then NY Hospitals would have acted differently to his prior order of "Use it or Lose it, and Get Fined", issued on January 4, 2021. At this time, hospitals were NOT allowed to vaccinate patients, even though many were clamoring to do so. (2/n)
As a consequence, it is not surprising (and entirely predictable based on the incentive created by @NYGovCuomo) that many academic medical centers vaccinated lower-risk and non-patient facing staff, as outlined today in the @nytimes by @apoorva_nyc (3/n) nytimes.com/video/us/polit…
It is important to get at the bottom of why this occurred and to report this critical problem with a more substantial journalistic approach. I am deeply frustrated with the #VaccineStrategy and utter failure at the executive level to put processes in place for a more (4/n)
equitable approach. The article has many legitimate points - employees of academic medical centers that do not engage in patient-facing activities should NOT have received the vaccine. My comments also do not apply to medical centers outside of New York State highlighted (5/n)
in the article. In hindsight, @NYGovCuomo should have expanded #SARS_CoV_2 vaccine eligibility BEFORE threatening medical centers with fines for holding on the vaccine stocks. We need a public system in place NOW to distribute #COVID19 vaccine in the community (6/n)
and need to focus on high-risk populations and lower barriers to #vaccine access. This was evident months ago and reflects inadequate planning at the statewide level. If we institute purity tests for vaccine eligibility, rollout will be slow, painful and result in further (7/n)
loss of life. Academic medical centers simply do not have the capacity to act as the major vaccination sites for high-risk individuals. I am proud of the many colleagues @sloan_kettering who have volunteered to help with vaccinations. In the end, I share the goal of getting (8/n)
the vaccine into arms as equitably and rapidly as possible. We are doing our level best in these extraordinary times, and working beyond capacity to diagnose, treat, heal, and vaccinate patients. #IDTwitter#VaccinesWork@nytimes@apoorva_nyc
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1/n I read this article with tremendous interest and have some comments on this situation. Why are we in this situation? Conflicting forces are driving the vaccination process. At Elite Medical Centers, Even Workers Who Don’t Qualify Are Vaccinated nytimes.com/2021/01/10/hea…
2/n @sloan_kettering there was a deliberative and transparent process to identify and prioritize vaccination among patient-facing healthcare workers. However, hospitals in NY State were not yet allowed to offer vaccine to high-risk patients. Vaccine uptake is not uniform
3/n among priority patient-facing vaccine groups and since substantial financial repercussions were threatened if the vaccine was not administered very rapidly, this created an incentive to administer vaccine to other (lower risk) workers at academic medical centers. Remember
Concerned about the #COVID19 vaccines and autoimmune disease?
Both the #Moderna and #Pfizer vaccines do not contain an attenuated virus or instructions (via mRNA) to make viral particles that could replicate in vaccine recipients. (1/n)
I have psoriatic arthritis (on #methotrexate for about a decade) and had no hesitation to receive the vaccine @sloan_kettering. I am fortunate and was able to stop methotrexate for one month prior - this is atypical for most patients with autoimmune diseases - and will (2/n)
resume the medication a month after the second shot. I stress that this is not a medical recommendation for other patients with psoriatic arthritis or any other autoimmune disease. Patients should discuss how treatments for autoimmune conditions may impact vaccine immunity (3/n)
1/n Much will be made about this case report. I am very pleased that the patient did well and survived #COVID19 after a difficult course. On the heels of tweeting about anti IL-6 therapy (tocilizumab) I'm taking a stab at this case report. ashpublications.org/bloodadvances/…
2/n It is a purely correlative, observational study. The title is misleading though. An alternate, equally valid title would be: First case of COVID-19 in a patient with multiple myeloma successfully treated with methylprednisolone. The patient received corticosteroid (MP)
3/n therapy on five consecutive days (day +2 to day +6). On day +9 the patient received tocilizumab. He continued to improve and was released from the hospital 10 days later. Did tocilizumab cause this improvement? It is impossible to tell. However, I conclude that it is safe to
1/n I am thinking about the various modes of #COVID19 transmission. Although not common, gastrointestinal symptoms are routinely reported by COVID patients. In humans, the SARS-CoV2 receptor ACE2 is not only found in alveolar epithelial cells (lung), but also in cells that line
2/n the small intestine, among other sites (heart and kidneys). Humans shed high levels of #COVID19 in the stool, a finding that raised the question whether fecal-oral transmission may occur. This would be very relevant for measures to limit the spread of disease.
3/n The concern for fecal-oral transmission is clearly outlined in this review. nature.com/articles/s4157…
1/n I am asked on a daily basis about IL-6 blockade in #COVID19 patients @sloan_kettering . The truth is that I don't know if this intervention is helpful, neutral, or harmful. Colleagues point to the role of IL-6 blockade in treating CAR T cell toxicities and its cytokine storm.
2/n In the CAR T cell setting, IL-6 is clearly pathological and the IL-6 levels observed are typically far higher (10x or more) than those in critically ill COVID19 patients. It is not at clear to me that this concept is applicable to COVID. Why? There are important differences
3/n between a viral infection and genetically engineered T cells that causes a sterile inflammation. First, your immune system needs IL-6 to stimulate T follicular helper cells to foster Ab responses. This is likely to be important in generating sterilizing humoral (Ab-mediated)
1/n One of the most challenging things about the #COVID19 outbreak in NYC is having to act both fast and slow. What do I mean by this? On one hand, as an ID physician, I am in state of perpetual impatience. I want to do the best possible thing for the one patient under my care at
2/n any particular moment. I want the instant gratification of feeling I did something important and relevant for this particular human being. So my heart wants to tear open a package of hydroxychloroquine and offer a tablet, to set up the IV for an infusion of convalescent
3/n serum, to block cytokines that are elevated in a patient's serum, to provide medications to ease a cough. That's the fast. On the other hand, my mind knows that hydroxychloroquine has not shown antiviral activity against any human viral disease in the clinic (the jury is out