2 May, 11 tweets, 4 min read
Did elections contribute to the COVID-19 surge? We are always tempted to say yes. I decided to do a comparison. Surprisingly, the graphs I obtained from election & non election states are near-identical. This suggests that the wave is a seasonal surge in a geographic region.
1/9
The two images represent election states (where big outdoor gatherings occurred) on the right, and comparable non election states on the left. I have included two sets of pictures. The names of the states are on the graph. If you compare the timelines, it is near-identical.

2/9
The question is whether the surge would have occurred anyway, by pattern, and maybe the large election rallies amplified it to an extent.

This virus behaves in a wave-like pattern in most nations. The reason for the steep upward slope is exponential increase.

3/9
Exponential curves are gentle at first, when numbers are small.

As they increase by geometric progression, the time taken for a large number to double is the same as for a small number to double.

Hence it turns steep after a long and gentle rise.

(See pics)

4/9
As the surge breaks, the downtrend that follows also is exponential. That is an exponential DECLINE.

After the peak, the transmission apparently stops suddenly; the graph shows a steep downward slope (reason is unclear: definitely not “herd immunity”, weather or lockdown)

5/9
The same pattern is seen in multiple nations and might reflect the behaviour of the virus in a region. Human intervention is not enough to explain the sudden drop, as not all nations have done the same measures such as “lockdowns”. See my graph below that compares 6 nations.
6/9
I am writing this thread just to show that our understanding of repeating waves of the pandemic are far from perfect.

Why the virus only “hangs around” in a region only for about 3.5-4 months, and returns 2-3 times a year is a mystery.

7/9
Solving this mystery might give us the key to outwit the virus & the pandemic.

e.g. Do a swarm of viruses have an genetic activation key that turns itself off at a particular time point?

Do they reactivate themselves into hyper mode after a period of quiet endemic spread?

8/9
Finding solutions requires out-of-the-box thinking.

My instinct is that there is something very important about viral behaviour that we are missing altogether. It might be the elephant in the room.

9/9

@PeterHotez @VirusesImmunity @doctorsoumya
@GKangInd @angie_rasmussen
Graphs obtained from covidindia. org
One can see that states like Maharashtra and Kerala (which have high numbers of overseas travel) have shown a sight endemic tendency between waves, the edge being rather jagged. Could be multiple separate introductions of the virus into the region, each with its own programming.

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4 May
This thread is a classic example of personal bias overriding scientific temperament. >80% COVID-19 patients recover with no medication, but credit is given to drug given.

Bacteria, their benefits apart, do not require to be killed, unless they cause secondary infection.

🧵 1/4
Besides no one gives any journal the license to make guidelines. Peer reviewed journals hold a high standard of eliminating fraudulent claims and at this time, they are a relatively credible source of evidence. Whether we adapt from the paper depends on many factors.

2/3
For starters, never believe the conclusions of any research paper. As a doctor you must have the basic knowledge of biostatistics to look at the methodology, raw data, primary outcomes, confidence intervals and the merits of the tests of association they used.

3/3
4 May
The dubiously named “double mutant” has become “single” it seems.

Yes, the B.1.617 has lost one of the two mutations* E484Q and become B.1.617.2, which has more cases in UK than the original.

(*B.1.617 has ~13 mutations in fact; only L452R & E484Q received attention)

1/4
Total cases of “double mutant” B.1.617 in the UK is only 193, while its new “single version” B.1.617.2 already has 202 cases.

Losing the E474Q mutation (and ‘becoming single’) must’ve seemed a good thing for the virus.

2/4

health.economictimes.indiatimes.com/news/industry/…
Only B.1.617.1 and B.1.617. 3 have the E484Q mutation, while B.1.617.2 dies not.

Please note that E484Q isn’t the same as E484K, the latter has known immune escape properties.

3/4
4 May
Evidence based medicine is not being practised enough in India. Many "official COVID19 treatments" in India have already been discarded by the world, but patients still receive long lists of drugs that only add to cost & side effects.

1/10
scroll.in/article/993859… via @scroll_in
Chloroquine, Ivermectin, plasma, steam inhalation, 'coronil', azithromycin, doxycycline, oseltamivir, vitamin D (for people without proven deficiency), Zinc, vitamin C, PP inhibitors are still prescribed in India, despite lack of evidence. This is called polypharmacy.

2/10
"There is no harm in giving it" is not a scientific explanation that can justify irrational use. Besides, all harms need not be obvious to the prescriber.

Doctors are trained to use the minimum number, dose & duration of medication for any disease, and only if necessary.

3/10
4 May
Cell entry mechanisms of SARS-CoV2. Fusion peptide molecules in the spike protein need to undergo a conformational change ("bending") to help "clip" the 2 membranes together (virus & human cell);energy is needed to overcome a repulsive hydration force. 1/n
pnas.org/content/117/21…
The fusion process - or final conformational change- varies by availability of multiple cellular proteases, and may be facilitated by environmental factors (physical force/temperature/chemical) in addition to furin preactivation.

2/n
The SARS-CoV-2 virus is a 'more advanced model' than the original 2003 SARS virus, in that its RBD remains hidden (in lying down / 'off' position) helping it escape our immune surveillance.

While this might theoretically affect its ability to bind to the ACE-2 receptor,

3/6
2 May
T cells work against variants & are not affected by E484K or N501Y mutation.

1 dose of vaccine is enough if past infection: the response was so amplified, it even covered the major variants B.1.351 & B.1.1.7. Note that vaccine is based on old virus.

1/5
science.sciencemag.org/content/early/…
But in naive patients, T cell response was lower with one dose of vaccine.

96% (22/23) of vaccinated post infection individuals made a T cell response to Spike protein, compared to 70% (16/23) of vaccinated naïve individuals.

2/5
After 1 dose, vaccination-naïve (no past infection) group attained similar antibody titers to the post infection group at 16–18 & 28–30 weeks.

The majority of SARS-CoV-2 immune naïve individuals made no nAb response to the B.1.1.7 (18/20) and B.1.351 (17/20) after 1 dose.

3/5
2 May
“It is time for India’s policymakers to trust those with relevant expertise, to make sure the necessary data are collected and available, and to accept the value of scientific findings, even if they do not fit the government narrative”