1/The COVID virus doesn't know political borders or geography.

Countries which controlled the pandemic from the outset made 1) the politically & economically hard decision of closing borders except through quarantined entry, and 2) test/trace/isolate within.
2/ Depending on how many cases were already inside, some countries had to also implement universal masking and distancing. Countries which managed to seal borders before significant amount of cases got inside the country could get away with limited masks and distancing measures.
3/ Countries where COVID could not be controlled in time unfortunately ended up with large numbers of affected people. Masks & distancing are needed to limit spread & save lives until a definitive solution could be implemented. We have a highly promising solution now: Vaccines.
4/ So far data indicates that countries that have vaccinated at high rates have seen the number of cases and deaths plummet. This is great. If we are lucky, the vaccines will protect also against serious disease caused by variant strains.
5/ Countries that managed to keep COVID under control so far (Eg Australia, NZ, S. Korea etc) continue to have a susceptible population. So they really cannot change the current border control & other preventive measures till a sufficient proportion of their public is vaccinated.
6/Ultimately for the world to return to near normal we need to vaccinate 70-80% of the population, globally. A massive task. But doable.

I also feel we are headed to annual boosters.
7/ The silver lining, if any, is that the discoveries and the lessons learnt during this pandemic will help mitigate a whole host of other medical problems. Including new treatments and vaccines that can be developed rapidly.
8/ In spite of everything going on I'm optimistic long term.

9/For countries like India which are experiencing a massive increase in cases this may seem totally unrealistic. But I think with masks, distancing, and rapid vaccination, things can be brought into control.

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More from @VincentRK

15 Apr
Did COVID cause remission of an advanced cancer?

61 year old man was diagnosed with Hodgkin Lymphoma. He then developed COVID. Only got supportive care. No steroids or immunotherapy. 4 months later, cancer had mostly resolved (left image vs right) 🪢

onlinelibrary.wiley.com/doi/full/10.11…
There are 3 possible explanations:

1) Hodgkin Lymphoma is unique among cancers in that what you see as big lumps of tumor are not cancer cells: Bulk of tumor mass is just normal reactive lymphocytes with small amounts of cancer (Reed Sternberg) cells mixed in. (Owl like cells)
So after COVID the reactive cells may disappear due to the severe viral infection, making it look like the cancer has gone into remission. But maybe only the normal reactive cells have disappeared. Time will tell if the true Hodgkin cancer cells are still there and will come back
Read 7 tweets
14 Apr
Low platelets: common
Blood clots in legs/arms: common

Blood clots in veins draining the brain: very rare
Blood clots in veins draining the brain plus very low platelets: extremely rare

Early on, Astra Zeneca: puzzle
Now: J& J. Hence the pause.

Pfizer/Moderna: No such clots
The risk is very small.
6 cases after 7 million doses of J&J vaccine. But just need few days to verify numerator, and assess risk/benefit.

Risk from COVID likely far outweighs risk from Astra Zeneca or J&J vaccine greatly in almost all people >age 30.
We have 2 other safe vaccines, Pfizer and Moderna in the US: After 180 million doses given no concern for such blood clots related to the vaccines.

Vaccine administration sites are adjusting. We have enough vaccines for everyone.

Things will be clearer in a week.
Read 4 tweets
13 Apr
Breaking: FDA asks states to pause J & J vaccine due to blood clots in 6 women age 18 to 48.

J & J vaccine is an adenoviral vector vaccine, as is the Astra Zeneca vaccine

These unusual clots have NOT been seen with mRNA (Pfizer, Moderna) vaccines.
cnbc.com/2021/04/13/us-…
I don't have the details of the 6 cases of thrombosis that prompted the recommendation. But it looks like the concern is the unusual combination of serious blood clots with low platelets in young people that prompted it. Not regular blood clots. @nytimes google.com/amp/s/www.nyti…
The good news is that the US will maintain and reach vaccine related goals even without the J &J vaccine. @ASlavitt is quoted in this story @CNN.

google.com/amp/s/amp.cnn.…
Read 8 tweets
11 Apr
Astra Zeneca vaccine & blood clots. Summary.

Rare form of blood clots plus low platelets. ~60% involve veins of brain. Almost all after 1st dose.

Risk (UK MHRA): 1 in 250,000 people
Risk (EU EMA): 1 in 100,000 people

Risk of dying: 20-25% of people with these clots have died
Approximately half of the deaths in the UK (11 of 19) were under age 50.

The benefits of the Astra Zeneca vaccine according to regulators appear to outweigh risks in all except those less than age 30. bmj.com/content/373/bm…
While blood clots occur at a certain rate in population what is unusual about these clots is the association with low platelets. Platelets help make blood clots & when platelets are low we are at risk of bleeding not clotting.

Low platelets in context of blood clots is unusual.
Read 13 tweets
10 Apr
If we have more COVID vaccines than people, but cannot get to herd immunity due to vaccine hesitancy then we have messed up the messaging.

The message should be clear and should come from every leader in the country.
Forget who did what wrong on the messaging. Just focus on the messages going forward.

Don't get stuck in debates of whether vaccines prevent transmission. They do reduce transmission dramatically. (It's will also be a largely moot question once 80% have been vaccinated).
Read 4 tweets
8 Apr
Mortality rate of symptomatic COVID when healthcare system was overwhelmed early on (as in Italy, Spain, Belgium, & parts of the US) was incredibly high. As we flattened the curve & learnt to treat, the rate reduced to 2-3%.

cf. Australia didn't get overwhelmed. @OurWorldInData
It is indeed remarkable how across the world the mortality rate of confirmed, presumably symptomatic, COVID has coalesced to around 2-3%.
Although with improvements in treatment, mortality rates of symptomatic COVID may be lower that what we saw early last year in places that got overwhelmed, no country should be in a situation where the healthcare system is overwhelmed. That leads to much higher loss of life.
Read 5 tweets

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