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Vincent Rajkumar Profile picture
@VincentRK
May 1, 2021 • 14 tweets • 6 min read • Read on X
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

Vincent Rajkumar Profile picture
Jun 25
Cure is a simple word. But there is confusion when it comes to cancer. What cure is in cancer, and what we should aspire for?

When can we say that a given type of cancer is curable?
Thread
1/
There is a difference between when we can say a particular cancer is a curable type versus whether individual patients with a given cancer can be considered potentially cured.

They are not the same.
2/
To call a cancer curable we must be able to treat the cancer for a finite duration, stop all therapy, and know that a certain % of patients will never relapse

Early stage solid tumors, Hodgkin lymphoma, DLBCL, ALL, AML are curable. Real cure. The definition of curable cancer
3/
Read 13 tweets
Vincent Rajkumar Profile picture
Jun 1
The 4 big myeloma randomized trials to watch out for @ASCO #ASCO24

1. Isa-VRd vs Isa-Rd newly diagnosed
2.Isa-VRd vs VRd (IMROZ)
3.DREAMM8 Bela-Pd vs Pd
4.Ven Dex vs Pom Dex (Canova)

See thread for why they are important.
1) The Triplet vs Quad trials with will define role of quads in elderly patients with newly diagnosed myeloma. They also provide frontline phase III data with Isatuximab— and a choice between Dara and Isa. For some patients Isa will be more cost effective. @Myeloma_Doc #ASCO24
2) Belantamab will make a comeback.

Corneal toxicity is low with reduced frequency dosing. The drug works very well. And in many patients with refractory myeloma belantamab may be safer and easier to do than bispecifics. We need options. #ASCO24
Read 12 tweets
Vincent Rajkumar Profile picture
May 31
Just out: Updated mSMART recommendations for treatment of relapsed refractory myeloma. #MedTwitter @MayoMyeloma

1/ CART is now included as an option for second or higher relapse. msmart.org/mm-treatment-g…
2/ Even though CART (cilta-cel) is approved for first relapse we are NOT including it in our main algorithm. Reserved only for special circumstances in this population. We have a long track record with standard triplets, and we are concerned about CART side effects. Image
3/ The current approach for second or higher relapse continues to define 3 specific types of Triple Class refractory. This makes it easier for clinicians to consider options. Image
Read 6 tweets
Vincent Rajkumar Profile picture
Apr 23
To my followers who wonder what MOC is, and why many doctors are tweeting about it. Thread.

1) Maintenance of Certification (MOC) is a redundant requirement thrust on US physicians by a private organization. We resent it.
2) MOC is causing frustration and burnout. Over the years, ABIM certification and MOC have become entrenched and institutions and insurers require it and will not accept any other alternative.

I am advocating on behalf of my colleagues in the US for change. To end MOC.
3) MOC requires us to pay fees imposed on us by a private organization and take multiple choice question tests irrelevant to our practice.
Read 8 tweets
Vincent Rajkumar Profile picture
Apr 17
10 suggested action items for physician colleagues suffering under the burden of @ABIMcert MOC. #MedTwitter

1. If your institution allows it, stop participating in MOC. Personally, MOC has no value to me.
2. If your institution requires ABIM certification, advocate for @InfoNbpas as alternative option.
3. Do not participate in more than one ABIM MOC specialty, the one that’s required by your institution. Save your money. Don’t spend a penny more than you have to.
Read 15 tweets
Vincent Rajkumar Profile picture
Apr 12
I see a lot of wrong analysis on accelerated approval and surrogate endpoints.

It’s always easy to criticize from the outside. The criticisms raised are well known to the FDA and investigators. They are considered. We go in eyes fully open. We try to do what’s best for patients
Without accelerated approval using surrogate endpoint of overall response rate in single arm trials, for 2-3 years lives would have been lost waiting for drugs like Velcade, Revlimid, pomalidomide, Daratumumab, carfilzomib and more.

My defense of accelerated approval in MM.
What kind of benefit are we talking about? How many years of life gained from accelerated approval pathway in MM?
Read 5 tweets

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