1st completed Randomized Clinical Trial for Convalescent Plasma finds NO IMPROVEMENT in mortality or progression to severe disease. Preprint: bit.ly/3iE1Qnd

You'll recall after pressure from President, FDA authorized the therapy in August: bit.ly/3c5sHGp 🧵 1/6
During that announcement the President, Sec. Azar & Commissioner Hahn all falsely claimed the therapy reduces mortality by 35%. Hahn later retracted.

Azar: "We dream in drug development of something like a 35% mortality reduction" 2/6

nytimes.com/2020/08/24/hea….
FDA authorization was based on a NON-randomized Mayo study that showed some improvement.

But the new study out of India, the first completed randomized trial, found no mortality reduction. Separately, a randomized Netherlands study was discontinued, having found no benefit. 3/6
The Netherlands study found no benefit in mortality, hospital stay, or disease severity and concluded "Most COVID-19 patients already have high neutralizing antibody titers at hospital admission" 4/6
medrxiv.org/content/10.110…
Lack of randomized data is why in August NIH's Fauci/Collins/Lane halted FDA authorization before the President stepped in to reverse it. “Three of us are pretty aligned on the importance of robust data through randomized control trials" -Dr. Lane 5/6
nytimes.com/2020/08/19/us/…
Still, some hope Plasma will yield benefit. Indian Trial administered it 8 days post-symptom onset. Giving it earlier from donors w/high titer may help. Also, there was improvement in viral clearing

But this highlights importance of randomized trials 6/6
the-scientist.com/news-opinion/i…

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More from @AliNouriPhD

29 Sep
NIH STUDY: 3 interventions had the most impact on COVID infections: closing schools, closing bars, wearing masks.

Here's Maryland where trajectory of case rate (green) hospitalizations (blue) and death (black) all change with a few days of lag time after closures🧵 1/n Image
Researchers also looked at school closure, alone. Here's Georgia where school closure occurred prior to closing bars and appears to cut the rate of infections (green) in half, beginning 8-14 days post-closure. Rates of hospitalizations (blue) & death (black) also went down (2/n) Image
Mask mandates also led to a drop in the rate of infections (green); drops in the rates of hospitalizations (blue); and deaths (black) "Mandating masks is to drop the slopes about 2 fold". Here's New Jersey (3/n) Image
Read 5 tweets
22 Sep
VIRUS RESURGING, and it's not even winter yet: after crushing the curve, France🇫🇷/Spain🇪🇸 recording more cases than during prior peak. Consequence of ill-prepared reopening, travel, spread among youth, bar-goers...In some place ICUs almost at saturation: wapo.st/3ck8qgl🧵
In the meantime, as Israel's cases soar, it became the first country to enter into a second lockdown. With some hospitals at capacity and turning patients away, the military is stepping in to set up field hospitals: bit.ly/3kBoTj7 2/4
Iran🇮🇷is in trouble: Among earliest to be hit, now in its 3rd wave. Each wave's baseline worse than last. Iran also coming off holiday travel & inadequate masking:bit.ly/2EmFuI5
“We no longer have orange and yellow, the whole country is in red" - Dep. Health Minister 3/4
Read 4 tweets
21 Sep
CDC: the coronavirus is airborne.

CDC finally acknowledged what scientists have been saying for months:

The virus isn't just spreading through large repiratory droplets that fall under gravity (6ft rule) but on small ones too that can travel farther. 1/3
newsweek.com/cdc-coronaviru…
This highlights the need for ventilation, in addition to masks, physical distancing, and hygiene. There are numerous examples of longer-distance aerosol transmission in indoor spaces. A few examples here: 2/3
This has been the defacto view in many countries. The Feb 3rd scientific study that characterized the virus even says "we propose that the disease could be transmitted by airborne transmission.."

The question is why it took us so long to accept it. 3/3
nature.com/articles/s4158…
Read 5 tweets
20 Sep
1. CDC: nearly 11,000 exposed to coronavirus on flights. Agency investigated 1,600 cases of people who flew while at risk of spreading the coronavirus, identifying nearly 11,000 people who potentially were exposed to the virus on flights 🧵
washingtonpost.com/local/traffica…
2. According to story, CDC contends viruses don't spread easily on planes w/air filtration systems, but being in close proximity to people for long periods is a problem. CDC’s guidance for travel is that staying home is safest. Indeed, in-flight transmission has been observed...
3. Yesterday researchers published an example of SARS-CoV-2 spread on planes. In March, a super-spreading event on a 10-hour London to Hanoi flight led to 16 Infections due to what is thought to be airborne transmission on the aircraft...
Read 5 tweets
20 Sep
1. Japan has a remarkably low death rate despite avoiding harsh lockdowns. That's because it a) recognized early that the virus doesn't just transmit at close distances, but also long-range & b) its public adheres to public health guidance. Western nations should emulate these 🧵
2. One feature of the virus is super-spreading where small minority can infect many others, often in crowded, poorly ventilated places. Few examples below👇. While @CDCgov, @WHO, others ignored or were too slow to acknowledge this, Japan embraced it early.
3. It did that by advocating for the 3 Cs: avoid close contact, crowded places, and closed spaces WITH POOR VENTILATION. In other words, the virus doesn't just come out of your mouth and fall to the ground within 6 ft, but can float in the air you breathe, so mix in fresh air.
Read 5 tweets
18 Sep
1. CDC: Super-spreading event on a 10-hour London➡️Hanoi flight w/16 Infections very likely acquired on board✈️.

"This finding...is generally in line with the mounting evidence that airborne transmission of SARS-CoV-2 is a major yet under-recognized transmission route"🧵
2. Authors go on: industry classifies in-flight transmission risk as very low & recommends only use of face masks w/o additional measures to increase physical distance, such as blocking the middle seats. "Our findings challenge these recommendations."
wwwnc.cdc.gov/eid/article/26…
3. This is why @FAScientists have asked the airlines to block the middle seat. It won't make the problem of long-range aerosols go away but will reduce the risk of short-range transmission: mailchi.mp/fas.org/airlin…
Read 6 tweets

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