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AaronRichterman's profile
Aaron Richterman, MD
Aaron Richterman, MD
Aaron Richterman, MD
@AaronRichterman

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Aaron Richterman, MD

@AaronRichterman

infectious diseases, health equity @PennMedicine. prev @BrighamWomens @GlobalHealthMGH. “His horoscopes were especially popular because they were often right”

Philadelphia, PA
scholar.google.com/citations?hl=e…
Joined July 2010

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    1. Aaron Richterman, MD‏ @AaronRichterman 12 Jan 2021

      Aaron Richterman, MD Retweeted Aaron Richterman, MD

      Interesting poll. Selection/response bias aside, majority picked a low probability, but 40% still thought there was 10+% prob that vaccines will not substantially prevent transmission. This is why I have become convinced this concern is highly unlikely (borderline implausible) 🧵https://twitter.com/AaronRichterman/status/1348492463229562880 …

      Aaron Richterman, MD added,

      Aaron Richterman, MD @AaronRichterman
      What is the probability that vaccines 95% effective at preventing symptomatic covid-19 do not substantially prevent transmission?
      Show this thread
      4 replies 36 retweets 96 likes
      Show this thread
      Aaron Richterman, MD‏ @AaronRichterman 12 Jan 2021

      Aaron Richterman, MD Retweeted Jake Johnson

      1. Data from screening PCR at the time of the 2nd moderna mrna vaccine, showing reductions in asymptomatic PCR positivity. This is before the 2nd dose and if anything will underestimate effect. Will have additional confirmation from unblinding pcr and abhttps://twitter.com/JakeJohnsonMD/status/1348665305799811072?s=20 …

      Aaron Richterman, MD added,

      Jake Johnson @JakeJohnsonMD
      I'm very surprised by the results of this poll. We actually have clear data in the moderna vaccine trial that asymptomatic covid is less common. Supplemental appendix: 89.6% of asymptomatic or symptomatic disease was prevented at the time of dose 2... https://www.nejm.org/doi/suppl/10.1056/NEJMoa2035389/suppl_file/nejmoa2035389_appendix.pdf … https://twitter.com/AaronRichterman/status/1348492463229562880 … pic.twitter.com/PgbZZNsv0r
      6:42 AM - 12 Jan 2021
      • 5 Retweets
      • 23 Likes
      • Fredric Douglas Bellamy Yannis Hodges-Mameletzis (he/him) 🦠🧬 Shan Lina Deirdre Connolly¹ Govind Persad Daniela Vadala Poles Nico Vallone Whitney R. Robinson
      3 replies 5 retweets 23 likes
        1. New conversation
        2. Aaron Richterman, MD‏ @AaronRichterman 12 Jan 2021

          2. Data from AZ vaccine chadox study is a mess, but they did weekly PCR screening and points in the same direction. https://www.thelancet.com/action/showPdf?pii=S0140-6736%2820%2932661-1 …pic.twitter.com/MSsQCKlUU4

          3 replies 1 retweet 10 likes
          Show this thread
        3. Aaron Richterman, MD‏ @AaronRichterman 12 Jan 2021

          Aaron Richterman, MD Retweeted Paul Sax

          3. We aren't reinventing immunology and need to consider our priors based on experience with other vaccine-preventable infections.https://twitter.com/PaulSaxMD/status/1337149176832876544?s=20 …

          Aaron Richterman, MD added,

          Paul SaxVerified account @PaulSaxMD
          Prevention of symptomatic disease without also preventing subclinical infection would be extremely rare for a vaccine preventable illness. Yes, let's see data. But would be enormously surprised if these highly effective vaccines didn't also make people less likely to transmit. https://twitter.com/Laurie_Garrett/status/1337147832755773442 …
          1 reply 2 retweets 21 likes
          Show this thread
        4. Aaron Richterman, MD‏ @AaronRichterman 12 Jan 2021

          Aaron Richterman, MD Retweeted Monica Gandhi MD, MPH

          3b. Another thread from @MonicaGandhi9 on thishttps://twitter.com/MonicaGandhi9/status/1347988651179798530?s=20 …

          Aaron Richterman, MD added,

          Monica Gandhi MD, MPHVerified account @MonicaGandhi9
          Please allow me to go back to this question of "do vaccines prevent transmission?". What do vaccines do? Stimulate antibody (from B cells) and T cell responses (not often measured) and then a "boost" of 2nd dose helps stronger memory B/T cell to form. pic.twitter.com/hHrSrinyRC
          Show this thread
          1 reply 1 retweet 8 likes
          Show this thread
        5. Aaron Richterman, MD‏ @AaronRichterman 12 Jan 2021

          Aaron Richterman, MD Retweeted Sanjat Kanjilal

          3c. The interesting counterargument involves requirement of IgA for upper resp tract mucosal immunity (vs IgG to prevent LRT symptomatic disease). However, as @leela_davies points out, IgG-generating vaccines prevent transmission in other resp viruseshttps://twitter.com/SanjatKanjilal/status/1348544271310331909?s=20 …

          Aaron Richterman, MD added,

          Sanjat Kanjilal @SanjatKanjilal
          Replying to @AaronRichterman
          In @florian_krammer's fantastic review of #COVID19 vaccines from back in September (https://www.nature.com/articles/s41586-020-2798-3 …), I read that sterilizing immunity of the upper respiratory tract requires IgA. These vax only generate IgG but if they reduce asx infxn then that is fantastic news.
          1 reply 1 retweet 11 likes
          Show this thread
        6. Aaron Richterman, MD‏ @AaronRichterman 12 Jan 2021

          Aaron Richterman, MD Retweeted Aaron Richterman, MD

          4. Even if we assume vaccines ONLY prevent symptomatic disease, turning all into asymptomatic infections, there is a solid body of evidence 👇 (inc systematic reviews from @mugecevik and @nicolamlow) that this alone would substantially reduce transmissionhttps://twitter.com/AaronRichterman/status/1340285330428182529?s=20 …

          Aaron Richterman, MD added,

          Aaron Richterman, MD @AaronRichterman
          Thankful to Singapore for surveillance systems that allow for the detailed studies required to truly assess the relative transmission risk of asymptomatic vs symptomatic cov-2 👇, which they find to be much higher in those who develop symptoms /1 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32651-9/fulltext … pic.twitter.com/hLbKPhHOVB
          Show this thread
          4 replies 1 retweet 24 likes
          Show this thread
        7. Aaron Richterman, MD‏ @AaronRichterman 12 Jan 2021

          5. Based on this, I think the possibility that these vaccines don't meaningfully reduce transmission (to the point that populations can move back towards normal life in due course) is low enough that we should treat this as a mostly theoretical concern at this point.

          1 reply 9 retweets 33 likes
          Show this thread
        8. Aaron Richterman, MD‏ @AaronRichterman 12 Jan 2021

          Aaron Richterman, MD Retweeted Aaron Richterman, MD

          6. An enduring lesson of this pandemic (& others) is the need to communicate uncertainty honestly (in both directions). Of course its reasonable to be careful, but lets not forget that this theoretical concern is being cited as a reason not to get the vaxhttps://twitter.com/AaronRichterman/status/1348494121019826178?s=20 …

          Aaron Richterman, MD added,

          Aaron Richterman, MD @AaronRichterman
          Returning to normal activities is one important motivator for public to get vaccinated. Emphasizing that vaccines are unlikely to facilitate this because lots of transmission might happen anyway undermines this, especially when that seems unlikely based on what we know now 👇🏻 https://twitter.com/MonicaGandhi9/status/1347988651179798530 …
          Show this thread
          2 replies 6 retweets 31 likes
          Show this thread
        9. Aaron Richterman, MD‏ @AaronRichterman 3 Feb 2021

          Aaron Richterman, MD Retweeted Eric Meyerowitz, MD

          7. implications of monoclonal post-exposure prophylaxis data on transmissionhttps://twitter.com/EricMeyerowitz/status/1354231883190722571?s=20 …

          Aaron Richterman, MD added,

          Eric Meyerowitz, MD @EricMeyerowitz
          1/ Key question right now is how much SARS-CoV-2 vaccines will decrease transmission. Data from Regeneron mAb cocktail prevention press release may help us think about this https://investor.regeneron.com/news-releases/news-release-details/regeneron-reports-positive-interim-data-regen-covtm-antibody …
          Show this thread
          1 reply 0 retweets 7 likes
          Show this thread
        10. Aaron Richterman, MD‏ @AaronRichterman 3 Feb 2021

          Aaron Richterman, MD Retweeted Aaron Richterman, MD

          8. More on why reducing symptoms/severity w vaccines will probably reduce transmissionhttps://twitter.com/AaronRichterman/status/1351548094710652928?s=20 …

          Aaron Richterman, MD added,

          Aaron Richterman, MD @AaronRichterman
          These two statements are at first confusing, but crucial to understanding prevention of cov2 transmission, including through use of vaccines. https://twitter.com/BogochIsaac/status/1351544832771186691 …
          Show this thread
          1 reply 1 retweet 8 likes
          Show this thread
        11. Aaron Richterman, MD‏ @AaronRichterman 3 Feb 2021

          8a. (Aside - Good paper with biases to be mindful of when comparing secondary attack rates of symptom/asymptomatic in households (page 19). h/t @mugecevik) https://dash.harvard.edu/handle/1/37366192 …pic.twitter.com/ez5IssUk0F

          1 reply 0 retweets 6 likes
          Show this thread
        12. Aaron Richterman, MD‏ @AaronRichterman 3 Feb 2021

          Aaron Richterman, MD Retweeted Aaron Richterman, MD

          9. Some more discussion on Moderna dose 2 testinghttps://twitter.com/AaronRichterman/status/1350591945702318083 …

          Aaron Richterman, MD added,

          Aaron Richterman, MD @AaronRichterman
          Here is one more look at Supplementary Table 18 from the Moderna NEJM paper, the best direct data we have on this question. Follow me here for a moment 🧵 /1 https://twitter.com/zeynep/status/1350586029359702016?s=20 … pic.twitter.com/7ID8Tjlq0u
          Show this thread
          1 reply 0 retweets 4 likes
          Show this thread
        13. Aaron Richterman, MD‏ @AaronRichterman 3 Feb 2021

          Aaron Richterman, MD Retweeted

          10. Implications from regular pcr monitoring after natural infection. Less infections, lower viral load, more asymptomatic. Will reduce transmission. https://twitter.com/dylanhmorris/status/1357003968208121861 …

          Aaron Richterman, MD added,

          This Tweet is unavailable.
          1 reply 0 retweets 8 likes
          Show this thread
        14. Aaron Richterman, MD‏ @AaronRichterman 3 Feb 2021

          Aaron Richterman, MD Retweeted Aaron Richterman, MD

          10a. That said, similar caveats as below re whether those were even all reinfections.https://twitter.com/AaronRichterman/status/1355567294882131972 …

          Aaron Richterman, MD added,

          Aaron Richterman, MD @AaronRichterman
          Important thread below on immunologic basis for skepticism of 0% protection by prior natural infection on reinfection with B1.351 suggested by the small novavax study in S Africa So why else might they have found identical cases by sero+/-? Speculation before seeing full data: https://twitter.com/profshanecrotty/status/1355552010158764036 …
          Show this thread
          1 reply 0 retweets 5 likes
          Show this thread
        15. Aaron Richterman, MD‏ @AaronRichterman 6 Feb 2021

          11. More data from the Oxford/az randomized clinical trial. Vaccinated ppl who developed infection had lower viral loads and were pcr+ for one week shorter time relative to placebo. True for both asymptomatic and symptomatic cases. =>reduced transmission https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3779160 …pic.twitter.com/NsnUzCmrZk

          2 replies 3 retweets 16 likes
          Show this thread
        16. Aaron Richterman, MD‏ @AaronRichterman 8 Feb 2021

          Aaron Richterman, MD Retweeted Yaniv Erlich

          12a. And real world data from Israel. Interesting analysis inferring vaccine status by age and following cycle thresholds over time, suggesting lower VL in vaccinees w infection. Cool time series. Caveat: unclear what symptom status is but assume mostly symptom prompted testing.https://twitter.com/erlichya/status/1358477762495930368 …

          Aaron Richterman, MD added,

          Yaniv Erlich @erlichya
          Idea💡: we know the age of the person and the date of the test. Since vaccination was started with 60+, we can compare the average Ct value positives in this age group as a function of time and compare to 40-60 as a control. Here are the results: [Red: 60+;Blue:40-60] pic.twitter.com/X24YG5SCmZ
          Show this thread
          2 replies 1 retweet 5 likes
          Show this thread
        17. Aaron Richterman, MD‏ @AaronRichterman 10 Feb 2021

          12b. Here are the pre-prints from the two real-world Israel studies of time series w viral load reduction after mrna vaccination. Some limitations including unknown symptom status, but suggestive. https://www.medrxiv.org/content/10.1101/2021.02.08.21251329v1 … https://www.medrxiv.org/content/10.1101/2021.02.06.21251283v1 …pic.twitter.com/z7yOhh6GPi

          1 reply 0 retweets 5 likes
          Show this thread
        18. Aaron Richterman, MD‏ @AaronRichterman 22 Feb 2021

          13. Nice study of healthcare workers after Pfizer vaccine with regular PCR screening every 2 weeks. They found 70% reduction in all infections (asx or sx) dose1+3wks, 85% dose2+1wk. May be overestimated if vaccine ⬇️ duration of pcr+, but expect large transmission ⬇️pic.twitter.com/okdA1wLh0U

          2 replies 13 retweets 46 likes
          Show this thread
        19. Aaron Richterman, MD‏ @AaronRichterman 22 Feb 2021

          13a. Link for that last study: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3790399 …

          1 reply 0 retweets 2 likes
          Show this thread
        20. Aaron Richterman, MD‏ @AaronRichterman 24 Feb 2021

          Aaron Richterman, MD Retweeted Aaron Richterman, MD

          14. 75% protection against asymptomatic seroconversion in J&J vaccine trial.https://twitter.com/AaronRichterman/status/1364575515978440708 …

          Aaron Richterman, MD added,

          Aaron Richterman, MD @AaronRichterman
          Transmission prevention: 74% efficacy against seroconversion without prior symptoms ie protection against asymptomatic infection. They have only completed planned serologies on a subset of participants but extremely promising for this vaccine to prevent transmission. pic.twitter.com/xlGh2dca5P
          Show this thread
          1 reply 2 retweets 7 likes
          Show this thread
        21. Aaron Richterman, MD‏ @AaronRichterman 24 Feb 2021

          14a. Important for those worried about b1.351. While this prelim analysis of asymptomatic infection after j&j is based on 29% completed serology data, most of the serologies from South Africa had been done.pic.twitter.com/PeFLn5jhbT

          1 reply 0 retweets 3 likes
          Show this thread
        22. Aaron Richterman, MD‏ @AaronRichterman 26 Feb 2021

          Aaron Richterman, MD Retweeted Eran Segal

          15. No posted pre print yet but if this holds we now have 3 lines of evidence suggesting 85-90% reduction in all infections by the mrna vaccines (moderna RCT, Pfizer UK regular screening healthcare workers, 👇🏻 Israel regular screening). H/t @EricMeyerowitzhttps://twitter.com/segal_eran/status/1365263943229452289 …

          Aaron Richterman, MD added,

          Eran Segal @segal_eran
          Israel: Vaccines may reduce infections by 88% Key in this study by the national covid center, is use of **routine testing** of nursery home workers, thus less biases Based on 8300 vaxed and 2600 non-vaxed workers under 65 y/o Note lower rise in vaxed 7-10 days after 2nd dose pic.twitter.com/68mKv5Sa3i
          1 reply 1 retweet 8 likes
          Show this thread
        23. Aaron Richterman, MD‏ @AaronRichterman 26 Feb 2021

          15a. There is a little separation in the first few days so will need to see what kind of adjustment has been made here.

          2 replies 0 retweets 2 likes
          Show this thread
        24. Aaron Richterman, MD‏ @AaronRichterman 28 Feb 2021

          16. On interpreting cross-sectional pcr during vaccine trials (i.e. moderna asymptomatic swabs at the time of dose 2) https://twitter.com/mlipsitch/status/1366172405119541250?s=20 …pic.twitter.com/7aHfqRYV5N

          2 replies 0 retweets 3 likes
          Show this thread
        25. Aaron Richterman, MD‏ @AaronRichterman 4 Mar 2021

          17. Another study with regular (weekly) asymptomatic screening of hcw finds large reduction in pcr+ after Pfizer vaccine. The case for a large transmission reduction w vaccine seems closed at this point but will keep collecting these for now.https://www.authorea.com/users/332778/articles/509881-single-dose-bnt162b2-vaccine-protects-against-asymptomatic-sars-cov-2-infection …

          1 reply 14 retweets 49 likes
          Show this thread
        26. Aaron Richterman, MD‏ @AaronRichterman 4 Mar 2021

          17a. At least until these stop coming on a daily basis... https://www.nytimes.com/live/2021/03/04/world/covid-19-coronavirus/its-unclear-how-easily-vaccinated-people-may-spread-the-virus-until-the-answer-arrives-scientists-urge-caution … https://www.google.com/amp/s/www.wired.com/story/we-still-dont-know-how-well-covid-vaccines-stop-transmission/amp …

          2 replies 0 retweets 14 likes
          Show this thread
        27. Aaron Richterman, MD‏ @AaronRichterman 9 Mar 2021

          Aaron Richterman, MD Retweeted Laura Waters

          18. Neutralizing antibodies (like those induced by vaccines) reduce infection by 50% overall and in those who become infected there are fewer symptoms, lower viral load peak, shorter infections ~> large reductions in transmissionhttps://twitter.com/drlaurajwaters/status/1369328999944568836 …

          Aaron Richterman, MD added,

          Laura Waters @drlaurajwaters
          #CROI2021 REGEN-COV vs placebo to asymptomatic #COVID19 contacts: 100% protection against symptomatic infection & 50% reduction in infection overall. All infections in active arm asymptomatic with lower peak & shorter duration viraemia, less transmission potential & FEWER AE! pic.twitter.com/oq5X5EBonk
          1 reply 2 retweets 6 likes
          Show this thread
        28. Aaron Richterman, MD‏ @AaronRichterman 9 Mar 2021

          Aaron Richterman, MD Retweeted Laura Waters

          18a. Same thinghttps://twitter.com/drlaurajwaters/status/1369323658821464067 …

          Aaron Richterman, MD added,

          Laura Waters @drlaurajwaters
          #CROI2021 Myron Cohen presented BLAZE-2: bamlanivimab vs placebo - 80% reduction in symptomatic #COVID9 in residents & 72% amongst high risk staff, lower viral load & shedding if infected. 4 deaths, all on placebo. Hugely exciting data for monoclonal antibodies!! pic.twitter.com/2ojbSy43Xs
          1 reply 1 retweet 2 likes
          Show this thread
        29. Aaron Richterman, MD‏ @AaronRichterman 10 Mar 2021

          19. Interesting study of pre-procedural asymptomatic cov2 pcr screening - 80% reduction (95% CI 56-91%) in asymptomatic infection after both doses of mrna vaccines. Similar reduction after a single dose.https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciab229/6167855 …

          1 reply 3 retweets 6 likes
          Show this thread
        30. Aaron Richterman, MD‏ @AaronRichterman 12 Mar 2021

          20. First observational study of household members of healthcare workers receiving mostly pfizer vax. After adjustment, 54% reduction in risk for household members (95% CI 30-70%) after both vaccine doses +14d in hcw. H/t @mugecevik https://github.com/ChronicDiseaseEpi/hcw/blob/master/vaccine_manuscript.pdf …pic.twitter.com/izXumhKISL

          1 reply 2 retweets 6 likes
          Show this thread
        31. Aaron Richterman, MD‏ @AaronRichterman 12 Mar 2021

          20a. Remember that this is not a contact tracing study and so reduction can be thought of as lower bound from the vaccinated household member since exposures may have occurred elsewhere

          1 reply 0 retweets 3 likes
          Show this thread
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