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Eric Feigl-Ding Profile picture
@DrEricDing
Mar 21, 2021 • 34 tweets • 19 min read • Read on X
PAY ATTENTION—There is one crisis we all needs to pay attention to—and that is the unprecedented Brazil 🇧🇷 surge of the #P1 variant, overloaded hospitals, & sharp mortality spike. If more contagious #P1 out of control worldwide, we are all endangered. 🧵

#SOSBrazil #COVID19 ImageImage
2) I cannot overemphasis how serious the crisis in Brazil is. It is virtually impossible to find any ICU bed, and many hospitals running out of sedative medications to perform intubation with—so doctors are intubating without any analgesic meds. Hospitals are in collapse.
3) I’m not exaggerating that hospitals in Brazil are in collapse. This is the headline of a major newspaper. Image
4) Don’t just listen to me. Listen to the reporting on the ground. This report was filed last week by @MattRiversCNN — he says it has gotten only worse.

5) Nobody can deny the pandemic when hospitals are completely overrun. Don’t let anyone dismiss #COVID19 and what is happening in Brazil - hospitalizations and deaths DO NOT LIE. Image
6) The crisis is described by the @fiocruz @fiocruz_en foundation as the **worst sanitation and hospital collapse in the history of Brazil** Image
7) I’m told by reporters that even “we're also hearing very consistently, that in Brazil more and more young people are dying on the virus. doctors keep telling us that their patients keep getting younger, no comorbidities” - from doctors across many cities. @MattRiversCNN
8) But also more concerning — Brazil experts analysis says P1 is potentially 2-2.5x faster transmission (more contagious) than the old common strains. That means it is also faster than #B117 sweeping the world.

We need to get serious about Brazil crisis. ?
9) Another Brazil research group puts #P1 transmission at 2x faster than old strain (instead of 2.5x above), but they estimate a way worse whopping 25-60% reinfection rate. That’s serious.

bbc.com/news/amp/healt… Image
10) How good is are the mRNA vaccines against this #P1 variant menace? Only semi— it has moderate neutralization- better than the SA #B1351, but worse than #B117 (which responds well to vaccine).

FYI earlier Pfizer-conducted study said okay, but this bigger study disagrees.
11) But the problem for Brazil is that it doesn’t have the mRNA vaccines. It has the AstraZeneca and SinoVac vaccine. We don’t know the exact efficacy yet for #P1, but SinoVac vaccine showed a much lower 50% efficacy in Brazil trials, before P1.

google.com/amp/s/www.bbc.…
12) Now 50% is still good, and for severe disease, it’s 78% for SinoVac, so that’s decent.

J&J vaccine shows mid to upper 80% for Brazil, but J&J isn’t available in Brazil yet either.

Main problem is Brazil doesn’t have enough! google.com/amp/s/amp.cnn.…
13) state of Rio de Janeiro suspended its vaccination campaign because it had run out of vaccine supplies.

"This is a disaster, a total disaster," a woman told CNN after being denied her vaccine. "Who is to blame for all this? I think our leaders, our politicians suck."
14) “less than 10 million people in the country of about 220 million had received at least one dose, according to federal health data. Only 1.57% of the population had been fully vaccinated.”

THIS IS AN EPIC DISASTER in the making for Brazil. google.com/amp/s/amp.cnn.…
15) How the hell did Brazil screw up its vaccine supply so much?

“multiple experts say the ineptitude of the federal government, led by Covid-skeptic Bolsonaro, has sabotaged. They point to a distinct lack of urgency on the fed govt to secure supplies”
cnn.com/2021/02/01/ame…
16) Brazil is in talks with the US to import some vaccines. The US already “loaned” 4 million doses to Mexico & Canada. But the talks with Brazil started March 13th and still have not reached any deal. Brazil needs it soon. Hope Bolsonaro is playing ball.
google.com/amp/s/www.voan…
17) Even with vaccine imports, and the delay in rollout and immunity kicking in, the next month will be brutal for Brazil. We might see what unmitigated full onslaught with a downplaying Bolsonaro looks like.

Meantime, Brazil ordering 3x the coffins.

metropoles.com/brasil/covid-a…
18) But I also want to offer a message of hope to the people of Brazil 🇧🇷— the world sees your struggle and your pain. I talk to colleagues at the WHO and in DC. The world has not forgotten you—even if your leader maybe sometimes has. The world needs to care and does care.
19) Meantime, Bolsonaro is the one person that world leaders need to call out and pressure. He is literally stopping all efforts to improve the situation. This is untenable.

If this Brazil crisis keeps going, I worry for its stability. google.com/amp/s/amp.cnn.… Image
20) I don’t believe in doomed fate. “There is no fate but what we make.”

Brazil needs help, Brazil needs change. Brazil needs leadership that will put human lives first, and to end suffering of its poor.

May God & the world help the people of Brazil.
21) To the rest of the 🌎—please don’t be selfishly withholding aid/vaccines. If Brazil’s #P1 crisis grows, so will the risk for the world. We rise as fall as one planet & civilization. We need to remember the motto—“All for one, one for all”—let’s all find our inner humanity. 🙏
22) p.s. the Oxford-AstraZeneca reported to be is efficacious against the #P1 variant. But the study hasn’t be released yet by researchers - details forthcoming.

US has a stockpile over over 30 million doses of AstraZeneca—it needs to release now.
cnbc.com/2021/03/05/oxf…
23) UK Imperial team:

⚠️“data show #P1 variant is 1.4-2.2 times more transmissible than other variants & original #SARSCoV2 strain, and 25%-65% more likely to evade existing protective immunity from previous non-P.1 infections—susceptible to reinfection.”
edition.cnn.com/world/live-new… Image
24) The catastrophe in Brazil is the worst in its history. And likely will be the worst in the annals of this pandemic — we desperately need to urgently send aid and vaccines to Brazil 🇧🇷.

Please help @WHCOS @aslavitt46 @ASlavitt @JeffZients @DrTedros @mvankerkhove @gabbystern
25) good news - vaccine deals inked by Brazil to buy more.

Bad news—most of the vaccines ordered aren’t coming for many many months.
26) Vaccine inequality is the great inequality that will lead to more tragedy in this pandemic.

We need to send vaccines urgently to Brazil, Mexico, and all of Latin America. #COVID19 #COVID19Vaccine

(HT @fibke) Image
27) The longer we neglect to vaccinate low and middle income countries (LMIC), the longer this crisis will continue.

#VaccinEquity for Brazil and all of Latin America and Africa and Asia.

(Ht @fibke)

pandem-ic.com/vaccine-equity… Image
28) ...I’m hearing some signals US might help Brazil hospitals in some potential ways soon. Unclear what yet. But there are some in WH that are exploring. Fingers crossed of what’s to come.
29) this was Brazil 3 days ago... and those spikes have now surged even more.
30) Now Brazil’s #P1 crisis has spilled over into neighboring countries...
31) And now #P1 has invaded North America - British Columbia 🇨🇦 has a recent sudden surge of #P1.
32) The Brazilian 🇧🇷 #P1 epidemic has now definitively spilled into other countries and caused outbreaks—the largest being in British Columbia, Canada.
33) P.s. small update on Brazil 🇧🇷 situation - I have receive word that Brazil is now engaging with the US directly. Hopeful 🙏
34) Brazil needs to act fast.... now more young people are dying than in first wave.

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More from @DrEricDing

Eric Feigl-Ding Profile picture
Feb 21
Woke or biology? There are actually more than the basic “male” XY & “female” XX sexes. Why? Because biology also creates people with single X chromosomes, or extra chromosomes like XXX, XXY, XYY, or XXX+, plus many 🧬genes. 👉All I’m asking is— please be kind to others. Thanks🙏 Image
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2) “The most frequent SCAs include Turner syndrome (45,X), Klinefelter syndrome (47,XXY), Trisomy X syndrome (47,XXX), and Double Y syndrome (47,XYY).”

pmc.ncbi.nlm.nih.gov/articles/PMC10…
3) “The phenotype seen in SCAs is highly variable and may not merely be due to the direct genomic imbalance from altered sex chromosome gene dosage but also due to additive alterations in gene networks and regulatory pathways across the genome as well as individual genetic modifiers.”
Read 5 tweets
Eric Feigl-Ding Profile picture
Feb 16
I'm shocked a lot of doctors don't know about this newer flu antiviral drug called Baloxavir (XOFLUZA)... that shortens your flu illness by 33%, and reduces your viral load by day 2, versus what a placebo takes 5-6 days to achieve. Baloxavir also seems superior to TAMIFLU (oseltamivir) for smashing your viral load on 2 day, achieving what takes Tamiflu 3-4 days. CDC even lists Baloxavir on their website as one of the top 4 drugs that it tracks whether it works against new flu strains (it works)Image
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2) "Baloxavir was associated with significantly more rapid declines in infectious viral load than placebo or oseltamivir (Figure 3A and 3B)."
nejm.org/doi/full/10.10…
3) Adverse events for baloxavir were no different than placebo. in fact theres even hints that it could be lower than Tamiflu.

"Adverse events that were considered to be related to the trial regimen were more common in oseltamivir recipients (8.4%) than in baloxavir recipients (4.4%, P=0.009)"Image
Read 13 tweets
Eric Feigl-Ding Profile picture
Feb 14
⚠️WORST FLU SEASON ever since 2002-2003 when we began to track flu (red, first graph). Worst hit this year are children ages 0-4 and 5-17. ▶️We also have significantly LOWER flu vaccine uptake this year, one of the lowest flu vaccine coverages (red 3rd graph). Indisputable facts. Image
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2) I don't need to tell you that certain US states have vastly lower vaccination rates than others. See map (lighter green, less flu vaccination coverage), and which have higher (darker green)...

If you want to see details and demographics on which state has the LOWEST flu vaccine coverage rates... the data is here.
cdc.gov/fluvaxview/das…Image
3) It’s not just the flu that is going around… Gaines County, TX, where the epicenter of the measles outbreak is, has one of the lowest measles vaccination rates too.
Read 7 tweets
Eric Feigl-Ding Profile picture
Feb 11
INFLUENZA REACHES EPIDEMIC THRESHOLD in New York—Influenza A (Unknown variety) positivity soars (yellow), while hospitalizations stand higher than past 3 years. The rise of unknown subtyping Flu A has led NY to issue new alert to subtype all Flu A immediately for bird flu. Image
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2) This was the reason for the urgency in NY issuing an alert to subtype all hospitalized cases for bird flu if Flu A. See thread below 👇
3) the testing memo seems very aggressive for bird flu.
Read 7 tweets
Eric Feigl-Ding Profile picture
Feb 10
BREAKING—22 States sue to block Trump WH cuts to NIH research grants. Image
2) Attorneys general representing 22 states sued the Trump administration on Monday, asking a federal judge to temporarily block a major policy change by the National Institutes of Health that would substantially limit payments for research overhead

statnews.com/2025/02/10/nih…
3) In the lawsuit, filed in U.S. District Court for the District of MA, the AGs argued that NIH’s abrupt decision to set a 15% cap on payments for indirect costs would cause major harm to institution budgets, jeopardizing basic operations and medical research.
Read 5 tweets
Eric Feigl-Ding Profile picture
Feb 8
💣TORPEDOING MEDICAL RESEARCH—NIH indirect grant funding just got slashed by Trump to 15%. What does this mean for you? Colleges and universities won’t be able to support students, tuition will increase, especially graduate students & researchers who find cures/preventions for cancer, diabetes, heart disease, Alzheimer’s and more. This will not only raise tuition and hurt pipeline of future scientists/doctors, but COMPLETELY DECIMATE MEDICAL & PUBLIC HEALTH RESEARCH. It will also give more power to big pharma to manipulate research agendas and buy out ideas that should remain in the public domain. Ie THE RICH BIOTECH TYCOONS (eg Vivek Ramaswamy) WILL GET RICHER. The lay public will someday only see future drug/tech prices soar as biotech and big pharma control more science and make more money.

Also, Trump’s NIH posted this graphic - but it ignores that most public universities also heavily rely on indirect to subsidize tuition, and train next generation of scientists and medical doctors doing research. (Public colleges can’t compete with wealthier schools who do have endowments, and hence will fall further behind). Public colleges that do medical research will literally fall apart without this mechanism.Image
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2) People don’t seem to get 2 things:

📌Indirect funds college administration and facilities and support services. Academic advising, building operations, new labs and classrooms for students— where does that money come from? If not indirect grants, then it’ll have to come more from ⬆️student tuition.
3) Most universities don’t have billion+ endowments. Most have almost none — so when you slash NIH indirect grant funding to just 15%… it hurts small schools and public colleges the most—smaller places might even go under. Rich school survive, public schools do not.
Read 4 tweets

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