If we focus on getting as many people vaccinated as possible, and continue basic precautions till each country reaches herd immunity, COVID will be history, mutants and all.
COVID minus its ability to make people severely ill or cause deaths is nothing. Vaccines work. And that’s what they will reduce COVID to.
Every month will bring news of a new variant or mutant. But for vaccinated people the chances of getting seriously ill will be very low. Not zero. But very low. In the range of what annual influenza outbreaks are. Time will tell. But I’m optimistic.
The key is to reduce misinformation about vaccines, and stop worrying about lab studies that vaccines may not work against mutant strains etc which are of academic interest but don’t change strategy: Vaccinate as many people as possible, globally, with approved vaccines, fast.

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More from @VincentRK

5 Feb
Even yesterday I heard from a close friend who lost an elderly parent to COVID. They were just hoping to get vaccinated. But it was too late.

Every delay costs lives. There were over 3500 stories like this yesterday across the country.
15,000 across the world.
The new Administration took over only 15 days ago. They have a lot to deal with in terms of decisions that were already made. I have full confidence in their approach. I hope they can turn the vaccine situation around in a month.
But it’s not up to the federal government. It’s everyone from states to local governments to hospitals that have to gear up to 24/7 vaccination. Especially if J & J is approved and we have sufficient doses to dispense. Planning has to start now.
Read 4 tweets
3 Feb
I will repeat: Not having Astra Zeneca COVID vaccine approved in the US is a blunder. A huge blunder. bbc.co.uk/news/health-55…
See thread by @DrEricDing on how the Astra Zeneca vaccine can cut transmission. This was totally expected. Basic immunology.
Once we knew results of the RCT that the Astra Zeneca vaccine was safe and at worst was 60% effective we should have moved. We knew quite well that there simple wasn’t enough Pfizer and Moderna vaccine to get the vulnerable vaccinated quickly.
Read 4 tweets
2 Feb
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.
Read 9 tweets
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
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
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

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