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1. 2021-01-10 15:34 Kristian G. Andersen open
   > 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).
2. 2021-01-10 15:36 Kristian G. Andersen
   > 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...
3. 2021-01-10 15:41 Andrew Rambaut open
   Nuno's virological post is going to drop very soon. They are just polishing up the coverage on the genomes.
4. 2021-01-10 15:47 Andrew Rambaut open
   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.
5. 2021-01-10 15:48 Andrew Rambaut open
   But I feel that we need some serious modelling done here.
6. 2021-01-10 16:01 Kristian G. Andersen open
   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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