineage. I'm concerned. Not because of reduced vaccine efficacy, but simply because a further increase in transmissibility above B.1.1.7 would be quite bad news for countries where vaccination is low and for hopes of near-elimination everywhere.Quote TweetJohn Burn-Murdoch@jburnmurdoch · 27 MayNEW: B.1617.2 is fuelling a third wave in the UK, with not only cases but also hospital admissions rising. Vaccines will make this wave different to those that have come before, but it remains a concern, and one that other countries will soon face. Thread on everything we know:Show this thread

Weekly update This will be the last US domestic visualization Details -> https://github.com/hsayama/COVID-19-geographical-animations

@skellydonal @ShonaCMoore

18/Many thanks to the many healthcare workers who took part, @DHSCgovuk who funded the study, plus our other funders @UKCICstudy @UKRI_News @NIHRresearch

17/These immunology results are at a population level, not individual, & there is huge variation in responses. Don’t worry if you got 2 vaccines on a “short” interval – 2 jabs are great! Please accept vaccines when you are offered them

16/Importantly we do not know yet what this means clinically for protection from infection or severe disease over time after the 2nd dose. We also do not know yet whether responses are more durable after “long” interval dosing – we will follow up

15/Unlike neutralising antibodies, T cell responses to spike did not demonstrate immune escape for the Delta variant in our assay. Go T cells!

14/… But T cells were again well maintained over time, just like after a single dose

13/Finally, we looked at what happens over time in #SARSCoV2 naïve people who had the “short” course dosing. Neutralising antibody levels had dropped significantly by week 13 after the 2nd dose…

12/We looked more closely at the character of the T cells and found the “long” interval resulted in more “helper” CD4+ T cells in SARS-CoV-2 naïve people. This may be an important factor in explaining the better antibody responses we see in this group

11/What about T cells? Again, we saw a different pattern to antibodies. The “long” interval did not result in higher T cell responses. In fact, the T cell response after the 2nd dose was slightly lower in SARS-CoV-2 naïve people (grey) receiving the “long” dosing regimen

10/This is mirrored in neutralisation assays, where in #SARSCoV2 naïve people, the “long” interval results in higher neutralising antibodies after the 2nd dose, including against the beta, gamma and delta variants

9/Does the dosing interval have an impact on your ‘final’ immune response? In #SARSCoV2 naïve people (grey), the ”long” interval results in higher antibody levels after the full course compared to the “short” interval; there is no difference in those previously infected (red)

7/This is mirrored by binding antibodies (easier to measure than neutralising antibodies) in #SARSCoV2 naïve people (grey). In those previously infected (red), we still see a drop during the “long” interval, but to a lesser extent and antibodies are maintained at a higher level

8/Interestingly (well we thought so as T cell enthusiasts), the T cell response behaved differently and was maintained after 1 dose during this “long” dosing interval in both #SARSCoV2 naïve (grey) and previously infected (red) individuals

6/In #SARSCoV2 naïve people who had “long” interval dosing neutralising antibody levels in blood (using ‘live’ virus by Screaton lab) drop during this interval. By 10 weeks, neutralising activity against the Delta variant is minimal, but a good response is seen after the 2nd dose

5/Firstly, to put our results in context, in the @PHE_uk #SIRENstudy led by @SMHopkins sustained protection following a single Pfizer dose was seen in healthcare workers out to 12 weeks. Caveat: this was at a time when the Alpha variant was dominant

4)What happens to antibodies and T cells during this “long” interval? 1)Is there a difference in the immune responses after the 2nd Pfizer dose in people getting the “short” (average 3 weeks) compared to “long” (average 10 weeks) dosing regimen?

3/Extension of the interval between vaccine doses for the BNT162b2 mRNA vaccine was introduced in the UK to accelerate population coverage with a single dose. Recruiting 503 healthcare workers across 5 UK centres, we set out to answer some questions...

2/Led by @rebecca37704429 and @susannajd with Paul Klenerman and Miles Carroll (not on twitter!)@DHSCgovuk @UKCICstudy @PHE_uk @stephanie200586 @chrisjaduncan @eleanorbarnesox @alexrichter3 @sarahlrj @LanceTurtle and more!

1/Our PITCH consortium preprint on immune responses during different Pfizer BNT162b2 dosing regimens is out! https://pitch-study.org TL;DR get both doses of whichever vaccine you are offered

Just to correct one misconception from my thread - many of you understood that we think there is no waning immunity. This analysis does not reject the waning hypothesis, it just shows that the vaccines are still highly effective even with possible waning.

So to summarize, the vaccines are highly effective in preventing severe cases and probably also symptomatic diseases, even for those vaccinated early.

This is what we got wrong. This “wave” started from cities with high vaccination rate and couldn’t “find” unvaccined adults at risk. The denominator we need to use until mid-July is >95% vaccination rate and not the country’s average.

We can see that cities on the lower quartile had low number of cases until recently, but since mid-July, most cases are coming from those cities.

So why does it look like there is no difference until mid-July? @AArgoetti looked at the trends of cases in cities stratified by their vaccination rates.

and now there are almost 3 times more daily new unvaccined severe cases. Looking at this plot, it seems that the R in the vaccined group is very close to 1, but in the last 10 days its almost 4 in the unvaccined group. We think its as expected with no mitigations beyond vaccines.

See this graph. Until mid-July, the number (normalized to group size) of severe cases in the 65+ group was more or less similar between vaccined and unvaccined. This seemed troubling. But in the last 10 days trends have changed,

You’ve probably seen reports from Israel on low vaccine effectiveness in this wave. Is it because of Delta? Waning immunity? We think the reason is mostly that we got the denominator wrong.Quote TweetDvir Aran@dvir_a · 21 JulAre we seeing immunity waning in Israel? The MoH shared some raw data, and together with @geller_mic we tried to get a qualitative answer to this question. TL;DR – it seems that there is immunity waning, increasing risk of infection of early vaccinated by ~80%. ==>Show this thread

Vaccine impact in Israel: changing trends. Analysis thread with @AArgoetti. From about a month and a half ago we are experiencing a new “Delta” burst. Cases are accumulating, and more and more severe patients are in the hospitals.Quote TweetAmir Argoetti@AArgoetti · 27 Julשינוי מגמה בארץ - הגל ״תפס״ את הלא מחוסנים. @dvir_a ואנוכי הסתכלנו על המידע העדכני וניסינו לנתח את המידע הגולמי על מנת שנוכל להעריך טוב יותר את מצב התחלואה ואת יעילות החיסון. שרשור! >Show this thread

Update:

And in case you're interested in more details on transmissibility of the Delta variant, here are some useful references: https://eurosurveillance.org/content/10.2807/1560-7917.ES.2021.26.24.2100509… from @fcampbell_ and the @WHO Health Emergencies Team https://bit.ly/react-1-round-12… from @SRileyIDD and the REACT study teamREACT-1 round 12 report: resurgence of SARS-CoV-2 infections in England associated with increased...Background England entered a third national lockdown from 6 January 2021 due to the COVID-19 pandemic. Despite a successful vaccine rollout during the first half of 2021, cases and hospitalisations...medrxiv.org

My take (4/4): Please get vaccinated when you're eligible. For now, continue to mask, sanitize, distance, ventilate, and if you can #stayhome. We owe it to each other and the health workers who have worked tirelessly throughout the pandemic and still have a long way to go.

My take (3/4): The last 15 months have been brutal for those of us in SA, as in most of the world. The next few months will continue to try us. Vaccination brings our best hope of making COVID manageable.

My take (2/4): The Delta variant dominates transmission in SA. Delta is ~2X as transmissible as the original virus and ~1.5X as transmissible as Beta. With what is likely <50% population-level immunity, we are in a similar boat to a year ago regarding transmission potential.

My take (1/4): Overall, seroprevalence in SA appears to be around 43%. The percent of people protected by natural immunity and vaccination may be higher. The test used in this study does not detect vaccine-derived antibodies, and the estimates could reflect some antibody waning.

The study is primarily funded by @theSANBS and @The_WCBS. #SACEMA and its researchers are funded by @dsigovza and @NRF_News. The study used the @Roche Elecsys platform, which detects antibodies produced by natural infection that bind to the N protein of the SARS-CoV-2 virus.

Juliet Pulliam, PhD@SACEMAdirector·28 JunThe new data are based on samples collected in May 2021, using the same methods as described in the earlier preprint from Sykes et al: https://researchsquare.com/article/rs-233375/v1… The study was led by @Marionvermeulen with data analysis by @laurettemhlanga, Dr Eduard Grebe, and Prof Alex Welte.Prevalence of anti-SARS-CoV-2 antibodies among blood donors in Northern Cape, KwaZulu-Natal,...Background: Population-level estimates of prevalence of anti-SARS-CoV-2 antibody positivity (seroprevalence) is a crucial epidemiological indicator for tracking the Covid-19 epidemic. Such data are...researchsquare.com

Juliet Pulliam, PhD@SACEMAdirector·28 Jun@theSANBS, @The_WCBS, and #SACEMA have released new information on SARS-CoV-2 seroprevalence among blood donors in South Africa, including in the 5 provinces for which data were not previously available. #NotYetPeerReviewed A full preprint will be released soon.

Worth reading thread below – and here's current epidemic curve for comparison:Quote TweetJuliet Pulliam, PhD@SACEMAdirector · 28 Jun@theSANBS, @The_WCBS, and #SACEMA have released new information on SARS-CoV-2 seroprevalence among blood donors in South Africa, including in the 5 provinces for which data were not previously available. #NotYetPeerReviewed A full preprint will be released soon.Show this thread