Our new paper out today in Science. Wonderful team effort, showing the importance of innate immunity in the earliest stages of respiratory viral infection... please re-tweet!
@ArisKatzourakis
@BBCNews
I did a rapid response interview on the BBC news channel this morning to say that vaccine side effects very, very rare in comparison with the preventable risks of COVID-19. The staff seemed alarmed and embarrassed that they had given him the a platform.
I'm so pleased to get this award, which is actually a tribute to all fantastic people I've worked with and all those who have promoted immunology, collaboration and mutual kindness in science. Thank you all.
We’re delighted that Prof Peter Openshaw,
@p_openshaw
, our past President, has been awarded a CBE in the
#NewYearHonours
in recognition of his services to Medicine & Immunology🎖️
All at the BSI send Peter our warm congratulations✨
Read more👇
Particularly interesting is the comparison of the viral load by PCR (viral genome) vs. the virus that is infectious (by culture). There is no infectious virus beyond day 8; RNA can be found long after and is also found in stool. Importantly, there is no live virus in stool.
Important new paper showing sites of
#COVID19
viral shedding and timing vs. symptoms. Mainly throat and lungs, with very high virus titers, and seroconversion after 7 days. Also in GI tract. Throat swabs likely sufficient for testing.
What a great start to the day. Just think what this could mean. Feel the grin widen and think of the suffering this might prevent. Science is just great.
Today, we shared positive pre-clinical data demonstrating our ability to combine 6 mRNAs against 3 different respiratory viruses in 1 vaccine: COVID-19 booster + Flu booster + RSV booster.
#mRNA
Roche: 'we will provide tocilizumab for free during the emergency, the only limit will be our need to maintain supplies for those patients using it to treat other pathologies.'
Roche: “fornire gratuitamente per il periodo dell’emergenza” il farmaco tocilizumab (RoActemra), con l’unico limite del mantenimento delle scorte necessarie per continuare a trattare quei pazienti che già fanno uso del medicinale per curare altre patologie."
While adenovirus 41 is a possible underlying cause, it does not fully explain the clinical picture. Infection with this adenovirus has not previously been linked to such a clinical presentation.
🆕
@WHO
Disease Outbreak News: Multi-Country – Acute, severe hepatitis of unknown origin in children
As of 21 April, 169 cases (aged 1 month to 16 years old) reported in 🇬🇧 🇪🇸 🇮🇱 🇺🇸 🇩🇰 🇮🇪 🇳🇱 🇮🇹 🇳🇴 🇫🇷 🇷🇴 🇧🇪. More info 👇
@PeteUK7
@danwalker9999
To be clear, I'm not advocating getting repeated infections as a way to build up immunity, and strongly believe that vaccination and avoiding infection is the preferred way to protect against illness.
It was wrong to believe that 'saving the economy' was an alternative to 'saving people's lives’.
If anything it is the other way around and the two goals go together so that countries that kept the health impact of the pandemic lower suffered smaller economic consequences.
"So, is COVID-19 vaccination safe during pregnancy? The data so far suggest that it is and, given the increased risks associated with COVID-19 in pregnancy, many pregnant people have decided to accept the vaccine."
Very interesting. Perhaps Omicron has developed a preference for ciliated epithelial cells like those in the nose, trachea, bronchus etc. and is getting better adapted to those areas (like RSV). This just compared ciliated bronchus to lung tissue.
Very interesting analyses about the virology of
#Omicron
, which may explain the faster spread of this variant.
According to a new lab study, Omicron infects & multiplies ~70x faster than the Delta variant and the wild type SARS-CoV-2 in the human bronchus, but not in the lung.
mRNA-1345 vaccine against RSV based on prefusion F glycoprotein expression. mRNA-1345 uses the same lipid nanoparticle (LNP) as Moderna’s authorized COVID-19 vaccine and contains optimized protein and codon sequences.
“Thousands of highly educated scientists, doctors, pharmacists, and at least four major medicines regulators missed a fraud so apparent that it might as well have come with a flashing neon sign. "
This is the culmination of 10 years of fantastic effort by the whole team. T and B cells put in the shade by innate defenses in the respiratory mucosa. Shows the power of human challenge to reveal mechanisms. Please retweet 👍📣
Please pass this on- inadequate swab technique leads to false negative tests. Really important to know how it's done or people will be deemed PCR negative when actually infected, and potentially infectious.
Andrew Pollard nails it again: The UK's NHS has transformed healthcare by training clinical research leaders, but they must have protected time to deliver. This cannot be achieved while doctors and nurses are drowning in a chronically understaffed system.
@ShamezLadhani
The rate of infection with Omicron was 6 to 8 times that of Delta in children younger than 5 years; this needs to be multiplied by the hospitalisation rate of 1.76% for Omicron vs. 3.25% for Delta. That's why admissions are high with Omicron. It's math.
Worrying reports of
#omicron
from Denmark of severity similar to Delta and many hospitalizations among those vaccinated. Need more solid data, but let's get boosters and slow down spread.
@charlot_summers
Sending you and the team our deep thanks and support. There are so many who are giving way beyond what anyone could expect. Please, hang on in there.
@DrNeilStone
To put some perspective on this, here's a thumbnail of an analysis of 192 million people given 354 million vaccine doses. There certainly is a big effort to find the facts, and the fact is that it's much more dangerous to have COVID than to be vaccinated.
An evidence review of face masks against COVID-19 A Concludes that most transmission of COVID-19 is via respiratory particles and that masks reduce transmission (including from those without symptoms).
Shows that HLA-B*15:01 is associated with asymptomatic SARS-CoV-2, and that CD8 cytotoxic T cells see peptide sequences from seasonal coronaviruses. Implication is that T cells really do matter 🤔
Just heard nice quote on
@BBCR4
from E. O. Wilson. Humanity’s problem is that we have ‘Palaeolithic emotions; medieval institutions; and god-like technology’. Nice.
'The government still lists fever, cough, and loss of sense of smell or taste—which were the most common with the alpha variant—as the covid symptoms to watch out for.' That should change, says
@timspector
.
'some patients died of fulminant myocarditis... our results should alert physicians to pay attention not only to the symptoms of respiratory dysfunction but also the symptoms of cardiac injury.'
Marion Koopmans, publications: https://pure.eur.nl
63% of patients that died had underlying conditions, 41% that recovered. Particular impact in persons with cardiovascular disease . Comparison of fatal and mild cases.
Vindication of the JCVI decision to delay boost until 12 weeks. Also quite good effect not just on symptomatic infections but also on PCR + asymptomatic episodes. Good prospects of reduced transmission. Great news.
Exciting news from Astrazeneca- 82.4% vaccine efficacy with a 3-month gap between jabs and very importantly a ‘substantial effect on transmission of the virus with 67% reduction’.
Testing mild
#COVID
patients with decreased exercise tolerance @~1 year, found peripheral limitation of O2 extraction and a hyperventilatory response to exercise. Maybe endothelial inflammation, microthrombi?
It's been the hardest paper I've ever written, but really worth it. Great example of what cooperative teams can achieve. Thanks to all the fantastic co-authors, collaborators, referees and editors, we made it! Now let's see what others make of the resource.
"The little-known virus that surged in children this year" little known?! Oh well. Respiratory syncytial virus is a terrible name, a marketing disaster. I half-tried to get it renamed The Savage Agent, but failed. via
@BBC_Future
Want career advice? Lots of wise words here. Aiming to win a Nobel prize is going to leave almost everyone feeling a failure. Instead aim to be kind and honest, doing your best each day. Beyond that, any success is a bonus.
2 doses of Pfizer vaccine was 91% effective vs. Multisystem Inflammatory Disorder of Children
#MISC
. All critically ill MIS-C patients were unvaccinated. Further evidence for vaccination of eligible children.
There's limited data from the UK limb of the Oxford/AstraZeneca vaccine that stonking responses are seen with a single booster in those who previously had COVID. Presume it's also
#mucosal
focused, so ideal.
Wouldn't it make more sense if people who already had COVID-19/are antibody positive only receive one shot? This would reflect a two-dose vaccine regimen and would spare doses (at least in some high prevalence areas). With some data to back that up, could that be implemented?
Bit of a marathon thread, but well worth reading through to the end. I'd add that I've regretted trying to shorten vaccine intervals in raising antisera. Booster works best if optimally delayed. MHRA info demonstrates improved Ab response ++ in 12 wk group.
I've been seeing a lot of discussion around the dosage gaps recommended by government for the Astra/Oxford & Pfizer/BioNTech vaccines. My thoughts on the potential benefits & risks of such an approach, and the need for much greater transparency around these decisions. Thread.
In a randomized trial in Bangladesh, increased wearing (13.3%, up to 42.3%) reduced symptomatic
#COVID
in villages by 35% (adjusted prevalence ratio = 0.65 [0.45, 0.85]). Masks are an effective method to reduce symptomatic SARS-CoV-2.
Interesting that gut biopsies 4 months after onset of
#COVID19
showed persistence of virus in 7 out of 14 recoverees. Conclude that memory B cells evolve between 1.3 and 6.2 months after infection in a manner that is consistent with antigen persistence.
'When the Great Barrington Declaration authors declare their opposition to lockdowns, they are quite literally arguing with the past... Tim Harford noted the “scientists divided” theme featured prominently in the campaigns of tobacco firms keen to delay action'. Spot on.
WHO announcement 'reflects the political reality of Covid... the legacy ... will be profound ... [the] virus is still killing one person every 3 minutes... many survivors suffering the debilitating impact of long Covid'. 😞
In 161 vaccine breakthrough Delta infections in 24,706 vaccinated healthcare workers, PCR Ct-values were similar but where there's infectious virus (found in 68.6% of breakthroughs) it declined faster. More good news for vaccines.
Neuer Nachweis dass Geimpfte nach Inf. deutlich weniger ansteckend sind als Ungeimpfte:
Studie zeigt, dass bei Infektionen von Geimpften im Vgl. zu nicht Geimpften mit
#Delta
bei gleichen Ct-Werten (!) deutlich weniger infektiöses Virus vorhanden ist.
Why can’t some people admit they were wrong? Devi Sridhar: "extreme positions have received disproportionate exposure in comparison to the “silent majority” who seem to understand the complexity of the situation".
THREAD: The Covid Pandemic in England in 2022...
a look at what happened.
TLDR: One thing that didn't happen was the end of the pandemic.
Despite people telling you it's just like flu, Covid had far greater impact on illness, hospitals and deaths than flu. 1/13
Key points:
● N501Y affects receptor-binding domain (RBD), increasing binding to ACE2.
● S deletion 69-70del may allow evasion of immune response.
● P681H is near furin cleavage site, again of possible biological significance.
If this is just PCR+, no symptoms, no transmission, it's not that surprising or alarming. Need to see the evidence before extrapolating to alarming conclusions, but important to know more.
"As many as 14% of recovered
#coronavirus
patients in China have tested positive again...betwn 3 to 14% of patients were diagnosed w/ the coronavirus, after already being given the all-clear."
A 2nd wave coming?
Are
#COVID19
tests failing?
Superinfection?
One of the most amazing images I've seen in years. This is the result of coinfection of a cell with RSV and influenza: RSV stalk, clumps of flu at the head. Amazing!
Be prepared, move fast, worry later. And don't worry about being perfect, just be good. Great advice in the face of a pandemic threat. He said this when we had about 500 cases in the UK. Let's hope we can get back down there.
A short thread
1/ Throughout my time working on
#covid19
response here in Massachusetts, I have come back time & time again to this single video by the head of the WHO epidemics response,
@DrMikeRyan
If there's only one thing you watch, let it be this:
"The perception that virologists are not paying attention to the possible risks of their research is simply wrong and harmful." Vital that we all stand up against anti-science misinformation now. They'll come for you next.
Worryingly high rates of visuospatial impairment and memory problems in a fairly young cohort. Potentially affected by selection bias, but fits with neuroinflammatory process after mild COVID-19.
In the Christmas week an average of 3,631 patients with
#COVID19
in hosp (up 57% from Nov).
Norovirus up 61% from the same period last year; serious flu continues to spiral (an average of 942 patients with flu in hosp per day).
Is
#LongCovid
just something we see after severe viral disease in general, or special to
#SARSCoV2
? Here's an important study out on 14th December in The Lancet ID comparing flu and COVID.
It's vital that we don't pre-judge the results of randomized controlled trials. Is it ok to assume how these patients would have fared without the drug? How typical are they and the centres in which they were managed? Must do proper trials or risk harm.
Big for
#COVID19
therapy: the compassionate use results for remdesivir in 53 patients looks very encouraging, especially in very sick patients on mechanical ventilation with 18% fatality (only, expect > 50%) and overall 68% improvement
@NEJM
Really authoritative thread on myocarditis in relation to Covid-19. It's not simple, needs deep understanding. I'm more concerned about the effects of COVID on the heart than the effects of vaccines.
Team it's time to address the Hoeg et al preprint on post-COVID vaccine myocarditis. How am I qualified to speak about myocarditis? I am board certified in paediatric cardiology and currently have patients recovering from this condition. TLDR: They are doing quite well.
#MRI
Kind of you, but I wasn't there so can't say if I would have dissented if I'd been there to hear the arguments. I generally think that you accept collective responsibility even if you are absent because you've chosen to be somewhere else.
Brilliant to see the GSK vaccine for older adults approved, likely to be ready to go into arms this autumn. News - US drug regulator approves world's first RSV vaccine
Looks like the rate of decline is about the same regardless of the type of vaccine or infection- agree? The most potent vaccines keep levels up for longer because levels are higher.
Davide Corti has some very interesting data for neutralization drop against Omicron that includes Sputnik V and SinoPharm (BBIBP-CorV, inactivated vaccine).
What’s going on with SARS-CoV-2 in England and Scotland?
Introducing the new Winter Covid Infection Survey, a collaboration between the
@UKHSA
and the
@ONS
!
Our report came out this morning, and you can find it here:
🧵1/8
Use the term viral shedding with caution. PCR detection doesn't equal infectivity, especially after the antibody response cuts in. Period of infectivity needs to be assessed directly or inferred from culture data.
Important thread about severe cases of
#COVID19
in China. Non-survivors were older (median 69y), male with high D-dimer, IL-6, LDH, Trop, procalcitonin & low lymphocytes. Worryingly, median viral shedding time was 20 days but up to 37 days. Outcomes may differ in other settings.
1) I wanted share some data from a manuscript that just wen online at . This was spearheaded by the fantastic Dr. Ania Wajnberg in collaboration with many parts of the Mount Sinai Hospital and Icahn School of Medicine.
'Anti-Spike IgG from serum of severely ill COVID-19 patients induces a hyper-inflammatory response by human macrophages. The excessive inflammatory capacity of this anti-Spike IgG is related to glycosylation changes in the IgG Fc tail'
Fantastic result! Two different IL-6 blockers, both benefit those entering ITU. Now we have new seroprotecton study from Argentina, steroids for intermediate hypoxic disease from UK and then this great European study! Immunology works. So do trials.
'Elimination is superior to mitigation for GDP growth on average and at almost all time periods. GDP growth returned to pre-pandemic levels in early 2021 in the 5 countries that opted for elimination, but is still negative for the other 32 OECD countries.'
Can't stop thinking about this paper; countries (including the UK) that focused on mitigation of SARS-CoV-2, rather than pushing for elimination, had more deaths, and in the end, negative GDP growth & actually more severe restrictions on civil liberties
Nice short report: the Ab response to single vaccine dose in those who've had COVID equals/exceeds those seen after regular 2 dose regimen. However, the generalised flu like side effects were quite bad; a booster may not be needed.
So, here is our data comparing immune responses in people who had a SARS-CoV-2 infection and were then vaccinated once and people who were naive and then were vaccinated once. I'll explain this a little better tonight if I find time.
South African doctor told The Telegraph that the symptoms of the new variant are unusual but mild. Intense fatigue, not loss of smell. Wondering what the
#LongCovid
rate will be.
This could be the best Omicron news of the day if further confirmed tracking all confirmed cases
Not many have been thinking that the mutation laden variant could decrease virulence
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:
AY.4.2 subvariant of Delta reaching almost 20% of isolates in southeast region, common in teens and spilling into young middle age adults. Gradually expanding, perhaps becoming dominant. Further data awaited on immunity.
The UK Health Security Agy issued a rpt on the new
#COVID19
variant, AY.4.2 -- a sub-lineage of
#DeltaVariant
. Finds:
- higher rate of household spread than other
#SARSCoV2
types
- higher death rate
- reproduces faster
- seems not to be more transmissible
New
@NEJM
today: 2 new randomized trials showing high efficacy and safety for an RSV vaccine in pregnancy (against infant illness) and adults 60+ years of age
Back then, we wondered if these recently characterised cells were equivalent to antibodies in antiviral defence. They were antiviral for sure, but with a lethal effect. Showed that disease wasn't just due to the virus but also the host response.
🧐Today's
#JEMLegacy
@JExpMed
goes back to the ‘80s!
in 1988 Peter Openshaw
@p_openshaw
& colleagues reported that clearance of
#RSV
by CTLs was accompanied by acute respiratory disease in immunocompetent mice.
📰
Let's also remember that mRNA vaccination induces good CD4 responses, Th1 T cells. That should enable immunological memory and prolonged protective responses. Gives me a warm feeling inside 👍
Just a reminder of the immunogenicity of the
#moderna
#vaccine
in older people. Neutralising (virus-disabling) antibody response in those aged >70 equivalent to that seen in recovered patients. Need to know how long immunity lasts, but promising...
'BA.5 was growing 35.1% faster than... Omicron subvariant BA.2, while BA.4 is growing approximately 19.1% faster' High rates in London and Scotland, admissions also increasing.
Important study, largely backing up what came out from Bavaria and NYC. Evidence accumulating that post-symptomatic cases may still be PCR + for weeks but not infectious. Major policy implications if confirmed.
Korean CDC analysis of 285/447 (64%) who retested
#SARSCoV2
positive post
#COVID19
👉Viral cell culture (n=108): 0% pos
👉Contacts traced (n=790): only 3 ill, all w/ other exposures
👉These ppl are not re-infected or still contagious. It's old, dead virus.
All of us refereeing are under huge pressures but this looks terrible. Lousy flow cytometry is still lousy, even in times like this. Must maintain standards, even on COVID19 papers!
"SARS-CoV-2 infects T cells"? They DON'T use
#Tcells
, they use a T cell line &
#flowcytometry
NOT PROPERLY ANALYZED: all cells negative after viral transduction, they just drew a gate cutting a section of population 24% "infected" "positive" cells
#COVID19
US Vets data on 153,760 cases of
#COVID19
cf. >10m controls, increased hazard ratio (HR) of cerebrovascular disease, dysrhythmias, ischemic and non-ischemic HD, pericarditis, myocarditis, heart failure and clots
Example from BBC: Foreign Secretary Dominic Raab, who is deputising for the PM, has said he was "confident" the PM would recover from this illness, describing him as a "fighter". Any evidence that 'fighters' do better or worse? Calm + compliant do best?
Completely agree. Always freeze when a friend or relative says 'you can fight this one', setting someone up to fail and blame themselves if things don't go well. Dying is bad enough without feeling guilty too.
Spending per head on healthcare in Australia in 2019 was £4184. In the UK it was £2647. The G7 average was £3523. Bear this in mind next time someone says we have an NHS problem. What we have is a government problem.
Study of 4 monkeys. Viral replication seems lower than in man. Two were rechallenhed at day 28. Did not take, but no controls. I'm cautious. Don't over interpret, extrapolate too far.
Good news. Rhesus macaques seem to be immune to re-challenge with SARS-CoV-2. This suggests that we are also immune once we clear the infection (serology in humans points in same direction). Not sure how long immunity lasts but likely for months or years.
Hand washing works! Handwashing with soap reduced any ARI, lower resp infections and upper respiratory infections significantly. But that doesn't mean that masks don't work. Need both.
Effectiveness of handwashing with soap for preventing acute respiratory infections in low-income and middle-income countries: a systematic review and meta-analysis
I think these cases of reinfection will be exceptions. The initial illness was unusually prolonged, and the second illness developed very soon after. Need to know more about the immune system in such cases.
“[R]einfection cases tell us that we cannot rely on immunity acquired by natural infection to confer herd immunity; not only is this strategy lethal for many but also it is not effective.” Insightful commentary by
@VirusesImmunity
via
@TheLancetInfDis
Really important paper, long awaited. Viruses rather than bacteria are upfront and central; many viruses found in controls as well as pneumonia cases (eg rhino) but RSV leading the way as the most associated with severe disease.
Using counterfactual modelling, UK mortality would be x2 had Swedish policy been adopted and Swedish mortality would 1/2 if Sweden adopted UK/Danish strategy. Small changes in the timing have large effects on total mortality within a rapidly growing epidemic.
A great man. Deserves huge respect and gratitude for so many years of careful service to the public and to the facts, almost always unbent by politicians (however hard they tried).
Anthony Fauci just gave his final press briefing at the White House after decades of service as America’s top disease expert.
“Every day, for all of those years, I’ve given it everything that I have,” Fauci said when asked what he wanted Americans to remember about his legacy.
Remarkable preprint: zoster vaccine reduced dementia rates by ~20% over a 7y period. The way it was rolled out in Wales was a "natural experiment", indicating causality. Need to know if Shingrix does the same.
I've been asked this question too. Nice explanation about why mRNA isn't going to modify our genome. Those who've struggled with gene therapy for years might wish it could, but it can't. Simply can't.
Several people have expressed concern over the Pfizer/Moderna vaccines because of their mRNA composition and the alleged possibility that this mRNA could integrate into our DNA and remain in our DNA forever (kind of like HIV does). Short threat about why this can't happen. (1/n)
“relapse cases are due to technical limits of the PCR testing." 263 people in Korea tested positive for the disease again after being declared virus-free. “The respiratory epithelial cell has a half-life of up to three months.. RNA ..can be detected after the elimination” Oh said