💡TWO SOLUTIONS—Vaccines key but too slow. What India 🇮🇳 can do to immediately slow #COVID19 surge now—

➡️Better masks (KN95, FFP2, KF94), tighter masks, or double masks— augmented by million of rapid tests! 🧵

@RanuDhillon @AbraarKaran @sri_srikrishna. washingtonpost.com/outlook/2021/0…
2) “India will not be able to vaccinate its way out of this surge quickly, no matter what. Even if the United States were to donate all of its vaccine doses to India now, it would still take months to immunize enough people to control the outbreak.
3) “Lockdowns, as some states and cities are reinstituting, can quickly stunt transmission of the virus, but in a country with high rates of poverty, informal work & unreliable social safety nets, restrictions need to be implemented with adequate social and economic support”
4) “But two other interventions could be implemented almost immediately to counter the tsunami of infection: more masks and rapid home-based antigen tests. Biden WH is sending millions of such masks & tests to India as part of the U.S. emergency assistance, which is a good start.
5) “The coronavirus is transmitted by respiratory particles, including smaller aerosols that can get through or around many cloth masks. “Hi-fi” masks that have both high-grade filtration and a tight fit around the mouth and nose can more reliably block these particles.
6) “A number of such masks exist, including N95s and reusable elastomeric masks from US, KN95s, KF94s from South Korea and FFP2s from Europe. India needs to urgently assess the availability of these masks and begin a campaign to procure and distribute them in huge numbers
7) “India should also make efforts to accelerate domestic production. Another option would be to mass-produce and distribute “mask-fitters” that enhance the seal formed by surgical masks, which have sufficient filtration to block most particles that transmit the virus.
8) “The fitters have simple designs made from common materials, allowing for immediate scale-up of their production. One makeshift approach that can be used until other options are available would be double-masking, with a cloth mask used over a surgical mask to improve its fit.
9) “If worn widely when indoors and among crowds, these options could rapidly impede transmission. They can be mass-distributed through existing channels such as the national food supplementation system, which has a designated person in each village to distribute food rations.
10) “In addition, public uptake of such masks will require politicians and celebrities — some of whom have, in recent months, not been wearing masks in public — to promote them now.”
11) “The second intervention that can have an immediate effect is the large-scale deployment of rapid antigen tests that can provide results in minutes and be administered by community health workers (already in place nationally in India) or even possibly by people themselves.
12) “Currently, India relies on PCR, or polymerase chain reaction, testing. But given the sheer volume and pace of virus transmission, PCR cannot be scaled widely enough nor deliver results fast enough to identify those infected before they transmit to others or become sick.
13) “Some experts have argued against using such rapid tests because they can sometimes result in false negatives or false positives. Studies, however, have shown that rapid tests tend to be accurate when people are most infectious and could be used every few days…”
14) “so that an infection missed on one day is likely to be detected by the next test. False-positive results can also be offset by using PCR or another rapid test that targets a different antigen to confirm the diagnosis.”
15) “Another challenge is whether people who screen positive will have the space and resources to isolate safely. This is tough to solve in a crisis, but communities could perhaps designate buildings or spaces in cities and villages for people to isolate with food & essentials”
16) “Even if implemented imperfectly, widespread rapid testing would still be better than the alternative of people not getting tested. If done at scale, this approach could help cut off enough chains of transmission to help reduce the surge.
17) “As with masks, India needs to urgently assess the global supply chain for rapid tests so available supplies can be imported and deployed as soon as possible.
18) “If pursued nationally with global support, hi-fi masks and rapid tests could be scaled up within a matter of weeks alongside efforts to engage communities on why these measures are important and how to employ them.
19) “These measures could damp the exploding rates of infection while longer-term interventions to boost care capacity and vaccination take root. Masks and rapid antigen tests should be used urgently to start pushing back the tide.
20) “Without these urgent interventions to slow transmission, the crisis is likely to get much worse before it gets better — and thousands more lives will be lost.”

Thx again @AbraarKaran @RanuDhillon @sri_srikrishna washingtonpost.com/outlook/2021/0…
21) Meanwhile, another critical logistical crisis for India 🇮🇳 to overcome…

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More from @DrEricDing

6 May
⚠️Don’t ignore—

"Ignoring variants today, suggesting they aren't important, leads us to ignore variants tomorrow.

Ignoring the variants of tomorrow is potentially a f***ing big mistake!"

…says Dr. @michaelmina_lab,
Harvard immunologist & epidemiologist
#COVID19 #vaccinate #P1 ImageImage
2) “variants are extremely concerning. Most data at this point shows anywhere from a 10-fold to a 30-fold reduction in nAb against the variants”
3) “When we mix these variants with elderly immune systems that will wane - we will see new cases emerge amongst fully vaccinated vulnerable in our communities this year. it will be bad in this fall and it will lead to outbreaks and deaths again.” 🔥
Read 5 tweets
6 May
Insulin was invented ~100 years ago, and its patent sold for $1.

“Do you know the reason why [insulin is] $1,000 with insurance?” ~@AOC

There is no reason for insulin to cost $21 in Canada for a 10 ml bottle, while it costs a mortgage payment in the US.
2) atrocious amount of big pharma price gouging on insulin. Absolutely atrocious. Heartbreaking atrocious. Shamefully atrocious.
3) Let this sink in:

In 2018:
J&J CEO made $30M
Pfizer CEO made $28M
Merck CEO made $18M
Eli Lilly CEO made $16M
Gilead CEO made $16M


📌Americans spent $535B on Rx drugs

📌1/4 of diabetics rationed insulin to survive

📌500K Americans went bankrupt from medical bills.
Read 10 tweets
6 May
📍GET BOTH DOSES! Great variants & #COVID19 vaccine news—Pfizer/BioNTech vaccine had great efficacy of 89.5% vs #B117 🇬🇧 variant & 75% vs #B1351 🇿🇦 variant for infection—but only with 2 doses. The 1 dose efficacy was just ~29% vs #B117 & ~17% vs #B1351. 🧵
nejm.org/doi/full/10.10… Image
2) “Viral genome sequencing conducted from February 23 through March 18 indicated that 50.0% of cases of Covid-19 in Qatar were caused by B.1.351 and 44.5% were caused by B.1.1.7. Nearly all cases in which virus was sequenced after March 7 were caused by either #B1351 or #B117.”
3) To be clear—this was not a trial, but an observational case-control study. “Vaccine effectiveness was estimated with a test-negative case–control study design, a preferred design for assessing vaccine effectiveness against influenza (see the Supplementary Appendix).”
Read 7 tweets
5 May
Joe Biden waived the vaccine patents in the 4th month of his presidency. Donald Trump would not have waived the patents if he was President for another 4 years, 4 decades, or 4 centuries. Elections matter.
2) Biden’s trade ambassador has begun the process of waiving the patents. It will take time, but it’s coming.
3) Let this sink in—Trump WH actually moved to block efforts to waive the vaccine patents in October 2020!!! So damn straight Trump would have kept blocking it. washingtonpost.com/health/2021/05…
Read 4 tweets
5 May
📍VARIANT TAILORED VACCINE—Moderna announced that a variant-tailored 3rd dose of the NIH-Moderna vaccine greatly boosted antibody levels in volunteers in a new study. The updated vaccine, tailored against the #B1351 variant from 🇿🇦, worked best.🧵 #COVID19 businessinsider.com/modernas-boost… Image
2) Earlier research, done in petri dishes, suggested the B.1.351 variant was able to partially reduce the effectiveness of leading vaccines, including from Pfizer and Moderna. businessinsider.com/coronavirus-va…
3) How much did the #B1351 variant decrease neutralization from Pfizer and Moderna vaccines? A lot. 20-30x fold drop for Moderna. And 30-40x fold drop for Pfizer - akin to a completely unrelated distant bat coronavirus. While not equal to efficacy, this is a big drop. See 🧵
Read 9 tweets
5 May
Biden waives the vaccine patents. Saving humanity is more important than protecting corporate IP, which taxpayers paid for with our research dollars anyway.

In America, right matters. Saving the world matters. #COVID19 #CovidVaccine
2) Previously, the Trump WH had *blocked* patent waivers where it was first proposed in October 2020!! Let that sink in how much elections matter! washingtonpost.com/health/2021/05…
3) Been yelling about this for weeks. 50 companies stand ready to produce the vaccines. But to fully produce it, the pharma companies need to assist in technical sharing too. We can’t let pharma off the hook.
Read 4 tweets

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