BC COVID19
Saved by @AntonTweets

⚠️TWO DIFFERENT #COVID19 PANDEMICS—Many think with cases dropping that pandemic is nearly over. But truth is, there are now 2 different #SARSCoV2 pandemics diverging—old strain is waning, while the more contagious #B117 strain is dominating. We will be soon slammed very hard. 🧵

 2) Here is what is really going to happen... most countries are having a gentle case decline with R(e) currently around 0.9. But this is deceiving. The #B117 is still relatively rare so far, so the R is being influenced mostly by the old common variant. But not for long...
3) Here is what is going to happen... currently R is ~0.9 in many places, but with the more infectious #B117, the R will jump 50% approximately. And it is inevitable (all CDC and Danish models say this) that B117 will take over as the reigning dominant variant soon...
4) and when that happens, what worked before to keep the pandemic contained at R of 0.9 will no longer work. Here is the model for Alberta, 🇨🇦 by @GosiaGasperoPhD. The B117 dotted red line will soon dominate and drive a new surge in latter half of March and April.
5) And Denmark 🇩🇰 CDC has found the same thing. I GQR works now for keeping R around 0.9 or even 0.8, will absolutely not work anymore once #B117 variant takes over. Forget about it. We will be hit hard. But there is a way—if we suppress R to 0.7 or less.
https://t.co/gOq0put4H5
6) The solution to defeating the #B117 is to chase a #ZeroCovid approach and slam the R even lower to below 0.7.... but optimally 0.6 or less. So that even when the #B117 arises, it will keep R under 1 (0.6*1.5=0.9). And by keeping R at 0.6 now—we will have buffer room for B117.
7) And again Denmark 🇩🇰 CDC agrees with that assessment. Their model for R of 0.8 shows it is insufficient to defeat #B117. But its model for R 0.7 shows it can be enough.
https://t.co/gOq0put4H5
8) The problem is that of the declining states, only 1 state is under R 0.7... which is Wyoming (figure below sorted from lowest to highest R). Every other state’s R is over 0.7. Thus while they would yield decreases now—they won’t once #B117 takes over.
https://t.co/EWqtBZpsuh
9) Meanwhile, the replacement thing is happening in England. #B117 is dominating while old common #SARSCoV2 is all but nearly gone. Total cases dropping only because of tight UK lockdown. But can UK sustain & not let up on gas pedal before politics caves to reopen too soon?
10) Here is another @GosiaGasperoPhD model of the same thing. Keeping the R at 0.8 level is not enough to stop the spread once #B117 takes over.
11) Denmark 🇩🇰 CDC @SSI_dk has been warning about this for over a month. The world hasn’t been listening. Aggressive mitigation for keeping R under 0.7 now is the only way. https://t.co/XfZOC7UXXB
12) Let’s slam this home. suppose we have 1000 cases/day now... with an R=0.86 we could reduce it to 500/day in 2 weeks.

➡️But w/ added contagiousness of B117 variant that has ~60% higher R, in 2 weeks, 3000 new cases/day instead.

➡️6x difference in 2 wks

HT @GosiaGasperoPhD
13) The problem is that to get R low enough, what used to work won’t work anymore. When we previously could afford to open schools, it may be that when B117 becomes dominant, we might lose that buffer to keep R<0.7. https://t.co/yVld1eSrQS
14) Denmark CDC is becoming more right — contagious #B117 variant is continuing to solidify itself as 12.1% of sequenced #SARSCoV2 samples. 70% increase per week!

2.4%

4.0%

7.4%

12.1%
15) Denmark officials, despite their lockdown induced case drop, are really panicking. Seriously— read the WaPo article or this thread 🧵 below. They express that without the 100% sequencing, they would have been lulled into complacency. https://t.co/gMiJdcc6MC
16) “Without this variant, we would be in really good shape,” said Camilla Holten Moller, co-leader of the @SSI_dk group modeling the spread of the virus.

“If you just look at the reproduction number, you just wouldn’t see that it was in growth underneath at all,”
17) The good news so far is that all the vaccines tested so far perform decently against the main #B117 variants, but maybe less so against the 🇿🇦 #B1352 and 🇧🇷#P1 variants. Pfizer, Moderna, etc mostly good for B117. See thread 🧵 below to catch up. https://t.co/x30ufKmTW8
18) So here comes the “but”... there is a new subtype of #B117 emerging... a mutated sublineage of regular main #B117 that had acquired the troublesome E484K mutation. This is the bad mutation that 🇿🇦 CDC & other studies helps B1351 evade antibodies. https://t.co/3Ktkb9Iv8n
19) So what do we know about the #B117+E484K combo sublineage? Not much except this preprint study showing it is might be more resistant to antibody neutralization (more antibodies needed in lab study to neutralize the pseudovirus) than the common strain and the regular B117.
20) This #B117+E484K isn’t for sure resistant to vaccine. We don’t know yet. And we don’t know if it will still be more contagious like the main B117 is, but we should assume it is—& take precautions that it might be the double combo of more contagious & maybe antibody resistant.
21) could #B117+E484K be a fluke? Maybe. But it emerged recently in UK twice—independently arising in Wales, and arising in England. Just like in 🇧🇷 and 🇿🇦—so 4 times means convergent evolution is real. And convergent evolution is usually always greater survival fitness.
22) The other way to win is with mass vaccination like in Israel 🇮🇱 that has already vaccinated 50 shot per 100 people in the elderly. Hence now look how fast the cases, hospitalizations are diverging for those age 60+ vs 59 or under. That is the effect of **mass** vaccinations.
23) Actually, Israel 🇮🇱 has now reached 60 vaccination shots per 100 people: 4x UK 🇬🇧 and 6x the 🇺🇸. Rest of EU is much much lower.
24) Another alarming datapoint: 10% of the village of Corzano 🇮🇹 has the #B117 variant—10% of all residents!!! https://t.co/edbN2KYihV
25) Moreover, of the 10% of the infected 🇮🇹 village with #B117 UK variant, 60% of cases are kids from kindergarten and primary school, while other 40% are their parents. Schools in the village have closed now. https://t.co/xdiZqKOLVc
26) BOTTOMLINE: unless we can mass vaccinate quickly like Israel (which is still not 1/3 of the way done), we must continue to mitigate with *premium* masks preferably and with airborne virus precautions to ventilate.

💡No virus = No mutation.

#ZeroCovid #COVID19 #COVIDzero
27) here is where you can find the R(e) or R(t) in your US state. https://t.co/EWqtBZpsuh
28) Please switch to premium masks if you can. KN95, KF94, FFP2, etc.... the new variant is just too contagious not to take extra precautions. https://t.co/5pDv4nloRi
29) If you’re skeptical, you don’t have to take my word alone. Read this article in Science magazine by @kakape, he essentially outlines the same thing as I have with the ominous pandemic future of #B117. I trust my colleagues at Denmark 🇩🇰 @SSI_dk a lot. https://t.co/5i0oMxNrh1
30) Also why aren’t we aware of that much #B117 in other countries besides Denmark and UK? Well because most countries sequence almost nothing (panel B is a log scale - so the drop off is much much worse as you go down), and also very slow in sequencing even when they do.
31) Based on the limited #SARSCoV2 genomic sequencing that we do have... here is how different mutations are growing in each country so far (data slightly older by 1.5 weeks). Pink is the N501 mutation (seen in a few, but #B117 is the main variant with it)
https://t.co/Dz6NYYEdaX
32) Is #B117 a VARIANT or new STRAIN? People are now use them interchangeably. Let’s end the confusion. Experts say a variant is crowned a new strain when:

📌Becomes dominant (B117 🇬🇧)

📌More transmissible (B117), deadlier, or modifies immunity. #COVID19
https://t.co/nBnmm6gdV4

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Eric Feigl-Ding
Eric Feigl-Ding
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Stupid—Oregon church has huge 74+ person #COVID19 outbreak after dozens of maskless churchgoers stood onstage singing & clapping inside a packed indoor venue for Easter Sunday service. The Peoples Church, is vowing to do continue church service on Sunday.

2) Now, the Oregon Health Authority says that at least 74 people associated with the church have tested positive for the coronavirus — one of the state’s largest workplace outbreaks.

3) “In a statement, the church’s leaders attributed the outbreak to a recent rise in covid-19 cases in Marion County, Ore.

Murray said the church, which has held in-person services throughout the pandemic, intends to continue with in-person ceremonies on Sunday.

4) Who saw this coming? Countless scientists. If only airborne-denialists didn’t muzzle the airborne aerosols science.
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Eric Feigl-Ding
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@DrEricDing
ATROCIOUS big pharma price gouging of insulin:

This crying mother can’t afford the $1000 for her son’s insulin.

📌yet, it only costs pharma $5 to produce.

📌Insulin was invented 100 years ago by Fred Banting—who donated patent for $1 to make it free for all.

Let that sink in.


2) Insulin is one of the most disgusting cases of price gouging ever.

America has long taken a free market approach to pharmaceuticals.
Drug companies haggle separately over drug prices with a variety of private insurers across the

3) “Meanwhile, Medicare, the government health program for those over age 65 — it’s also the nation’s largest buyer of drugs—is barred from negotiating drug prices. That gives pharma more leverage, and it leads to the kind of price surges of EpiPens, opioid antidotes, & insulin.”

4) In 2018:
Johnson & Johnson CEO made $30M
Pfizer CEO made $28M
Merck CEO made $18M
Eli Lilly CEO made $16M
Gilead CEO made $16M

Meanwhile:

📌Americans spent $535B on Rx drugs

📌1/4 of diabetics rationed insulin to survive

📌500K Americans went bankrupt from medical bills.

5) What’s the right price patients should pay for medications? ZERO dollars, because no copay ==> more patients get their medicine ==> saves lives and saves money. Copays decrease adherence, and copays hurt patients who actually need them.
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Eric Feigl-Ding
Eric Feigl-Ding
@DrEricDing
Breaking—UK scientists just reported a case-control study that the mutated UK 🇬🇧B.1.1.7 variant is not associated w/ more severe #COVID19— “found no significant differences in hospital admissions and case fatality at 28 days, & occurrence of reinfections”, says @mvankerkhove

2) That said, the new UK mutated strain is a more transmissible (contagious) variant. Keep transmissibility and illness severity separate. They are two different things. Don’t get them confused.

3) The new UK variant severity study is included in today’s WHO report, to be released soon this afternoon according to WHO sources. Waiting for it to drop. I’ll keep folks posted on the details.

4) Update: here is UK Technical report on #SARSCoV2 variant of concern (B.1.1.7) in 🇬🇧 with prelim findings from their case-control study of no increased severity for the new variant that I reported yesterday.

5) Also keep in a mind that a virus that spreads faster (more contagious) yields much worse total outcomes than a virus that is just merely more severe.

All things equal, a new mutated variant that is more contagious & no more severe is worse. And that is what we now have.
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Eric Feigl-Ding
Eric Feigl-Ding
@DrEricDing
📍DOUBLE REINFECTIONS—wow, both PM Justin Trudeau and Biden’s HHS Secretary Becerra got *reinfected* with #COVID19–from same conference—➡️when did Becerra last get infected? May 18th 2022—not even a full month ago! Trudeau in Jan 2022. I worry it’s reinfections due to #BA5/#BA4.


2) #BA5 and #BA4 are worrisome. They are surging and they have high reinfection potential. Your past BA1/BA2 doesn’t substantially protect you from #Ba5/4


3) Excess deaths—the new #BA4 & #BA5 variants of the coronavirus are currently the **fastest growing** strains in the US & UK. ➡️They are exponentially replacing all other past strains. Learn from South Africa’s early warning signs and their excess deaths. #CovidIsNotOver #COVID


4) Is it a Paxlovid rebound for Becerra, as some are asking? Unclear—Paxlovid rebound usually only happens at day 10-14 that we know of and have data. The FDA says it’s 1-2% rebound but I counted 12% from this Pfizer graph submitted to FDA.


5) and yes, #ba5 / #BA4 are very problematic. they are 2x more resistant than even BA2 for neutralizing the virus compared to those who had breakthrough reinfections from older Omicron.
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Eric Feigl-Ding
Eric Feigl-Ding
@DrEricDing
JUST ONE PERSON—UK 🇬🇧 scientists think one immunocompromised person who cleared virus slowly & only partially wiped out an infection, leaving behind genetically-hardier viruses that rebound & learn how to survive better. That’s likely how #B117 started. 🧵 https://t.co/bMMjM8Hiuz


2) The leading hypothesis is that the new variant evolved within just one person, chronically infected with the virus for so long it was able to evolve into a new, more infectious form.

same thing happened in Boston in another immunocompromised person that was sick for 155 days.

3) What happened in Boston with one 45 year old man who was highly infectious for 155 days straight before he died... is exactly what scientists think happened in Kent, England that gave rise to #B117.


4) Doctors were shocked to find virus has evolved many different forms inside of this one immunocompromised man. 20 new mutations in one virus, akin to the #B117. This is possibly how #B1351 in South Africa 🇿🇦 and #P1 in Brazil 🇧🇷 also evolved.


5) “On its own, the appearance of a new variant in genomic databases doesn’t tell us much. “That’s just one genome amongst thousands every week. It wouldn’t necessarily stick out,” says Oliver Pybus, a professor of evolution and infectious disease at Oxford.
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