I'm convinced India needs a nationwide shelter-in-place order to minimize devastating loss of life from COVID. This must be implemented with adequate support to the poor. Agree with this article in @scroll_in @Lakshmi_RKG scroll.in/article/993572…

Thread 1/
2/ The first lockdown was harsh. But it showed COVID can be controlled.

The first lockdown had many mistakes. We can avoid repeating them.

The first lockdown had no endgame. Now we have vaccines.

With good support for the poor, shelter in place can save a huge number of lives
3/ India has about 3000 confirmed daily deaths due to COVID. Given the complete breakdown in testing, reporting, and healthcare delivery, the true death count is much higher.

To control COVID quickly and reduce loss of life now a stay at home order & universal masking is needed
4/ Will a lockdown work? Yes.
It worked last year. It is showing signs of working even in the current situation in Maharashtra.
5/ With exponential rise in cases, people are getting COVID while just trying to get medicines and oxygen for their loved ones as they navigate huge lines everywhere.

People are not able to get to the hospitals on time. A planned shelter in place will also help with this.
6/ When hospitals are overwhelmed the mortality of severe COVID increases dramatically. A nationwide shelter in place will help flatten the curve.

When you have >380,000 cases a day, and are 155th rank out of 167 countries in hospital bed capacity— you need to flatten the curve
7/ Shelter in place must be planned and nationwide. Cases are rising exponentially nationwide. What happens in Delhi is a few days before other places in the south. As @samanth_s writes, disorganized rules give pain but no good benefit. @qz qz.com/1999650/would-…
8/ This has to be a nationwide shelter in place which has the benefits of the first lockdown (control of COVID) and avoids its mistakes. This article has the framework of how this can be done. @Lakshmi_RKG @scroll_in scroll.in/article/993572…
9/ The Indian government must act quickly. abc.net.au/radionational/…
10/ Until then people should just take their own initiative and simply stay home unless it's absolutely necessary to go outside.
11/ Control in daily new cases is essential for a safe and effective vaccination campaign.
12/ Here is Dr. Fauci. google.com/amp/s/www.trib…
13/ Here are similar views from members of the governments COVID India task force. @kaunain_s @IndianExpress indianexpress.com/article/india/…
14/ Dr Randeep Guleria, Director, AIIMS on the need for lockdowns in places where the test positivity is >10% in India. @aiims_nd @rishika625 @ndtv google.com/amp/s/www.ndtv…

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More from @VincentRK

12 Jun
For those of you interested in multiple myeloma, here is a brief state of the science for treatment.

1/ For newly diagnosed patients, triplets, VRd or DRd, are the standard of care. Current RCTs are examining if we can improve outcome using quadruplets. Eg. PERSEUS trial.
2/ In newly diagnosed myeloma, another question given the cost & potential toxicity of quadruplets is to start with a triplet, and based on MRD status identify patients who need 4 drugs versus this who do equally well with 3 drugs. Eg: EQUATE trial. @myelomaMD @mtmdphd @eaonc
3/ Auto stem cell transplant is still standard of care for eligible patients. Current data indicate overall survival is similar whether the transplant is done early or delayed. But for many reasons we prefer early transplant for most patients.
Read 7 tweets
11 Jun
The delta variant is the triple threat I have talked about. I am not saying this lightly. I take no pleasure in alarming people. It's just the facts after 2 months of being closely involved with the India COVID crisis. This is not last years COVID. Get vaccinated.
The message is not alarm. The message is that there is an easy solution that works. #GetVaccinated
Read 5 tweets
10 Jun
When the FDA approves a drug, it is not only approving the drug. Its actions provide prolonged monopoly protection to a drug in a country where the seller can set whatever price they want, the buyer cannot negotiate price, and competitors will face more severe barriers to entry
If like other Western countries we had a 2-step process for prescription drugs: regulatory approval followed by value based pricing determination, I would have less problem with an FDA that is more lenient.
If like other countries barriers to market entry to competition are not so hard, then I would have less problem with an FDA that is more lenient.
Read 5 tweets
9 Jun
Vaccine hesitancy in alive and well in the US. And it is going to cost lives. The level of vaccination we have in the US is simply not sufficient against the delta variant.

Friends: tell unvaccinated friends to get vaccinated.

Leaders: lead. Talk to your constituents. Beg them
30 million people who got one dose of vaccine need second dose. One dose is not enough.

Another 60-100 million people need to be fully vaccinated.

Get vaccinated even if you had COVID before.

Im trying not to be alarmist even though I'm extremely worried.
The delta variant is a triple threat. It is here.

1) More transmissible: In India, If often if one family member had it, everyone got it.

2) Vaccine evasive: In UK study a single dose of Pfizer or AZ had only 33% protection against symptomatic COVID.

3) Likely more virulent
Read 8 tweets
8 Jun
Incidental COVID positive test after full vaccination without COVID symptoms is not COVID.

Better still I have been calling for Reinfection COVID and Post vaccination COVID to have their own names, because the natural history and prognosis will be different.
COVID is the name of a disease: SARS CoV-2 infection in people without prior immunity to SARS CoV-2 infection. It carried a certain hospitalization / mortality rate.

SARS CoV-2 infection in people who previously had COVID or were fully vaccinated are different diseases.
You have to define the natural history of each separately because both for the individual patient and for public policy the implications are different.

It doesn't mean Post Vaccination COVID cant be serious: it means the prognosis from such diagnosis will be different from COVID
Read 4 tweets
7 Jun
The reason Biogen's Alzheimer's drug is priced at $56,000 per year and not $112,000 is because they are being kind.

Nothing in the law or process that prevents them from setting whatever price they want. The system is not broken. There is no system.
Hope people at recent @icer_review meeting remember the comment I made at the myeloma meeting: Pharma is wary about lawmakers going after them for price increases. So the name of the game is going to be front loading. Get all you can get early.

@SarahKarlin @RESachs @DusetzinaS
Please for heaven's sake pass a law enabling Medicare to directly negotiate prescription drug prices. 90% of the public wants it.
Read 5 tweets

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