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michaelzlin's profile
Michael Lin, MD PhD 🧬
Michael Lin, MD PhD 🧬
Michael Lin, MD PhD  🧬
@michaelzlin

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Michael Lin, MD PhD  🧬

@michaelzlin

Associate Professor of Neurobiology & Bioengineering @Stanford ☘️🧪🦠🧠🌈🔬📖🇺🇲🌏 Molecular engineering for voltage, viruses, and SARSCoV2. Fan of facts.

Harvard/UCLA/HMS/UCSD/Stanford
linlab.stanford.edu
Joined July 2015

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    1. Michael Lin, MD PhD  🧬‏ @michaelzlin 21 Jun 2021

      But we've only fully vaccinated ~50% of eligible people and Delta with enhanced transmissibility is on the rise (already causing a big surge in Missouri and Arkansas). What's the worst-case scenario?

      1 reply 9 retweets 49 likes
      Show this thread
    2. Michael Lin, MD PhD  🧬‏ @michaelzlin 21 Jun 2021

      Worst case scenario, is that we have a widespread Delta wave in the fall. Actually that's the medium-case scenario; modeling predicts a fall surge that's 20% the size of the past winter wave, which itself was massive (causing 400,000 lives).https://www.cnn.com/2021/06/21/us/us-coronavirus-monday/index.html …

      4 replies 22 retweets 77 likes
      Show this thread
    3. Michael Lin, MD PhD  🧬‏ @michaelzlin 21 Jun 2021

      The worst-case scenario is Delta can percolate enough in unvaccinated or partly immunized (50% of the US population) or JNJ-immunized (only partly protected vs disease) through the summer to mutate to even more transmissible/evasive forms, or some new variant emerges from abroad.

      3 replies 13 retweets 67 likes
      Show this thread
    4. Michael Lin, MD PhD  🧬‏ @michaelzlin 21 Jun 2021

      Michael Lin, MD PhD  🧬 Retweeted Michael Lin, MD PhD  🧬

      The prediction of partial disease prediction for JNJ recipients derives from JNJ's 60% efficacy against disease from the Beta B.1.351 variant, which appears similarly evasive as Delta against vaccine-elicited antibodies. @ScottGottliebMD estimates the samehttps://twitter.com/michaelzlin/status/1403071331554381827 …

      Michael Lin, MD PhD  🧬 added,

      Michael Lin, MD PhD  🧬 @michaelzlin
      The J&J vaccine is <10% of vaccinations in the US, and ~0% outside, so it isn't studied as much as other vax. In particular how well J&J works against Delta (b.1.617.2) hasn't been discussed, whereas we know a lot about Pfizer/Moderna/AZ. So I've decided to take a stab at it. 🧵
      Show this thread
      3 replies 12 retweets 55 likes
      Show this thread
    5. Michael Lin, MD PhD  🧬‏ @michaelzlin 21 Jun 2021

      The most important PH measure of course is to keep on pushing for vaccination as quickly as possible. But can we do something easy for the already immunized at the same time to further protect them?

      3 replies 6 retweets 47 likes
      Show this thread
    6. Michael Lin, MD PhD  🧬‏ @michaelzlin 21 Jun 2021

      There is a clinical trial studying boosters for the already "fully" immunized which is defined as 2 shots of RNA (Pfizer/Moderna) or the 1 shot of J&J. The trial will look at neutralizing antibody titers and safety.https://clinicaltrials.gov/ct2/show/NCT04889209 …

      1 reply 18 retweets 73 likes
      Show this thread
    7. Michael Lin, MD PhD  🧬‏ @michaelzlin 21 Jun 2021

      The CDC might be waiting for the outcome before making any recommendations. But safety for J&J is almost certainly assured. UK and EU have already shown the safety of 1 shot of AZ adenovirus vaccine then RNA.https://www.nature.com/articles/d41586-021-01359-3 …

      6 replies 20 retweets 91 likes
      Show this thread
    8. Michael Lin, MD PhD  🧬‏ @michaelzlin 21 Jun 2021

      Efficacy in terms of neutralizing antibodies is also assured for J&J recipients. They have lower antibodies than the 2-dose RNA recipients, so there's room for improvement. Also AZ+Pfizer trial showed increased antibodies by after the Pfizer boosthttps://www.nature.com/articles/s41591-021-01377-8 …

      1 reply 9 retweets 67 likes
      Show this thread
    9. Michael Lin, MD PhD  🧬‏ @michaelzlin 21 Jun 2021

      So really there's not much mystery to the "delayed heterologous boost" trial (NCT04889209) for J&J recipients. It will confirm what the European data have shown already after 1 shot of the similar AZ vaccine.

      2 replies 9 retweets 57 likes
      Show this thread
    10. Michael Lin, MD PhD  🧬‏ @michaelzlin 21 Jun 2021

      At the same time, for J&J we have the largest need in terms of boosting efficacy against the upcoming Delta wave, or even further variants. The 40% of exposed people getting sick and being able to pass on to others is worth preventing if we can.

      2 replies 13 retweets 78 likes
      Show this thread
      Michael Lin, MD PhD  🧬‏ @michaelzlin 21 Jun 2021

      The 40% expected breakthrough in J&J recipients exposed to Delta is a big contrast to the 12% expected for RNA recipients. And recall J&J recipients can and should be going about their daily business the same as RNA recipients, e.g. dining in restaurantshttps://www.medrxiv.org/content/10.1101/2021.05.22.21257658v1 …

      12:37 PM - 21 Jun 2021
      • 50 Retweets
      • 144 Likes
      • Coffee Is My Drug Jonell is surviving a pandemic Kristina McC Gordon Glenn cheyenne 🏓 the murderHobos fugit cum forfex Carin Upstill Dr. Benedicte Callan
      11 replies 50 retweets 144 likes
        1. New conversation
        2. Michael Lin, MD PhD  🧬‏ @michaelzlin 21 Jun 2021

          Why not bump the protection against illness from (and tranmission of) Delta from 60% for J&J recipients to ~90% like the RNA recipients have? This can be easily accomplished with a RNA booster for existing J&J recipients.

          11 replies 27 retweets 176 likes
          Show this thread
        3. Michael Lin, MD PhD  🧬‏ @michaelzlin 21 Jun 2021

          On top of that, increasing protection against disease will reduce the probability of getting hospitalized (and dying, for the unfortunate) further. It might make a small difference to the numbers, but a big difference to individuals.

          1 reply 7 retweets 73 likes
          Show this thread
        4. Michael Lin, MD PhD  🧬‏ @michaelzlin 21 Jun 2021

          All it would take is a recommendation from the CDC that J&J recipients be allowed to receive boosters. If CDC wants to be cautious, they can suggest that doctors consider prescribing a booster on a case-by-case basis. It would then be allowable off-label use of an approved drug.

          4 replies 15 retweets 134 likes
          Show this thread
        5. Michael Lin, MD PhD  🧬‏ @michaelzlin 21 Jun 2021

          Thus with a glut of soon-to-expire RNA doses, no lines at vaccination locations, Delta surging, J&J not fully protected against disease, and overwhelming evidence for safety and efficacy of RNA boosters, allowing J&J recipients a RNA booster is a no-brainer.

          9 replies 35 retweets 203 likes
          Show this thread
        6. Michael Lin, MD PhD  🧬‏ @michaelzlin 21 Jun 2021

          In conclusion, CDC issuing guidance allowing RNA boosters for J&J recipients would be a proper application of the principle of "identifying the worst-case scenario using the most up-to-date science and recommending easy things that can mitigate that".

          18 replies 26 retweets 225 likes
          Show this thread
        7. Michael Lin, MD PhD  🧬‏ @michaelzlin 11 Sep 2021

          Old thread, but it seems to have aged well. A bit sad, actually, that my recommendations are applicable now, as it means we've wasted 3 months. However it's still not too late, if CDC now acts quickly.

          4 replies 4 retweets 47 likes
          Show this thread
        8. Michael Lin, MD PhD  🧬‏ @michaelzlin 18 Oct 2021

          Michael Lin, MD PhD  🧬 Retweeted Michael Lin, MD PhD  🧬

          We've now wasted 4 months and most of the Delta wave just to find out that J&J breakthrough vs Delta death is 20%, several times worse than Modernahttps://twitter.com/michaelzlin/status/1450319601275793409 …

          Michael Lin, MD PhD  🧬 added,

          Michael Lin, MD PhD  🧬 @michaelzlin
          You can see the difference in area under the curve between J&J and Moderna will be about 16/100k mid-July to mid-Sep (avg difference 2 per week). That's about 2400 fewer deaths if all 15M J&Jners had gotten Moderna instead. Hospitalizations probably scale by 5x - 10x. https://twitter.com/Michele_PhD_/status/1450279167552020482 …
          Show this thread
          4 replies 12 retweets 36 likes
          Show this thread
        9. Michael Lin, MD PhD  🧬‏ @michaelzlin 1 Dec 2021

          Michael Lin, MD PhD  🧬 Retweeted Edouard Mathieu

          What happened while the CDC held onto the fiction that #JnJers were fully immunized and thereby by definition the same as Modernates and Pfizerites See death curves by vaccine typehttps://twitter.com/redouad/status/1463175757740523525?t=yyqSPnUzl8jVQSc3fAwKHg&s=19 …

          Michael Lin, MD PhD  🧬 added,

          Edouard MathieuVerified account @redouad
          NEW: To understand how the pandemic is evolving, it's crucial to know how death rates from COVID differ by vaccination status. In this post we explain why rates are the key metric to use for this, and we show the latest data for the US, England, and Chile: https://www.ourworldindata.org/covid-deaths-by-vaccination … pic.twitter.com/STkJWfluwn
          Show this thread
          3 replies 8 retweets 25 likes
          Show this thread
        10. End of conversation
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        2. girldetectivex‏ @GirlDetectiveX 22 Jun 2021
          Replying to @jrwolfster @michaelzlin

          How were you able to get MRNA vaccines after J&J? Did you pay out-of-pocket?

          1 reply 0 retweets 2 likes
        3. Show replies

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