Here is one more look at Supplementary Table 18 from the Moderna NEJM paper, the best direct data we have on this question.
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https://twitter.com/zeynep/status/1350586029359702016?s=20 …pic.twitter.com/7ID8Tjlq0u
Complex systems, wicked problems. Society, technology, science and more. @UNC professor. @NYTimes columnist. My newsletter is @insight: http://www.theinsight.org
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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
For the sake of argument, lets hypothesize that the mrna vaccines eliminate severe diz and reduce symptomatic disease w 95% efficacy, as suggested by this trial, BUT do nothing to reduce infection (/transmission). If thats the case, all symptomatic infection would become asx /2
If that's the case, what would we expect to see when the moderna investigators screened all asymptomatic people prior to vaccine #2 with pcr? Either similar rates of pcr+ (if immunity not set in), OR higher rates of pcr+ in the vaccine group (since sx infection now asx) /3
Instead, we see a REDUCTION in asx infection prior to dose 2: symptomatic infections: 46 placebo, 7 vaccine (efficacy 85% 95% CI 66-93) asymptomatic screening pcr+ 39 placebo, 15 vaccine (efficacy 61%, 95% CI 30-79%) /4
The confidence interval is wide, yes, but (1) all shows reduction, not increase, in asymptomatic infection, which would be expected if sx infections just shifted subclinically & (2) remember this is before anyone even got the second dose, so ultimate efficacy is prob much higher
This is a tricky question, tell me how I'm thinking about this incorrectly @PaulSaxMD @sigal_md @IDDocJen @JenniferNuzzo @EricMeyerowitz @roby_bhatt @zeynep
My take on these data: asymptomatic infection reduced, but not by as much as symptomatic infection. But, ~2/3 reduction may understate it b/c some of asympt +'s at dose 2 will have been infected in the first week after dose 1, before ANY protection is seen, & just be late PCR+.
I hadn't considered what it means that symptomatic ppl are excluded from this testing ie how that would affect expected breakdown of asympt cases. (I also don't know if they were.) It's interesting, and I could argue it either way (expect same, or expect more asympt in vax'ed).
I still think until community prevalence goes down, we don't know enough to tell ppl not to mask in public, for their own sake & for others too. You want to be like the vaccinated ppl in the trial; they masked. (What if exposure amount matters to vaccine efficacy?)
By the way, I am not at all arguing against masking in public. Rather, I fear being dishonest about level of uncertainties for 2ary goals
Yep. This round of mismessaging is going to hurt us. Already doing so.
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