Private channel session 788
11 messages over 1h 24m, 2021-01-10 – 2021-01-10.
A “conversation” here is an activity session — a run of messages with under 60 minutes of silence inside it. The channel had no native conversation boundaries.
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> delaying second dose if you can get universal coverage I very much disagree - this could be the perfect breeding ground for immune escape. The neut titers are pretty terrible post the first dose and I highly doubt sufficient to protect against infection - maybe against disease (for awhile), but not against infection. That really strong neut response only develops after the second dose, so you're now have people run around with pretty lackluster immunity for 12 weeks (and you have twice as many) instead ofjust two weeks (with half the people). It's a potential disaster in waiting and I certainly wouldn't recommend it.(separately, I'm not concerned about people not developing good strong immunity after the second dose if it's delayed - may even be better. It's that interim period).If you gotta make the vaccines reach more people quickly, much better to half the dose(s).
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> EPI_ISL_792683 Holy shit... I actually DM'd Oli a couple of days ago asking for his take on reinfections in Manaus now they're surging again. Didn't get a reply, but I wouldn't be surprised if they're observing a lot. I guess we'll learn from Nunoand him. It's gonna take years to get this bug to a near-normal level...
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Nuno's virological post is going to drop very soon. They are just polishing up the coverage on the genomes.
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But having lackluster immunity doesn't really matter - you get infected and then you clear it (unless you are saying that having lackluster immunity will stop you generating your own immunity?). I.e., no worse off than before. You may encourage escapes to come up but they are not particularly advantageous for transmitting to the next person. What will really select for escape is if there are lots of properly immune people (in the absence of escape) but not atthe herd immunity threshold. At that point an escape mutant has a significant advantage over the wildtype.
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But I feel that we need some serious modelling done here.
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I'm hopeful that the mRNA vaccines with two doses will provide (near) sterilizing immunity. The issue with one doseis that you still have immunity, but you can't stop infection so the virus gets a chance to evolve in that milieu and the viruses that can escape will propagate. Sure, having full immunity will create a much stronger selection pressure (ifyou can't infect, you can't live), but if the virus can escape full immunity, then we have a much bigger problem on our hands.
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So that is what the Manaus experiment will be about. Did 501Y, 484K and 417T appear in combination because it isreinfecting people.
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Yeah - Manaus (and Israel) will be really really important.
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If we start seeing reinfections (or vaccine failures) in Manaus / Israel driven by escape, then we might have torethink our entire vaccination strategy. Stockpiling enough supply to vaccinate most of the population while (massively) driving down infections via NPIs - then go out and vaccinate as many people as possible as quickly aspossible.I don't think humans have the ability to do that. In fact, I'm getting increasingly pessimistic that we have the ability toeven control the first few years of the "Reign of COVID-19". I'm seeing too many indicators currently that are makingme very uncomfortable.
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(coupled with too much wishful thinking - we so desperately yearn for positive news that we forget that things don't just automatically get better).
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@Kristian Andersen I am now starting to think that the delayed dosing is vastly inferior to going with a half or one third dose followed by a second half or third dose.