Seeing a lot of explanations that attribute the horrific surge in India to one thing or another (variants, aerosols, vaccines, etc), all of which betray a facile understanding of how a crisis like this occurs.…
"It's because of more transmissible variants!"

This might contribute, but as Dr. @ashishkjha points out, 40% of the population lives in multi-generational households. This is conducive to the spread of any variant, especially to older, higher risk people.
And for their contribution to the overall cases, more transmissible variants are a problem in the surge of severe cases that are overwhelming the inadequately funded health care system. The variants may cause more infection, but more people are dying b/c they can't access care.
"It's because WHO didn't send India the memo that this virus is AIRBORNE!"

Except when @WHO released their scientific brief discussing aerosol transmission in July 2020, the Union Health Ministry stated they were following this closely.…
While the ICMR continued to attribute spread primarily to droplets at the time, they acknowledged the importance of masks and distancing and also said they were closely following the topic.…
And other scientists in India, like @RakeshMishraLab, director of @ccmb_csir, discussed aerosol transmission and the need for well-ventilated spaces:…
And this wasn't news to Dr. Mishra, whose institute released guidance in March 2020 encouraging, among other precautions, interventions for aerosol transmission including masks, distancing, staying home, and ventilation.
Since that time, Dr. Mishra conducted a study that shows, indeed, a respiratory virus like SARS-CoV-2 does indeed spread through inhalation. Which, again, WHO has acknowledged since last July.…
So the real problem with aerosol transmission isn't that WHO didn't bother to tell India about it. It's that you can't realistically say "get N95s & air purifiers & CO2 monitors to India NOW" when frontline HCWs are lacking basic PPE and supplies & there's inadequate testing.
And on top of that, the government implemented policies that put people at grave risk, including by encouraging large gatherings.
And btw, though this is a primarily outdoor event, close contact among large crowds with many infected people is a recipe for disaster. With enough people crowded for a sufficient duration of time, both aerosol & direct contact transmission will occur.…
But the greater failure is in the government's inaction and bad policy decisions that put people at risk, per Dr. Sumit Chanda. We've seen this time and again here in the US and elsewhere around the world.
Both Drs. Chanda and Jha were scathing about the government's failure to act on warning signs that became the appalling tragedy we are witnessing today.
"It's because there aren't enough people vaccinated!"

Sure, that doesn't help, but also that's the result of government complacency and pursuing unrealistic policy goals motivated by politics rather than public health.
Vaccines are still crucial for long-term suppression of the pandemic and for preventing a 3rd wave. But realistically, vaccines aren't going to be enough to contain the epidemic occurring right now without reliable data about regional hotspots to surge limited vaccine supplies.
And getting that data is a real problem when the government is spending more time trying to suppress criticism than prioritizing responses, including basic data collection that will allow for more effective public health interventions.
And this has been further complicated by a narrative that India had reached herd immunity in 2020, thus justifying government complacency, premature reopening, and policies that endangered people.
This was bolstered by "experts" who took it upon themselves to make definitive proclamations about this (sometimes as part of delivering a decidedly anti-vaccine message, ahem, Jay Bhattacharya).
The government pointed to a paper from September 2020 by their commissioned "supermodel" committee that likely grossly overestimated seroprevalence and suggested the herd immunity threshold had been reached.…
At the time, @winterapples wrote an in-depth piece for Science, dissecting the model's flaws and including the perspectives of many Indian scientists, who strongly disagreed with that conclusion.…
The present situation demonstrates clearly that this model's estimates were extraordinarily incorrect, and one more example of what I've taken to calling "catastrophic optimism." Optimism is important, but not at the expense of necessary precautions.…
So what's the point of all this? Well, I've been more and more pissed off by hot takes attributing this tragedy to individual factors that are either beyond our control (variants) or the fault of specific people (WHO didn't say it was airborne) or misinformation (herd immunity).
The reality is more complex. It's many factors: failed leadership, misplaced priorities, lack of access to health care, PPE, & vaccines, lack of epi data to guide evidence-based policy, demographics, epidemiology, misinformation.
I'm no expert in complex systems analysis, but you don't have to be to understand that "double mutants" or what WHO has tweeted are grossly oversimplified and do not adequately explain a national public health disaster (nor should they be used to advance personal agendas).
Reducing this emergency to a quip about variants or transmission not only fails to educate the public about the complexity of the crisis, but does a tremendous disservice to the people who have lost their lives.

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More from @angie_rasmussen

5 May
Public health people are often accused of "enjoying" the pandemic. Now some say that anxiety about reopening is actually "fear of normalcy."

Thanks @ChuckWendig for this perfect antidote to the stupid, unsympathetic idea of pandemic "addiction."… Image
The past 15 months have been extremely traumatic to all of us, and not just because of "fear." Of course fear is one part of what's made this so awful, but there's also: loss, grief, isolation, etc. It's entirely cruel and unsympathetic to suggest anyone is "addicted" to trauma.
And many of the people preaching this addiction gospel also position themselves as optimists. One person even created a hashtag #FONO ("fear of returning to normal") to further pathologize a completely normal reaction to trauma and suggest may be a worse epidemic than COVID.
Read 8 tweets
3 May
Last week the Sputnik V Twitter account said I was spreading "fake news" in this thread & that I read their statements and as-yet-unreleased correspondence with Anvisa, the Brazilian regulator, as proof.

Anvisa held a press conference. A minor correction is in order.
Let's just get the correction out of the way: Anvisa wasn't responsible for batch testing Sputnik V and didn't find plaques on A549 cells. That was Gamaleya, and they bent over backwards to claim that isn't what their data shows.

BUT IT DOES. Let me explain.
First, let's refresh:

Sputnik V is a viral-vectored vaccine. It uses a type of common cold virus called adenovirus to express the spike protein from SARS-CoV-2. The adenovirus vector is engineered to be replication-defective, meaning these viruses can't reproduce themselves.
Read 32 tweets
30 Apr
There's a lot of myths and misperceptions so I'll try to cover this quickly! See thread below:
1. Vaccines give you COVID. None of the currently authorized vaccines can give you COVID. They only use the SARS-CoV-2 spike protein, and there is no intact virus in any of the vaccines. Flu-like side effects aren't COVID...they are temporary and just show the vaccine is working!
2. mRNA vaccines are gene therapy. mRNA is chemically similar to DNA, but it is not the same thing. mRNA cannot alter DNA and never actually even gets into the part of the cell where DNA is stored (the nucleus). mRNA vaccines make spike protein for a day or two, then degrade.
Read 13 tweets
30 Apr
The vaccines are very safe! We knew this initially because of data from clinical trials, in which thousands of people were vaccinated and studied, as well as from observations of people who have been vaccinated since the vaccines came on the market. Some more detail below:
In the phase 3 trials for Pfizer, Moderna, and J&J there were a handful of severe adverse events reported out of more than 100,000 participants combined in those 3 trials. The most common (but still rare) safety concerns are with allergic reactions. Those are easily treatable.
Nearly 200 million doses of Pfizer and Moderna have been given in the US. There are no "safety signals" reported. "Safety signals" are reports of a severe illness that might be vaccine-related in a database at CDC called VAERS (Vaccine Adverse Event Reporting System).
Read 5 tweets
28 Apr
Они обалдели!

The Sputnik V vaccine Ad5 vector is evidently replication competent. The makers apparently neglected to delete E1, so getting this vaccine means being infected with live adenovirus 5.

Hence Brazil’s regulator correctly rejected it.…
Adenovirus-vectored vaccines like J&J, AstraZeneca, and Sputnik V use infection with adenoviruses, common pathogens that usually cause common colds.

But to increase safety and decrease risk of side effects, most vaccine vectors delete the AdV E1 and E3 genes.
E1/E3 deletions are standard in Ad-vectors. Deleting E1 prevents the virus from replicating and deleting E3 prevents it from interacting with the immune system.
Read 19 tweets
26 Apr
Jonas Salk once famously asked if you could patent the sun re: IP rights for the polio vaccine.

That's a far cry from Bill Gates' unilateral decision to place patent protection above global health in terms of priorities.…
Gates is right that it's not as easy as just repurposing factories in LMICs, but that is not a good argument against the TRIPS waiver.

Vaccine IP includes the manufacturing process—the recipe, not just the ingredient list. If that were shared, you don't need to "do the trial".
Having proprietary details about the manufacturing process means you could equip facilities to produce these vaccines. Not magically. But safely and in compliance with processes that have already been approved.
Read 6 tweets

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