@sumanthraman @EricTopol This is a great question. I’ll try my best to answer.
1) First is that the question also applies to Europe which is doing just as bad as the US. So why are USA and Europe doing worse than more crowded and much poorer countries?
@sumanthraman @EricTopol 2) I think one of the most likely factors is that there must be some form of pre-existing cross reactive immunity which is helping keep the disease severity low. So more asymptomatic cases, and fewer hospitalizations and deaths. I did a thread on this a while back.
@sumanthraman @EricTopol 3) The second factor is certain favorable demographics in countries like India: age distribution (lower median age), and lower prevalence of obesity. A lot of severe COVID is associated with these two factors.
@sumanthraman @EricTopol 4) Third is that mild cases of COVID are not likely being captured in India. So I think it’s hard to compare the case numbers. But it’s hard to hide overflowing ICUs or deaths. And so there is no question your observation is right; India has much less of severe COVID than the US.
@sumanthraman @EricTopol So some countries have done well due to doing everything right (S. Korea), some with great border control (New Zealand). Some have avoided high levels of deaths and severe COVID because of some protective factors: preexisting immunity, lower age, lower obesity rates.
@sumanthraman @EricTopol On another note, keep in mind u can only get COVID for someone with COVID. So some countries including crowded ones have successfully made COVID an external threat by test/trace/quarantine ALL internal cases with simultaneous strict border control to keep new cases from entering.
@sumanthraman @EricTopol Once you do that people can be packed in crowded areas and go mask free because there is no COVID around to get COVID.

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More from @VincentRK

4 Dec
Here are selected abstracts from @MayoClinic @MayoCancerCare being presented at #ASH20

1. CyTOF and TNA seq studies reveal major defects in the cellular tumor immune microenvironment with refractory myeloma. ash.confex.com/ash/2020/webpr… @Taxkourel @myelomaMD @MayoMyeloma
2. Lab studies using salicylates to augment anti tumor effects of selinexor. #ASH20 ash.confex.com/ash/2020/webpr… @JithmaA
3. In patients needing Auto transplant for relapsed DLBCL, interestingly the GCB type had poorer outcome compared to non GCB. #ASH20 ash.confex.com/ash/2020/webpr… @MadihaIqbal13
Read 13 tweets
3 Dec
One of the most common questions myeloma patients ask me is: Should I get a stem cell transplant, and if so when should I do it?

The update of the IFM trial at #ASH20 addresses this question. ash.confex.com/ash/2020/webpr… #ASH20VR

Thread 👇
1) Should eligible patients do a transplant: Yes

Two RCTs show an Overall Survival benefit of transplant over chemo alone.

2) Does timing early vs delayed matter?

4 RCTs (including IFM 2009) show similar overall survival regardless of when transplant is done (early vs delayed)
The IFM 2009 results show identical overall survival ~60% at 8 years with early or delayed transplant, even though not everyone who is in the delayed transplant group even gets to a transplant. But there are important caveats.
Read 7 tweets
3 Dec
Follow and search #ASH20VR for my commentaries (&critiques) on important myeloma related abstracts during #ASH20.

I have used these personal hashtags selectively to avoid information overload. Check #ASH19VR for last years picks. @MyelomaTeacher @NorthTxMSG @grpetersen1
I started doing personal hashtags at meetings a few years ago for my own selfish reasons. It has worked out great for me. And I’m hoping it’s useful for others.
I tweet a lot at ASH and other Hematology/oncology meetings but won’t add my personal hashtag unless I feel like it’s something very important that I would want to look up in the future.
Read 4 tweets
1 Dec
Should we screen for myeloma in high risk individuals?

For Blacks with one or more affected first-degree relatives, & all others with 2 or more affected first-degree relatives — Yes.

I’ve come to this conclusion after considering pros & cons. @nature nature.com/articles/d4158…
If you are going to offer screening, I suggest only a one-time year at age 50 and older, or 10 years before diagnosis in first degree relative.

Test: SPEP, Serum IFE, and Serum FLC. We are not screening for MGUS, but for evidence suggestive of high risk SMM or MM.
This recommendation affects a small number of people who are at high risk of developing SMM or MM. For all others, including general population, wait till results of iSTOP MM RCT, and other studies such as PROMISE. @sykristinsson @IreneGhobrial
Read 4 tweets
23 Nov
3 for 3!

@AstraZeneca @UniofOxford vaccine highly effective against COVID. Lower cost, easier storage & transport. This is also the vaccine that @SerumInstIndia is manufacturing: means great news for India. @nramind @rameshlaus @sumanthraman @DrEricDing nytimes.com/live/2020/11/2…
This comes on the heels of great results from @pfizer and @moderna_tx

With the pandemic affecting the whole world, we need all the vaccines we can get. I’m very pleased with the efficacy. I wouldn’t worry about 70% versus 95%. Efficacy is efficacy. @singersrinivas @ShirleySetia
The @UniofOxford @AstraZeneca vaccine is an adenovirus vector vaccine. See mechanism of action and doses reserved by country. @business @PSampathkumarMD 👇
Read 7 tweets
13 Nov
Here are my Top 5 #ASH20 @ASH_hematology myeloma abstracts. #ASH20VR
I’ve listed them with links to the full abstract. @mtmdphd @Rfonsi1 @MayoMyeloma @NorthTxMSG @Mohty_EBMT @BldCancerDoc @szusmani @ninashah33 @profghjackson @Phari @PerrotAurore @mvmateos
Thread for countdown👇
#5 Allogeneic off-the-shelf CAR-T therapy for myeloma. First in human results with Anti BCMA ALLO-647 shows clinical activity in myeloma.
5 of 15 responses. #ASH20 #ASH20VR @sloan_kettering @Phari @AllogeneTx ash.confex.com/ash/2020/webpr…
#4 Identification of a potential mechanism for frequent relapses after CAR-T therapy for myeloma: Bi allelic loss of BCMA locus at 16p. Important work. #ASH20 #ASH20VR @DanaFarber @NoopurRajeMD

ash.confex.com/ash/2020/webpr…
Read 8 tweets

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