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Vincent Rajkumar Profile picture
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21 Apr, 5 tweets, 2 min read
Important: The rate of blood clots with low platelets reported with Pfizer and Moderna are LOWER than expected for general population. These vaccines are safe and don't carry excess risk.
Clots with low platelets can occur with many hematologic conditions including HIT, HUS, TTP, Atypical TTP, Antiphospholipid antibody syndrome, etc.

The rates with Pfizer and Moderna are lower than what is expected for TTP in the general population.
We have vaccinated >120 million people with Pfizer and Moderna in the US. Compared to 7 million with J&J.

8 unusual clots with low platelets reported with J&J. If this was a problem with the other two vaccines, we would have known by now.
Note that even the rates with Astra Zeneca are exceedingly low overall.

Details on these unusual clots below.
Also note that it's not just "thrombosis with thrombocytopenia" that caused concern with AZ /J&J vaccines. It's the 1) clear temporal relationship, 2) occurrence in people without other risk factors, 3) unusual locations (brain and splanchnic veins), & 4) severely low platelets.

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More from @VincentRK

Vincent Rajkumar Profile picture
23 Apr
Updated Risk of vaccine related cerebral venous sinus (or splanchnic vein) thrombosis associated with low platelets

Astra Zeneca
1 in 100,000 (EU)
1 in 250,000 (UK)

J&J
1 in 500,000 overall.
1 in 150,000 for women age 18-49.

No risk seen with Moderna or Pfizer vaccines.
The risks are extremely low. Awaiting CDC panel recommendations on J&J pause.
The pause was justified. To determine the numerator & the denominator. CDC panel has voted today to resume vaccinations with the J&J vaccine. statnews.com/2021/04/23/cdc…
Read 6 tweets
Vincent Rajkumar Profile picture
22 Apr
One year had gone by. We thought that given India's population and crowding, that the number and severity of COVID was inexplicably low.

Well that part was true. But not because of a miracle or massive undercounting. It was sadly because the worst was yet to come. A crisis. ImageImage
Either lockdowns and restrictions had worked really well, and once everything broke free after November, COVID did what it does.

Or

New dangerous mutants evolved.

Or

Both happened together.

End Result: The present crisis.

@lfrayer npr.org/sections/goats…
In this time of crisis & desperation, 2 problems must be dealt with simultaneously.

1) Care of patients with COVID in a sensible way that optimizes the use of scarce resources & minimizes loss of life

2) Reduce new cases by masking, distancing, & rapid vaccination
Read 7 tweets
Vincent Rajkumar Profile picture
21 Apr
I was wrong in my assessment. Two months ago, I felt India had somehow miraculously escaped the devastation caused by the pandemic in so many countries. COVID has humbled me, again.
No easy solutions for India except masks, distancing, and rapid vaccination. It is a crisis. ImageImageImageImage
I still hope that one of the main points of my earlier thread that preexisting immunity (in addition to lower age and less obesity) will keep the mortality rate significantly lower is correct.

But with such a huge population, even a tiny mortality rate is millions of lives.
We thought 40% seroprevalence meant inching to herd immunity. No.

The 1.3 billion population means that 750 million people are still potentially susceptible and don't have immunity against COVID.
Read 7 tweets
Vincent Rajkumar Profile picture
20 Apr
A high viral dose exposure, a bad mutant variant, or an immune system compromised by prior illness or chemotherapy — are 3 potential reasons why COVID reinfection or post-vaccine infection may occur.
Lowering viral dose exposure can be achieved by masks, distancing, ventilation. I think it's a good idea to follow these measures until the pandemic is under control in your country, even if you have had prior COVID and are vaccinated. Helps you. And helps reduce spread to others
Immune system thats compromised by prior illness or chemotherapy can be helped by ongoing research on vaccine boosters. As well as improved treatments. But note that no matter how immunosuppressed, whatever protection we get from vaccines is definitely better than nothing.
Read 4 tweets
Vincent Rajkumar Profile picture
20 Apr
COVID vaccine & Blood clots update: The European Medicines Agency @EMA_News has concluded that unusual blood clots with J&J vaccine are a very rare side effect.

The clots are very very rare (8 cases out of 7 million vaccinated in the US). ema.europa.eu/en/news/covid-…
The blood clots with J&J vaccine resemble clots seen with the Astra Zeneca vaccine. Both these vaccines are adenoviral vector based vaccines.

These unusual clots are:
-Very rare
-Cerebral venous or splanchnic
-Associated with low platelets
-Have high PF4 antibodies
The risk estimates of these clots overall varies because we don't have full capture of numerator and denominator. What we know suggests risk:

~1 in 1 million with J&J
~1 in 250,000 with Astra Zeneca based on UK estimates
~1 in 100,000 with Astra Zeneca based on EU estimates.
Read 10 tweets
Vincent Rajkumar Profile picture
20 Apr
COVID What works:

Masks
Distancing
Ventilation
Vaccines
Dexamethasone
Convalescent plasma
Remdesivir

& Importantly for high risk groups:

MONOCLONAL ANTIBODIES
Bamlanivimab/Etesevimab
(Eli Lilly)
Casirivimab/imdevimab
(Regeneron)
phe.gov/emergency/even…
Note that FDA EUA for use of Bamlanivimab alone has been revoked.

Bamlanivimab plus etesevimab given in combination is authorized by FDA EUA. fda.gov/media/145808/d…
Regen-COV (casirivimab and imdevimab) is also available under EUA. fda.gov/media/145611/d…
Read 4 tweets

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