I'm beginning to worry that COVID mutant variants may be playing a significant role in the crisis in India, causing infections even in people who may have escaped with mild COVID during the 1st wave. This has implications for the world on how soon vaccine boosters may be needed.
It also has implications for border control measures and quarantine measures that countries should employ. Some tough policy choices ahead. And no easy solutions.
The other factor playing a role in India is is viral dose. With crowding and high prevalence, people are at risk of multiple exposures, and at high dose. This sets off a vicious cycle of high dose exposure. A large number of healthcare workers are getting seriously ill in India.
To control the crisis and limit further new mutants India needs a combination of 1) massive vaccination and 2) nationwide shelter in place (with adequate support of money & supplies for workers & the poor).

This will also reduce stress on hospitals & reduce loss of lives.
Here is the problem:

More infections = more mutations
More mutations = more infections.
Vicious cycle.

Even though a mutant that is both more contagious & more virulent will be a rare occurrence, when you have 400,000 new cases a day anything is possible.

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More from @VincentRK

3 May
India's choices:

Wait it out--> Will cause massive loss of life

Vaccinate quickly--> Not enough vaccines

Treat COVID effectively--> Shortage of oxygen/beds/HCWs

Voluntary precautions--> Low compliance

A nationwide shelter at home order--> Feasible. Can work if done right
All the choices are bad.
But only one is even feasible in current situation: a nationwide lockdown (with protections for the poor). With proper notice, & provision of supplies & money to workers and poor people, the economic pain can be reduced. Will save huge number of lives.
A nationally coordinated and implemented shelter in place will buy time for vaccines. It will flatten the curve, reduce stress on healthcare system, and reduce case fatality rate.

I don't see an alternative solution that will be associated with lesser loss of life.
Read 6 tweets
2 May
COVID crisis in India: If you want to help, here are 3 orgs doing outstanding work

Donate at aif.org

@Paytm (For people in India; They match) @vijayshekhar
Donate at paytm.com/oxygen-campaig…

Donate at vellorecmc.org
If you are a hospital in India needing oxygen request here. @Paytm #OxygenConcentrators

For guidance and resources on how to manage COVID in India, visit indiacovidsos.org

@PrakashLab @paimadhu @PSampathkumarMD @KrutikaKuppalli @FutureDocs
Read 7 tweets
1 May
To all the proponents of herd immunity by natural infections, and the (not so) Great Barrington Declaration proponents— India is what happens with uncontrolled natural infection. Variants arise, and the young are susceptible. This virus has no rules. Catastrophe.
The only way out, and that too if we are lucky, is herd immunity by fully vaccinating >80% of the population, whether people have had COVID or not. And plan for boosters. This is no ordinary virus.

The variants in India, are the worlds problem too. If not now, in a few months.
Protecting the elderly may sound good on paper but is not practical. Even so, the crisis in India shows the virus if fully capable of deaths in young fit people. We are hearing heartbreaking stories everyday from India.
Read 6 tweets
1 May
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
Read 10 tweets
28 Apr
Viral dose is an important factor in severity of COVID. As India waits for vaccines, I urge people in India to wear masks and avoid crowds. This is the best way to reduce viral dose, and repeated exposures.

Lower viral dose will reduce severity of illness. And reduce deaths.
For over a year we have been saying that masks play a role in reducing viral dose, and at this point I'm more convinced than ever before. Have to unearth old tweets and graphics.
Severity of COVID is influenced by many factors, but unfortunately most of these are not in our control. Not easily "changeable": age, obesity, comorbidities, type of mutant variant, genetics, etc.

The one factor that is in our control is reducing viral dose at exposure.
Read 8 tweets
27 Apr
US Vaccine Progress: Over 50% of the eligible population (140 million out of ~265 million) have had at least 1 dose of COVID vaccine.

Herd Immunity (80%):
125 million to go with vaccine alone.
Only 70 million more to go if we also include people who have had COVID & recovered
Two assumptions: I'm assuming ~30% of children & adults have had COVID & recovered (30 million confirmed; 60 million unconfirmed).

Also assuming all people who got need 2nd dose to be fully vaccinated will eventually get it (recognizing this is not happening & we need to fix it)
I'd prefer 125 million more people as the minimum target for vaccination. But suspect cases will decrease quite a bit if we get 70 million more vaccinated.

The last 50 million will be hard. We will need to overcome vaccine hesitancy through people they trust.
Read 6 tweets

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