India has 1.3 billion people.
4 times that of the US.

What’s going on is just amazing and needs in depth immunologic studies. These are raw numbers!
When I adjust to population, the differences are even more striking.
You cannot undercount ten times the death rate. That would also mean also undercounting 20 times the hospitalizations.

With friends& reporters I’m in touch with across the country, India has had nowhere near the deaths the US has per capita. Life is normal even in big cities
There are 3 likely factors lowering death rate in India:

-Younger age
-Lower obesity
-Cross reactive immunity from prior corona virus and other infections

The first two alone cannot explain lower severity. There are enough older people to overwhelm the health care system.
There are 4 other factors people have hypothesized but I don’t think they play a big role

-BCG vaccination
-High temperature
-Vitamin D levels
-Use of chloroquine, ivermectin etc
Disease severity not just deaths must be markedly less in India Reflected in the marked drop in number of cases even as social distancing became less. What we hear in big cities is: nearing herd immunity

Delhi & Chennai reached 40-50% seroprevalence months ago!
I just think it would be wise to do in depth scientific studies in India and neighboring countries so we better understand resistance to severe COVID that seems to occur in these parts. Looking at the seroprevalence a huge proportion must have been asymptomatic. Question is how?
My earlier thread on this topic is here.
My recommendation to India is inspire of the fall in cases vaccinate the whole population as fast as possible. And with single minded focus.

The vaccines will protect you from variants.
*in spite
Remember countries like China, South Korea, Australia, New Zealand controlled the pandemic by dramatically controlling cases.

In India cases were not controlled & half the country is probably seropositive. The phenomenon I discussed is the striking lower severity & mortality.
Case counts in India have now come down as the number of people who have already had COVID and have become immune has risen. This is different than cases coming down due to lockdowns. Its as expected.

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More from @VincentRK

16 Feb
We should recognize how consensus medical guidelines are written. It’s a group of individual people discussing and agreeing on something. The bigger the group the more likely you will end up with a laundry list of options meant to keep everyone happy.
Sometimes in order to get consensus, recommendations get diluted to something everyone agrees with. Which may not necessarily be the correct one.

From masks to vaccines we have seen this phenomenon with COVID.
Read 4 tweets
16 Feb
To set the record straight:

1) Vaccines are not antibiotics.

2) No vaccine can prevent a virus from entering the body. It can only prevent us from getting seriously ill by helping us defeat the invader.

3) Vaccines willget back to normalcy. We are not stuck with this forever.
Vaccines are not the reason we have mutant variants. The reason we have mutant variants is we still have a huge susceptible population who have not been vaccinated and there is uncontrolled proliferation of the virus in millions of hosts across the world. So Mutations happen.
Vaccines are the solution.
Read 5 tweets
15 Feb
If COVID virus or mutant variants cause asymptomatic/mild infection in vaccinated people or reinfection, think of it as a booster dose of vaccine that protects from severe disease/death.

Best protection from reinfection? Vaccines

Best protection from rise of mutants? Vaccines
Think of why COVID wrecked havoc. Not because we had an epidemic of common cold that swept the world.

It wrecked havoc because it caused almost 1 death per 100 people infected. It put 2-3 people per 100 infected in the ICU. It caused deaths in elderly, young, healthcare workers
It made people have long term consequences even if they recovered.

This seriousness combined with easy transmissibility made it a menace. The ability of asymptomatic people to spread a serious disease to a totally immunologically naive susceptible global population made it COVID
Read 8 tweets
12 Feb
Update from my tweet from last week. Mutants and all, this is what is going on in the UK. Whatever the reasons for the drop, the more vaccinations, the more we sustain the drop and overcome this miserable virus.
Be focused. Be single minded. Let experts worry about the rise of the variants— for which the only practical and sustainable solution is to vaccinate as many people as possible with any one of the approved vaccines.
Do not worry about reports that the vaccines don’t prevent infections or mild disease from some mutant variants. They will work and prevent severe disease and deaths. The immune system works by memory. And vaccines provide it with information to prevent total surprise.
Read 5 tweets
10 Feb
I would like to share the story of how a patient with cancer came up with the idea for a randomized trial, & how listening to him saved a lot of lives.

1/ In 2002, I had just completed a randomized trial with the notorious drug thalidomide for the cancer, multiple myeloma.
2/ Thalidomide would later be FDA approved on the basis of this trial. As a young investigator I was thrilled with the success and eager for the next exciting trial testing fancy new regimens.

But a patient with myeloma, Mike Katz, had other ideas.
3/ Mike was on national patient advocacy committees. He had battled myeloma for years and knew all of the recent advances. More importantly he attended numerous patient support group meetings and had his finger on the pulse of what myeloma patients were going through.
Read 17 tweets
9 Feb
Maybe now some people will believe when I talk about cross reactive immunity. There are many redundancies in the immune system. It takes a lot for a whole world to be taken by surprise like it happened with COVID. Which is why we don’t have a new pandemic every year.
I wrote this thread about vaccines. But it also holds true for natural infections. The dose of exposure and presence or absence of repeated exposure determines durability and robustness of the immune response.
And why I’m confident that vaccines specifically designed to combat COVID 19 will be effective in preventing serious disease against new mutant variants.

The mutations have to be severe enough to make SARS CoV-2 into a new virus altogether to reduce protection significantly.
Read 4 tweets

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