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
I'm linking to some good threads on management by experts, based on what we have learnt in the last year. They share a deep love and concern for India.
Studies were reporting 40-50% seroprevalence in big cities in India even by December. The same cities (eg. Delhi, Mumbai, Chennai) are now totally overwhelmed with COVID.
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…
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.
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.
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.
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.
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.