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Leticia Kawano-Dourado πŸ‡§πŸ‡· Profile picture
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17 Jan, 15 tweets, 11 min read
1/ Covid19 is out of control in πŸ‡§πŸ‡· creating chaos & avoidable deaths.

This is the DIRECT result of a political agenda led by the Brazilian Federal Government.

I will provide evidence to help @ministerpublico @STF_oficial @camaradeputados @SenadoFederal do its job. Thread:
2/ Early at the beginning of the pandemic, the world knew very little about Covid

It is understandable that, at that time, wrong guidance was temporarily issued to the pop...

The important thing was that these GUIDANCES WERE UPDATED AS WE LEARNED MORE...
3/ By January 2021, it is CONSENSUS among the international scientific community that HYDROXICHLOROQUINE has *no* place in the management of Covid19:

WHO: bmj.com/content/370/bm…

NIH: covid19treatmentguidelines.nih.gov

CDC: cdc.gov/coronavirus/20…

In Brazil, various Medical Societies...
4/ ...have also issued guidance on the management of Covid19:

Brazilian Infectious Disease Soc: infectologia.org.br/2020/12/09/atu…

Brazilian Thoracic Society: sbpt.org.br/portal/coronav…

Brazilian Association of Critical Care Med: amib.org.br/pagina-inicial…
5/ Note that in all those documents there is NO MENTION to "early treatment" for Covid19.

Regarding ivermectin and nitazoxanide, there is less evidence available, even so, no recommendation is made for them to be used, and...
6/ It is absolutely unreasonable to expect that any of these drugs could completely change de daring situation Brazil is in.

These drugs could only be all this "Wonder on Earth" if their beneficial effect were HUGE. But that is not the case

bmj.com/content/370/bm…
7/ So it is clear by now that if you focus your strategy to control Covid19 on administering ineffective drugs to patients (or on a remote possibility: a benefit is seen but of small effect size) YOU ARE DOOMED TO FAIL TO CONTROL THE PANDEMIC
8/ And what about the effect of behavioral measures? Are they effective to control Covid19? BIG YES. Look at the data:

Hugely effective: bmcmedicine.biomedcentral.com/articles/10.11…

nature.com/articles/s4156…

publications.jrc.ec.europa.eu/repository/bit…
9/ If you like graphs like I do have a look at 🀩 those amazing steep-down curves after confinement in Italy or France

Italy: 1st lockdown on March 9th - peak of cases on March 26th --> IMPRESSIVE decline

France: 2nd lockdown on Oct 29th - peak on Nov 3rd --> IMPRESSIVE decline
10/ By the way, I am in France right now, and all of that WONDERFUL accomplishment in managing Covid was done using only evidence-based measures: No early treatment lies here!
11/ IMPORTANT: Bolsonaro's supporters have been offering "scientific evidence" to support their lies. They resource to low-quality evidence articles. It takes scientific literacy to sort out what is a good vs bad piece of evidence.
Example:
amjmed.com/article/S0002-…
12/ Other examples of bad pieces of evidence on Covid, that should not be used to guide anyone:

The ivermectin metanalysis :

or the ANONYMOUS website c19study.com
13/ Coming to an end:
By now you might be asking, why the πŸ‡§πŸ‡·Gov. is resisting so stubbornly against adopting efficacious measures to control Covid?

leticiakawano.com/post/covid-19-…

There might be more than one reason...Few possible explanations that I Ieave you with to think about:
14/
 - The immediate negative impact of the confinement on business people that funds Bolsonaro

- Positive effect of elderly deaths on defict da Previdencia

- Genuinely anti-science: science questions the world for truth: that is AGAINST the plans of any authoritarian.
15/ END:
@ministerpublico @STF_oficial @camaradeputados @SenadoFederal @RodrigoMaia @davialcolumbre

You have the obligation to SERVE the πŸ‡§πŸ‡· Nation. Look at all the gathered info above and take action.

Stop the MAD MAN and his gang #ImpeachmentBolsonaro

epoca.globo.com/guilherme-amad…

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More from @leticiakawano

Leticia Kawano-Dourado πŸ‡§πŸ‡· Profile picture
14 Jan
1/ Colleagues from Manaus reaching out in complete distress:
Covid19 patients that were *improving* are experiencing extreme anguish/panic while dying due to lack of Oxygen!

A system does not colapse out of the blue!

Avoidable catastrophe: Image
2/ NO BEHAVIORAL MEASURE to stop Covid19 was implemented in Manaus (nor anywhere else) in the last 4 weeks.

The population is left to its own luck (or lack of)

The President keeps disencouraging face masks, social distancing, and, BELIEVE ME, vaccination!
3/ If this was not enough, his proposal to address the Covid19 crisis in Brazil is early treatment with hydroxycholoquine, ivermectin, nitazoxanide 😱

Stop this madness!
@ministerpublico @STF_oficial @SenadoFederal @camaradeputados
@RodrigoMaia
Read 4 tweets
Leticia Kawano-Dourado πŸ‡§πŸ‡· Profile picture
18 Nov 20
1/ *tweetorial* on how to participate in #ATSchats

Helloooo #Medtwitter , #PCCSM people, and everyone else interested in participating in the #ATSchat s: this 🧡 is for you!

If it's your first time and you don't know how to do it, follow me ;-) @atsearlycareer @atscommunity
2/ At the scheduled date/time:
1.Type #ATSchat in the search bar at the top right of your window.
2.Ensure you click on the β€œlatest” tab: This allows the chronologically most recent tweets to show up allowing you to easily follow the chat!

(see screenshot below)
@SushmaCribbs
3/ @ATSearlycareer will post the questions starting with Q1, Q2, Q3, and so on.

You can answer the question in one of two ways:

a. Below is one way (see screenshot): type in #ATSchat and A1, A2 respectively and answer it ;-)
Read 9 tweets
Leticia Kawano-Dourado πŸ‡§πŸ‡· Profile picture
5 Sep 20
1/ Another result of the collaborative effort, Coalition Covid-19 Brazil, is out!
Kudos at this time to HIAE trial coordination: Otavio Berwanger & Remo Furtado, not on twitter πŸ˜• @JuliaMachline #COVIDγƒΌ19 @TheLancet @f_g_zampieri @a_serpaneto @FlaviaSepsis @azevedo_lcp
2/ Here the population included in the trial, note that about half of pts were on IMV, ~1/4 shocked. Steroids were being administered to only 15-20% (at that time, early on in the pandemic, steroids were not known to benefit severe covid-19 pts)
3/ At day 15, the use of azythromycin 500mg/d for 19 days did not change health status, look at death (6) and IMV (5) or discharged pts (1)
Read 6 tweets
Leticia Kawano-Dourado πŸ‡§πŸ‡· Profile picture
2 Sep 20
1/ It's out! The Codex trial.
This is the 2nd RCT result published as a result of an unprecedented collaborative research effort, the Coalition Covid19 Brazil πŸ‡§πŸ‡·.
Deserve special recognition: @azevedo_lcp @ICURevisited and all HSL team!

jamanetwork.com/journals/jama/… @JAMA_current
2/ In the Codex trial, mod-severe Covid-19 ARDS cases were randomized to Dexa 20mg/d for 5 days followed by 10mg/d for more 5 days.

*Dexa increased the number of days alive & free of mechanical ventilation in 28 days*

PS: for MV-free days, death was penalized as 0 free days
3/ When you breakdown the composite 1ary outcome in its components, note that mortality was the major driver of difference between groups. No short-term difference in AE was noted:
Read 8 tweets
Leticia Kawano-Dourado πŸ‡§πŸ‡· Profile picture
24 Jul 20
1/ Some more information on our study Coalizao 1, on HCQ/Azithro for #Covid19 that explains some issues:

@f_g_zampieri @damiani_petri @tlisboa79 @azevedo_lcp @FlaviaSepsis @a_serpaneto
Before I start, the first thread on the study is here:
2/ Back in March, we knew much less than we know today on Covid19 (and as a consequence v. little information to inform RCT design)
Regulatory agencies & WHO have defined the ordinal scale as an important outcome.

As @f_g_zampieri commented (in Portuguese) elsewhere
3/ We realized, after the trial started, that a clinical status ordinal scale would be potentially problematic given that the level of support offered could differ between countries and local practices not reflecting necessarily dz severity
Read 7 tweets
Leticia Kawano-Dourado πŸ‡§πŸ‡· Profile picture
23 Jul 20
1/ Our study (Coalition I) on HCQ and azithromycin for #Covid19 is out!
This study is the effort of an unprecedented collaboration (Coalition Covid19 Brasil) established between major Brazilian hospitals and research networks/Institutes.

nejm.org/doi/full/10.10…
2/ Coalition I is one of nine RCTs on drug repurposing and long-term consequences of Covid19 being conducted by this research team.
I am honored and humbled to be part of this research effort in Brazil in such daring times.
3/ 667 hospitalized pts w mild to moderate Covid19 (pts on NIV/HF or MV were non-eligible) were randomized 1:1:1 to:
-HCQ + Azithromycin + Standard of care* (SoC)
-HCQ + SoC
-SoC
*SoC: antibiotics (~60%), oseltamivir (~25%), and steroids (~20%) w/o difference between groups.
Read 8 tweets

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