What is the basis of this?
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.
What is the basis of this?
1) the first dose is likely to confer some degree of protection against disease, so better to roll this out as fast as possible, and
2) that for Oxford/Astra efficacy may be higher when the gap between doses is greater.
Vaccine efficacy among 18-55 yr olds SD/SD dosing was 59% vs LD/SD dosing at 90%.
Is this due to dosing, or differences in gaps between doses?
Differences in gaps don't appear to impact efficacy in this analysis.
https://t.co/9yaSAyHcKR
It looks like the first dose prevented all severe disease (although numbers were small) in the SARS-CoV-2 vaccine group compared to vaccine control after the first 21 days of vaccination, and <14 days after the 2nd dose.
https://t.co/966V4EYw13
U.S. is now considering idea of a single vaccination shot, delaying shot #2 until months later. Last wk, I thought that was a bad idea \u2013 the trials that found 95% efficacy were 2 shots; why add extra complexity & a new curveball. But facts on the ground demand a rethink. (1/7)
— Bob Wachter (@Bob_Wachter) December 31, 2020
1. Resources for roll-out are limited & fixed & we need to optimise how best to use them within limitations
2. There isn't significant decline in immunity after the 3 wk mark
3. Later dosing will not affect overall efficacy
A key part of the rationale appears to be a bottleneck in vaccine supply (rather than roll-out).
https://t.co/mccavkBGeb
The reasoning is public now https://t.co/ZkO1k0yqlL.
— Volker Schulz (@portefeuillefun) December 31, 2020
More from Deepti Gurdasani
This is the exact problem with our government's thinking & response- despite this strategy of 'tolerating deaths' and half-way measures having spectacularly failed, it's quite amazing that our govt still hasn't learned anything, & continues to promote a policy of death. Thread
Had we adopted an elimination strategy early on, rather than one of tolerating a certain level of infection, we wouldn't be here now. The reason we're here is because the govt never committed to elimination.
We eased lockdown in May when infection levels were much higher than when other countries in Europe did this. The govt was warned about this, but did this to 'help the economy'. Not only did this lead us into the 2nd wave, the need for further lockdowns harmed the economy further
It's very clear from global evidence that we cannot 'tolerate a level of community transmission' and maintain 'R at or just below 1', which has been our governments policy for a long time. This isn't sustainable & very rapidly gets out of control, leading to exponential rises
Coupled with late action to contain these surges, not only does this lead to many more deaths, and much more morbidity with Long COVID, it also creates a fertile ground for viral mutations to accumulate with a greater risk of adaptation, which is exactly what happened in the UK
U.K. needs to confront
— Esther McVey (@EstherMcVey1) January 2, 2021
\u2018The challenge that faces us is to decide - are we going to try to pursue the elimination of Covid-19 regardless of the costs or decide on a tolerable level of deaths (like we do with the flu) in order to return to a normal life?\u2019
https://t.co/9hWbHIPJUq
Had we adopted an elimination strategy early on, rather than one of tolerating a certain level of infection, we wouldn't be here now. The reason we're here is because the govt never committed to elimination.
We eased lockdown in May when infection levels were much higher than when other countries in Europe did this. The govt was warned about this, but did this to 'help the economy'. Not only did this lead us into the 2nd wave, the need for further lockdowns harmed the economy further
It's very clear from global evidence that we cannot 'tolerate a level of community transmission' and maintain 'R at or just below 1', which has been our governments policy for a long time. This isn't sustainable & very rapidly gets out of control, leading to exponential rises
Coupled with late action to contain these surges, not only does this lead to many more deaths, and much more morbidity with Long COVID, it also creates a fertile ground for viral mutations to accumulate with a greater risk of adaptation, which is exactly what happened in the UK
Thread on the recent report on the possible risk of increased death associated with the new UK variant (B117)- with a discussion of the evidence around this, and what this means.
First, there is strong evidence to support increased transmissibility of B117 - current estimates of increased transmissibility range between 30-70% - from epidemiological evidence examining the differential rate of growth of B117 with respect to other variants & increase in R
There is also evidence from PHE contact studies that the risk of transmission from those carrying the B117 variant is ~50% greater than with other non-B117 variants.
Increased transmissibility, even if a variant has the same fatality rate can increase deaths substantially, because the rate of growth of cases is higher- & more cases means more deaths.
Increased fatality rates also increase deaths- but do so
So how was risk of death with the variant studied?
We don't routinely sequence all samples for the virus. We've found that the variant has a particular deletion which means that some PCR tests on samples with the variant give a different read-out when the variant is present.
First, there is strong evidence to support increased transmissibility of B117 - current estimates of increased transmissibility range between 30-70% - from epidemiological evidence examining the differential rate of growth of B117 with respect to other variants & increase in R
There is also evidence from PHE contact studies that the risk of transmission from those carrying the B117 variant is ~50% greater than with other non-B117 variants.
Increased transmissibility, even if a variant has the same fatality rate can increase deaths substantially, because the rate of growth of cases is higher- & more cases means more deaths.
Increased fatality rates also increase deaths- but do so
How dangerous are the B.1.1.7 and 501Y.V2 hyper-transmissible strains?
— Eric Topol (@EricTopol) January 11, 2021
by @AdamJKucharski @CFR_orghttps://t.co/aycWMN3b5h
h/t @Karl_Lauterbach pic.twitter.com/JlaFzzP06t
So how was risk of death with the variant studied?
We don't routinely sequence all samples for the virus. We've found that the variant has a particular deletion which means that some PCR tests on samples with the variant give a different read-out when the variant is present.
Brief thread to debunk the repeated claims we hear about transmission not happening 'within school walls', infection in school children being 'a reflection of infection from the community', and 'primary school children less likely to get infected and contribute to transmission'.
I've heard a lot of scientists claim these three - including most recently the chief advisor to the CDC, where the claim that most transmission doesn't happen within the walls of schools. There is strong evidence to rebut this claim. Let's look at
Let's look at the trends of infection in different age groups in England first- as reported by the ONS. Being a random survey of infection in the community, this doesn't suffer from the biases of symptom-based testing, particularly important in children who are often asymptomatic
A few things to note:
1. The infection rates among primary & secondary school children closely follow school openings, closures & levels of attendance. E.g. We see a dip in infections following Oct half-term, followed by a rise after school reopening.
We see steep drops in both primary & secondary school groups after end of term (18th December), but these drops plateau out in primary school children, where attendance has been >20% after re-opening in January (by contrast with 2ndary schools where this is ~5%).
I've heard a lot of scientists claim these three - including most recently the chief advisor to the CDC, where the claim that most transmission doesn't happen within the walls of schools. There is strong evidence to rebut this claim. Let's look at
The science shows us that most disease transmission does not happen in the walls of the school, but it comes in from the community. So, CDC is advocating to get our K-5 students back in school at least in a hybrid mode with universal mask wearing and 6 ft of distancing. https://t.co/dfvJ2nl2s4
— Rochelle Walensky, MD, MPH (@CDCDirector) February 14, 2021
Let's look at the trends of infection in different age groups in England first- as reported by the ONS. Being a random survey of infection in the community, this doesn't suffer from the biases of symptom-based testing, particularly important in children who are often asymptomatic
A few things to note:
1. The infection rates among primary & secondary school children closely follow school openings, closures & levels of attendance. E.g. We see a dip in infections following Oct half-term, followed by a rise after school reopening.
We see steep drops in both primary & secondary school groups after end of term (18th December), but these drops plateau out in primary school children, where attendance has been >20% after re-opening in January (by contrast with 2ndary schools where this is ~5%).
More from Government
Caveat: This article is sourced from @Daily_Express !!!
"End of Sturgeon?"
Frankly, an appropriate response from @NicolaSturgeon might be to quote the infamous Mark Twain response to an erroneous 'obituary' known to all...
"The reports of my demise are greatly exaggerated."
https://t.co/Ce1xVVISR2
More accurately, the media have quoted:
"Ms Sturgeon said she had a “real job to do” and was focused on guiding Scotland through the Covid-19 pandemic."
It's very reassuring to hear that @scotgov and @ScotGovFM have prioritised safeguarding lives and Scotland, above all else.
"I’ll leave others to play games or politics. I have got a real job to do and people can decide themselves whether I am doing it well or not, but I am absolutely 100 per cent focused on leading this country through a pandemic."
💯% 😀👍
Making her priorities crystal clear!
“That’s what I’ve done since this time last year and it’s what I’m going to continue to do for absolutely as long as necessary.”
And again, making it absolutely crystal clear!
"End of Sturgeon?"
Frankly, an appropriate response from @NicolaSturgeon might be to quote the infamous Mark Twain response to an erroneous 'obituary' known to all...
"The reports of my demise are greatly exaggerated."
https://t.co/Ce1xVVISR2
More accurately, the media have quoted:
"Ms Sturgeon said she had a “real job to do” and was focused on guiding Scotland through the Covid-19 pandemic."
It's very reassuring to hear that @scotgov and @ScotGovFM have prioritised safeguarding lives and Scotland, above all else.
"I’ll leave others to play games or politics. I have got a real job to do and people can decide themselves whether I am doing it well or not, but I am absolutely 100 per cent focused on leading this country through a pandemic."
💯% 😀👍
Making her priorities crystal clear!
“That’s what I’ve done since this time last year and it’s what I’m going to continue to do for absolutely as long as necessary.”
And again, making it absolutely crystal clear!
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I just finished Eric Adler's The Battle of the Classics, and wanted to say something about Joel Christiansen's review linked below. I am not sure what motivates the review (I speculate a bit below), but it gives a very misleading impression of the book. 1/x
The meat of the criticism is that the history Adler gives is insufficiently critical. Adler describes a few figures who had a great influence on how the modern US university was formed. It's certainly critical: it focuses on the social Darwinism of these figures. 2/x
Other insinuations and suggestions in the review seem wildly off the mark, distorted, or inappropriate-- for example, that the book is clickbaity (it is scholarly) or conservative (hardly) or connected to the events at the Capitol (give me a break). 3/x
The core question: in what sense is classics inherently racist? Classics is old. On Adler's account, it begins in ancient Rome and is revived in the Renaissance. Slavery (Christiansen's primary concern) is also very old. Let's say classics is an education for slaveowners. 4/x
It's worth remembering that literacy itself is elite throughout most of this history. Literacy is, then, also the education of slaveowners. We can honor oral and musical traditions without denying that literacy is, generally, good. 5/x
As someone\u2019s who\u2019s read the book, this review strikes me as tremendously unfair. It mostly faults Adler for not writing the book the reviewer wishes he had! https://t.co/pqpt5Ziivj
— Teresa M. Bejan (@tmbejan) January 12, 2021
The meat of the criticism is that the history Adler gives is insufficiently critical. Adler describes a few figures who had a great influence on how the modern US university was formed. It's certainly critical: it focuses on the social Darwinism of these figures. 2/x
Other insinuations and suggestions in the review seem wildly off the mark, distorted, or inappropriate-- for example, that the book is clickbaity (it is scholarly) or conservative (hardly) or connected to the events at the Capitol (give me a break). 3/x
The core question: in what sense is classics inherently racist? Classics is old. On Adler's account, it begins in ancient Rome and is revived in the Renaissance. Slavery (Christiansen's primary concern) is also very old. Let's say classics is an education for slaveowners. 4/x
It's worth remembering that literacy itself is elite throughout most of this history. Literacy is, then, also the education of slaveowners. We can honor oral and musical traditions without denying that literacy is, generally, good. 5/x
These 10 threads will teach you more than reading 100 books
Five billionaires share their top lessons on startups, life and entrepreneurship (1/10)
10 competitive advantages that will trump talent (2/10)
Some harsh truths you probably don’t want to hear (3/10)
10 significant lies you’re told about the world (4/10)
Five billionaires share their top lessons on startups, life and entrepreneurship (1/10)
I interviewed 5 billionaires this week
— GREG ISENBERG (@gregisenberg) January 23, 2021
I asked them to share their lessons learned on startups, life and entrepreneurship:
Here's what they told me:
10 competitive advantages that will trump talent (2/10)
To outperform, you need serious competitive advantages.
— Sahil Bloom (@SahilBloom) March 20, 2021
But contrary to what you have been told, most of them don't require talent.
10 competitive advantages that you can start developing today:
Some harsh truths you probably don’t want to hear (3/10)
I\u2019ve gotten a lot of bad advice in my career and I see even more of it here on Twitter.
— Nick Huber (@sweatystartup) January 3, 2021
Time for a stiff drink and some truth you probably dont want to hear.
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10 significant lies you’re told about the world (4/10)
THREAD: 10 significant lies you're told about the world.
— Julian Shapiro (@Julian) January 9, 2021
On startups, writing, and your career: