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Vincent Rajkumar Profile picture
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2 Feb, 9 tweets, 5 min read
Breaking: Over 50% of Delhi is seropositive for COVID. @ndtv @divyanshu @rishika625 @GargiRawat @nramind @bimalarya

This supports my earlier thread on protection through cross reactive immunity. Otherwise the loss of life would have been 50 times higher. ndtv.com/india-news/cor…
The population of Delhi is 20 million. So far estimated deaths is 10,000. If 10 million have had COVID, we cannot reconcile the two numbers.

What are the factors besides lower age, less obesity, & underreporting that results in so much asymptomatic & mildly symptomatic COVID?
Of these 4 factors, low viral dose is likely not operational in India because of the lack of masking and the impossibility of social distancing.

There is also no special reason why innate immunity will be stronger & no data on unique genetic factors that protect Indian people.
Which leaves us with cross reactive immunity from prior corona virus infections. I had raised this issue in August, and since then I have just become more and more convinced.
It’s pretty hard to explain the two figures below when social distancing and masks have gone down dramatically in India in the last 3 months. And considering India has a population 4 times that of the US living in 1/4th the space. @FT @DrEricDing
At a time when LA is struggling for ICU beds, nothing close to this has been seen in recent months in major Indian cities.
So while we can discuss accuracy of numbers and talk data all day, the differences are so stark and essentially “unhideable”

And it’s not due to New Zealand style control of COVID by preventing the virus from setting foot in the country.
This thread is to explain an observed phenomenon with a hypothesis for which we have supporting data & new data that I heard is soon to come.

People in India must continue mask/distancing precautions and get vaccinated. Cross reactive immunity may not protect from mutant COVID.
Vaccines are absolutely essential and urgent even though the number of cases and deaths have decreased all across India. Vaccines can protect you from COVID including mutant variants of the virus, prevent spread, and provide more enduring protection.

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Vincent Rajkumar Profile picture
30 Jan
What’s happening in India?
Is the pandemic burning out? How? Where is the post Diwali surge that we worried about? #COVID19

I wrote about India in August. I was convinced that cross reactive immunity was at play. Along with younger age & less obesity, this is protecting India
People are often quick to criticize the numbers. But keep in mind you can miss asymptomatic or mildly symptomatic cases. But you cannot hide 10 times more deaths or ICU admissions.

This is real. And is not explained by just younger age and less obesity.
This is more than that. Sometimes epidemiological observations are much more powerful and give better insight than lab studies.

India is a country where social distancing outdoors or indoors is not easy.

We are seeing this play out. It’s staring at us: Cross reactive immunity.
Read 7 tweets
Vincent Rajkumar Profile picture
29 Jan
A nice review of the 4 main types of COVID vaccines. @cddpress @nature nature.com/articles/s4141…

1) Inactivated Virus

Eg: CoronaVac (Sinovac), SinoPharm, Covaxin (Bharat Biotech)
2) Spike Protein

Eg: Novovax
3) Spike protein mRNA

Eg., Pfizer/BioNTech, Moderna
Read 4 tweets
Vincent Rajkumar Profile picture
29 Jan
Mayo Clinic staging and risk stratification systems for plasma cell disorders. @MayoClinic @MayoCancerCare @MayoMyeloma @Rfonsi1 @MorieGertz @myelomaMD

1) Mayo 2005 MGUS Risk Stratification. ashpublications.org/blood/article/…

3 risk factors:
M spike size
M spike type
FLC ratio
2) Mayo 2012 Staging for AL Amyloidosis:

3 risk factors:
Cardiac Troponin T􏰁 >0.025 ng/mL
NT-ProBNP 􏰁 >1,800 pg/mL, and FLC-difference 􏰁 >18 mg/dL

4 stages (I, II, III, IV) with 0, 1, 2, and 3, risk factors respectively. ascopubs.org/doi/10.1200/JC… @myelomaMD
3) Mayo 2018 Risk Stratification for smoldering multiple myeloma. The 20-2-20 system.

3 risk factors:
Bone marrow plasma cells >20%
M spike >2gm/dL
FLC ratio >20

nature.com/articles/s4140…
Read 4 tweets
Vincent Rajkumar Profile picture
25 Jan
1/ When you get vaccinated you don’t make just one type of antibody. You make a whole portfolio of antibodies against various epitopes. So unless there is a huge number of mutations, vaccines will protect you, especially from severe disease. #VaccinesWork #Covid_19
2/ You not only make matching keys to fit multiple locks when all you need is to open just one lock, but you also make multiple slightly different keys for each lock in the process of making the perfect key. All of this redundancy is why vaccines work even if the virus mutates.
3/ The sheer number of COVID infections in such a short period of time, and the lack of significant pre existing immunity means a lot more viral replications, & a lot more opportunities for mutations to arise. Not every mutation will change the behavior of the virus. But some do.
Read 7 tweets
Vincent Rajkumar Profile picture
24 Jan
This is the first and best real world evidence that vaccines are highly effective in protecting people from severe COVID. Israel has led the world in vaccinations. I am very impressed with these results. #VaccinesWork @ASlavitt @TimesofIsrael google.com/amp/s/www.time…
As of now almost 40% of Israel has been vaccinated. Just phenomenal. Image
My suggestion. Keep razor focus on vaccinating as many people as possible.

Don’t worry about which vaccine.
Don’t worry about mutants. (Let scientists do the worrying)
Don’t worry about mild COVID

If we can stop deaths from COVID then COVID becomes the common COLD
Read 4 tweets
Vincent Rajkumar Profile picture
23 Jan
Looks like wearing masks does protect from colds and influenza.

Looks like Asian countries knew something we didn’t all along.

We don’t have to wear a mask forever, but once COVID is done if vulnerable people choose to wear a mask that’s A-OK.
With certain benign interventions (like mask wearing) that make logical sense and have observational data, the absence of randomized trial data doesn’t mean they aren’t the prudent course of action.

Absence of RCT evidence is not the same as evidence of absence. @jeremyphoward
In many Asian countries mask wearing pre COVID was just routine. Many people just did it. And it was not stigmatizing.

Even within Asia, wearing a mask pre COVID was common in Hong Kong but signaled you were not well in Singapore.
Read 4 tweets

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