In >125 countries, cumulative COVID cases are >10,000 per million.

If you are one of the few countries that managed to keep cases to <2500 per million through border control or other measures: India is a warning that your populations remain susceptible until full vaccination.
This includes Australia, New Zealand, China, and importantly many parts of Africa.

Please continue all precautions until this is achieved.
The threat is even higher now because:

1) People are fatigued by restrictions and may be prone to reducing precautions.

2) The virus itself may be more contagious and/or more virulent based on the events in India.
Throughout the pandemic we have witnessed countries that seemed to be doing very well for months and hailed as role models succumb over time: Countries in Eastern Europe, and more recently India.
There is no question now that most people are susceptible either because the virus itself has mutated into more infectious variants, or because of high viral dose exposure that occurs when people are not careful (indoor gatherings or crowding without masks), or both.
As India shows exponential rise can come so quickly that you have no time to prepare and the associated loss of life is staggering.

I really don't like writing scary tweets. But in this case I'm beyond worried. #GetVaccinatedASAP
With vaccines we have an end in sight. We have multiple effective vaccines. It's now important that all countries work together to get the world vaccinated with urgency.

The virus has continuously exploited the weakest link.
Allowing uncontrolled cases in parts of the world is the surest way to generate vaccine resistant variants.

Forget national identities and approach COVID vaccination as if everyone in the world is a citizen of your own country.

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More from @VincentRK

8 May
The Chief Minister of Tamil Nadu in India has just announced a statewide lockdown from May 10 to May 24, 2021. This is the right move and will save a huge number of lives. #COVID @mkstalin @nramind @GunasekaranMu @PSampathkumarMD
Modeling data from @iiscbangalore suggests >100,000 lives saved in India with a nationwide lockdown. Would translate to ~5000 lives saved, minimum in Tamil Nadu. Likely much more.
Here are a list of things the TN government is doing to protect the public during the lockdown. A blueprint for other states and the center to potentially follow. Kudos. @thenewsminute
Read 4 tweets
7 May
India's daily death toll from COVID is now undoubtedly the highest ANY country has ever recorded. Conservative estimate are deaths are 3𝙭 𝙧𝙚𝙥𝙤𝙧𝙩𝙚𝙙.

Ways to save lives:
-Nationwide lockdown
-Stay home
-Wear Masks
-If you a cold & fever: assume you have COVID & isolate.
Modeling studies @iiscbangalore @SashikumaarG @deepakns shows that a 15-day lockdown can reduce reported deaths by >100,000.

If actual deaths are 3 times reported, this means India can potentially save >300,000 lives with a 15-day lockdown.
Here is a framework on how a nationwide shelter in place order can be implemented with protections to prevent hardships for migrant workers and the poor. @Lakshmi_RKG scroll.in/article/993572…
Read 13 tweets
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
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.
Read 5 tweets
2 May
COVID crisis in India: If you want to help, here are 3 orgs doing outstanding work

@AIFoundation
Donate at aif.org

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

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

paytm.com/oxygen-campaig…
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

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