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ENirenberg's profile
Edward Nirenberg
Edward Nirenberg
Edward Nirenberg
@ENirenberg

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Edward Nirenberg

@ENirenberg

Views my own. Anti-disease. Big Nerd Energy. Will accept constructive criticism from qualified individuals. Fun at parties. he/him

United States
deplatformdisease.com
Joined September 2016

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    1. Edward Nirenberg‏ @ENirenberg 1 Aug 2021

      So why are vaccines different from antimicrobials? This paper (https://royalsocietypublishing.org/doi/10.1098/rspb.2016.256 …) discusses it thoroughly but the gist is really in this table.pic.twitter.com/eeRzZ955Vz

      3 replies 14 retweets 116 likes
      Show this thread
    2. Edward Nirenberg‏ @ENirenberg 1 Aug 2021

      To evolve resistance, you generally need mutation; but this requires replication. When a pathogen comes into contact with someone who is vaccinated, we already know infection might not occur at all- so no replication.https://www.cdc.gov/mmwr/volumes/70/wr/mm7013e3.htm …

      4 replies 16 retweets 113 likes
      Show this thread
    3. Edward Nirenberg‏ @ENirenberg 1 Aug 2021

      Now, say infection of the vaccinated person does occur. That means replication will too, which means mutations can happen, including those that might evolve resistance. But here's the thing: a vaccinated person's immune system is primed against the pathogen already.pic.twitter.com/tkPKXU64jA

      4 replies 9 retweets 106 likes
      Show this thread
    4. Edward Nirenberg‏ @ENirenberg 1 Aug 2021

      They get to have a secondary, tertiary, ternary, etc. response which is faster, better, stronger. An unvaccinated person however, is starting from scratch. It will take them longer to clear the infection and restrict the replication of the pathogen than the vaccinated person.

      3 replies 12 retweets 102 likes
      Show this thread
    5. Edward Nirenberg‏ @ENirenberg 1 Aug 2021

      This necessarily means that the pathogen has more opportunity to evolve in an unvaccinated individual, a point I will be returning to and elaborated upon more here: https://www.nature.com/articles/s41577-021-00544-9 … Meaning: unvaccinated populations are the FAR bigger risk for SARS-CoV-2 evolution.

      2 replies 32 retweets 142 likes
      Show this thread
    6. Edward Nirenberg‏ @ENirenberg 1 Aug 2021

      But: (most of) the vaccines are all targeting the spike protein. Isn't that just one thing- like the way that antimicrobials work? Shouldn't it be just a few mutations and poof- resistance? Not quite.

      1 reply 8 retweets 85 likes
      Show this thread
    7. Edward Nirenberg‏ @ENirenberg 1 Aug 2021

      The spike protein of SARS-CoV-2 is, deceptively, not just one target for your immune system. The protein comprises 1273 amino acids, and the immune system can target short stretches of them, giving it MANY targets. To escape, quite a large fraction of them would need to change.

      1 reply 19 retweets 125 likes
      Show this thread
    8. Edward Nirenberg‏ @ENirenberg 1 Aug 2021

      If your immune response involved just one antibody or one T cell, then yes, absolutely, the situation would be analogous to antimicrobial resistance. But here is a map of sites that B and T cells target on the spike protein (from https://www.medrxiv.org/content/10.1101/2021.07.01.21259833v1.full.pdf …):pic.twitter.com/1c2N7bxp8O

      3 replies 14 retweets 102 likes
      Show this thread
    9. Edward Nirenberg‏ @ENirenberg 1 Aug 2021

      T cells can target almost the entire spike protein. Antibodies' focus is more constrained because the spike protein is adorned with a sugars that shield parts of it from antibodies. We already know that variants don't seem to matter much for T cells: http://cell.com/cell-reports-medicine/fulltext/S2666-3791(21)00204-4?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS2666379121002044%3Fshowall%3Dtrue …

      1 reply 10 retweets 94 likes
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    10. Edward Nirenberg‏ @ENirenberg 1 Aug 2021

      Here's the other thing though: there isn't infinite space for SARS-CoV-2 to evolve. SARS-CoV-2 is a virus, meaning it's still a parasite. It can't do anything without a permissive and susceptible host cell- meaning it has to still be able to bind its receptor, ACE2 (and others).

      1 reply 16 retweets 110 likes
      Show this thread
      Edward Nirenberg‏ @ENirenberg 1 Aug 2021

      A spike protein that mutates so much that it can escape all of our antibodies (and T cells) would almost certainly have quite a bit of trouble engaging ACE2 (or other SARS-CoV-2 receptors) and getting into cells. So that's a bit of an evolutionary dead-end.

      2:15 PM - 1 Aug 2021
      • 29 Retweets
      • 159 Likes
      • POTUS speedrun record Louise Vincent Od Ogga Magrat Spontana Tviterapeut Carlos Solorio Ildfluer Adam Brooks the amtrak appreciator
      3 replies 29 retweets 159 likes
        1. New conversation
        2. Edward Nirenberg‏ @ENirenberg 1 Aug 2021

          It's also worth spending a moment summarizing what's known about the relative importance of T cell and B cell (antibody) responses here, which I think @profshanecrotty did an amazing job explaining:https://www.youtube.com/watch?v=Ie6NLMqbMU4 …

          1 reply 10 retweets 87 likes
          Show this thread
        3. Edward Nirenberg‏ @ENirenberg 1 Aug 2021

          Antibodies against SARS-CoV-2 can be extremely protective (esp before infection), but once you're actually infected with the virus, your T cell responses probably matter much more- and vaccination gives you a LOT to work with even if it's "just" spike:https://www.medrxiv.org/content/10.1101/2021.06.30.21259787v1 …

          2 replies 11 retweets 98 likes
          Show this thread
        4. Edward Nirenberg‏ @ENirenberg 1 Aug 2021

          The vaccines are holding up well against the variants that have emerged to date. Even with the Delta variant which seems to spread more effectively than ancestral variants, 2 doses of the Pfizer vaccine are 88% effective against symptomatic disease:https://www.nejm.org/doi/full/10.1056/NEJMoa2108891?query=featured_home …

          3 replies 14 retweets 109 likes
          Show this thread
        5. Edward Nirenberg‏ @ENirenberg 1 Aug 2021

          Edward Nirenberg Retweeted Adam Kucharski

          So if evolution of vaccine resistance is so unlikely, what are we worried about? Well to start with- not everyone is vaccinated. The emergence of a variant which spreads more effectively is exponentially worse for public health (as delta shows).https://twitter.com/AdamJKucharski/status/1343567425107881986?s=20 …

          Edward Nirenberg added,

          Adam KucharskiVerified account @AdamJKucharski
          Why a SARS-CoV-2 variant that's 50% more transmissible would in general be a much bigger problem than a variant that's 50% more deadly. A short thread... 1/
          Show this thread
          2 replies 12 retweets 107 likes
          Show this thread
        6. Edward Nirenberg‏ @ENirenberg 1 Aug 2021

          Vaccines are also not 100% effective- and a more transmissible variant is going to be able to find those individuals who didn't generate ideal responses to the vaccine and cause disease- like we see with the Delta variant. But you are still much worse off being unvaccinated.

          2 replies 11 retweets 92 likes
          Show this thread
        7. Edward Nirenberg‏ @ENirenberg 1 Aug 2021

          Vaccination saves lives and it will prevent the emergence of new variants of concern and we all NEED equity in vaccine distribution. If you're worried about SARS-CoV-2 variants, the best thing you can do is make sure you and your loved ones get vaccinated.

          3 replies 21 retweets 124 likes
          Show this thread
        8. Edward Nirenberg‏ @ENirenberg 1 Aug 2021

          This also does not mean that non-pharmaceutical interventions are unneeded, especially in surges like we are currently experiencing. Public health measures are additive and we should do all we can to bring this under control so that we can return to normalcy.

          1 reply 9 retweets 101 likes
          Show this thread
        9. Edward Nirenberg‏ @ENirenberg 1 Aug 2021

          Edward Nirenberg Retweeted Dr. Angela Rasmussen

          I should also attach this thread by the incomparable @angie_rasmussen who went through more of the datahttps://twitter.com/angie_rasmussen/status/1420024555981221897?s=20 …

          Edward Nirenberg added,

          Dr. Angela RasmussenVerified account @angie_rasmussen
          We should worry about the future "worse" variants that will likely result from uncontrolled spread. But they are not likely to "escape vaccine-induced immunity." There are several reasons why this is the case. https://twitter.com/DrTomFrieden/status/1419753679108911106 …
          Show this thread
          3 replies 9 retweets 80 likes
          Show this thread
        10. Edward Nirenberg‏ @ENirenberg 1 Aug 2021

          Also sorry for the broken link re vaccine resistance vs antibiotic resistance; this is the correct one:https://royalsocietypublishing.org/doi/10.1098/rspb.2016.2562 …

          1 reply 6 retweets 39 likes
          Show this thread
        11. Edward Nirenberg‏ @ENirenberg 1 Aug 2021

          Edward Nirenberg Retweeted David Boulware, MD MPH

          Also this is a really excellent thread that describes how your immune system has a head start if you're vaccinated in more detail than I did:https://twitter.com/boulware_dr/status/1421997079602290689?s=20 …

          Edward Nirenberg added,

          David Boulware, MD MPHVerified account @boulware_dr
          What is the anamnestic B cell response and why does incubation period of an infection (e.g. #COVID19) matter? - After a 2nd exposure to antigen, B cells rapidly expand over 1-3 days producing maximal antibody (Ab) response in 3-5 days. - With repeat exposure Ab binding is better
          Show this thread
          6 replies 9 retweets 63 likes
          Show this thread
        12. End of conversation

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