1/ Tocilizumab appears to reduce the risk of death in those hospitalized with severe #COVID19 infection, with results from the RECOVERY trial available today.

This is an anti-inflammatory/immunosuppressive medication, used in rheumatic diseases.



2022 patients were randomized to receive tocilizumab; 2094 to receive standard care. 80% of the participants were using dexamethasone.

596 (29%) in the tocilizumab group died within 28 days VS 694 (33%) in the usual care group.

"Tocilizumab also increased the probability of discharge alive within 28 days from 47% to 54% (rate ratio 1.23, [95% CI 1.12 to 1.34], p<0.0001)."

"This means that for every 25 patients treated with tocilizumab, one additional life would be saved."

This is likely enough evidence to shift the balance toward more tocilizumab use for severe #COVID19 infections in hospital settings, especially in the ICU.

Also, if you are going to share data by press release, this is the right way to do it.

It is pronounced: "toe-see-li-zoo-mab" by some, "taw-si-li-zoo-mab" by others, or even "taw-see-li-zoo-mab".

This may spur some heated debate.
But as always, the fine print is important - let's see the data.

Also this drug costs a fortune. Does it provide meaningful benefit? And how much & in whom?

My guess is it will be used in ICUs more than elsewhere, but would love to hear what others think.

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More from @BogochIsaac

31 Jan
1/ Many are talking about gradually lifting public health measures as #COVID19 cases are dropping in Canadian settings.

What is needed to avoid undoing our collective efforts & sacrifices as we reopen? And how do we account for more transmissible variants (eg B.1.1.7)? 👇👇👇
2/ We often hear people say that because of the more transmissible variants we need to "double down" on control efforts & vaccinate.

What exactly does doubling down mean?

It most likely means keeping R at (or preferably below) 0.8 to account for greater transmissibility.
Maintaining R at/below 0.8 would likely allow for a continued decline in cases as we see more B.1.1.7 circulate.

So what questions do we need to address to gradually & safely reopen in the context of community #COVID19 transmission & growing burden of B.1.1.7?

A few Q's👇
Read 11 tweets
30 Jan
1/ What is the #COVID19 situation like in Canada now?

Cases are down & the situation is improving in much of the country, but we still have a long way to go.

A few additional thoughts below...
2/ Most of the country has recovered from peaks in December or from a post-Christmas peak.

A few examples below Nationally & in AB, ON, QC.

Despite outbreaks in Eastern Provinces, cases still remain low there.

From: bit.ly/2Yul9qY
3/ Long Term Care - a significant black eye for Canada, is also improving. We failed to protect our most vulnerable (twice!), but cases are rapidly declining, perhaps mirroring reduced community transmission, widespread vaccination, or both.

Read 13 tweets
29 Jan
1/ Johnson & Johnson #COVID19 vaccine results are out.

As per press release, preventing both moderate & severe illness 28 days after vaccination:

-66% Overall
-72% USA
-66% Latin America
-57% in South Africa

2/ Important point:

"85% effective overall in preventing severe disease & demonstrated complete protection against #COVID19 related hospitalization and death as of Day 28"

If this can keep people from getting very sick/prevent hospitalization/death then this is an obvious win.
3/ This is a single dose vaccine, requires conventional refrigeration for storage & would be much easier to administer to populations.

Canada has access to this vaccine.
Read 4 tweets
29 Jan
The Novavax vaccine has excellent efficacy (~90%) against symptomatic #COVID19, where ~50% of cases were from the variant discovered in the UK (B117).

But it only had ~60% efficacy in the variant discovered in South Africa (B1351). bit.ly/3puHOiH

A good explanation👇
60% efficacy against B1351 is decent, but not amazing.
Important to point out that the numbers are still very small in this trial & this could change with more data. Also if the vaccine prevents severe #COVID19 disease (which it likely does), it would still be extremely helpful.
Just to clarify, in the South Africa study, efficacy is ~60% in those who were HIV negative, ~50% in entire trial including HIV+ individuals.

Still, no severe disease seen in #COVID19 cases confirmed to have B1351 (variant discovered from South Africa) in those vaccinated.
Read 4 tweets
25 Jan
"Vaccination with the Moderna #COVID19 Vaccine produced neutralizing titers against all key emerging variants tested, including B.1.1.7 and B.1.351, first identified in the UK and Republic of South Africa, respectively."

**Translation: This is really good news.**
(Also, yes this is science by press release, but see how they included valuable information/data here?)
There may still is an attenuated response to the variant discovered in South Africa, but it appears the vaccine will still provide some protection - and there is a lot more to an immune response than these antibodies.
Read 6 tweets
23 Jan
1/ Colchicine may be an effective treatment for #COVID19.

In a well designed trial (prospective, randomized, >4000 people) colchicine "resulted in a 25% decrease in hospitalizations, a 50% decrease in the use of ventilation & a decrease in deaths by 44%.“ bit.ly/39Vwpls
2/ This was in non-hospitalized patients with confirmed infection.

Standard caveats: Press release, no preprint data, etc.

Colchicine is a cheap, widely available pill.

If this pans out it will be very helpful - works via anti-inflammatory (& immunomodulatory?) mechanism.
Also, I'm still baffled that a pre-print (with actual data/analyses) could not be made available at the time of press release. That should be standard.
Read 6 tweets

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