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Vincent Rajkumar Profile picture
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15 May, 4 tweets, 1 min read
Lymphomas, myeloma, CLL are cancers of the immune system itself. The chemotherapy we use in these cancers are aimed at the very cells that help us fight infection.

The best recommendation I have is consider monoclonal antibody cocktails early, as soon as COVID is diagnosed.
We don't routinely check antibody levels after vaccination. It's like low in patients with lymphoma, myeloma, and CLL after vaccination. But patients should know that antibodies are just one part of the picture. They will likely still be protected from severe disease.
Even though CDC has said masks are not needed for fully vaccinated people, till we get more information on vaccine efficacy, patients with lymphoma, myeloma, & CLL on chemotherapy should probably continue to wear a mask indoors when people who don't live with you are around you.
Had a question on what monoclonal antibody cocktails to use. The two cocktails that have been granted EUA for use in the US are:

Bamlanivimab/Etesevimab
(Eli Lilly)

Casirivimab/imdevimab
(Regeneron) (REGEN COV)

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Vincent Rajkumar Profile picture
17 May
This drop in confirmed COVID cases in India is an illusion. First, due to limited testing, the total number of cases is a huge underestimate. Second, confirmed cases can only occur where you can confirm: the urban areas. Rural areas are not getting counted. @BDUTT ImageImage
The daily confirmed deaths in India had exceeded 4000. At no time in the pandemic did any country exceed 3500.

The 4000 deaths are also a huge underestimate. Last year deaths were probably undercounted by a factor of 2 or 3. Now probably 10.
Although a nationwide lockdown would have been ideal, this has not happened. However most states have instituted lockdowns. This is less that ideal (since strictness varies a lot) but will help bring true cases and deaths come down in 2 weeks.
Read 5 tweets
Vincent Rajkumar Profile picture
14 May
A lot of COVID deaths in India in young people who should be doing well & recovering.

I am making a plea to doctors in India to cut down the use of STEROIDS. Please.

Steroids are only useful after the patient is hypoxic. Harmful if given early, or given for too long
In the first week of the illness when the virus is dividing, the use of steroids can suppress the immune response and make the virus divide even more. Steroids are not antivirals. There was a trend to more deaths in RECOVERY trial in patients who were not hypoxic.
In patients who have hypoxia, it signals that there is lung involvement. By now the virus is likely controlled by the body and the damage is from the immune system. Only at this stage are steroids useful: at small dose (Dex 6 mg) and short duration (5 days).
Read 10 tweets
Vincent Rajkumar Profile picture
14 May
Pan Corona Virus vaccine thread

What you missed from the WH briefing yesterday: Dr. Fauci's comments. @ASlavitt

1/ We are going to keep having mutants/variants and one of the solutions would be to have a pan corona virus vaccine that stops the virus no matter what it does.
2/ Dr. Fauci referred to an important paper published in @nature on an exciting new nanoparticle cross neutralizing antibody technology targeting both pandemic and pre-emergent coronaviruses. nature.com/articles/s4158…
3/ The idea is to make a vaccine that elicits antibodies that can neutralize multiple different coronaviruses: A pan-coronavirus vaccine. And that it might be possible! Coming from Dr. Fauci who led the NIH team that developed the Moderna vaccine, I am taking notice.
Read 9 tweets
Vincent Rajkumar Profile picture
14 May
A year ago today, >100 prominent scientists wrote an open letter calling on leaders to require masks for all to control COVID.

Our letter had an impact. @jeremyphoward @zeynep @erikbryn @EricTopol @trishgreenhalgh @DrSidMukherjee masks4all.co/letter-over-10…
The letter was announced in @USATODAY

@jeremyphoward @zeynep @JillDLawrence google.com/amp/s/amp.usat…
The WHO updated its guidance on June 5, 2020, agreeing that masks are recommended for all people in areas with high transmission— not just people with respiratory symptoms.
Read 10 tweets
Vincent Rajkumar Profile picture
13 May
CDC revised guidance on masks. Good news. We have been saying for a while that our messaging on vaccines has to emphasize that masks will go away and restrictions will cease as vaccination rates increase.
Revised guidance: People who are fully vaccinated may skip masks and distancing in most indoor & outdoor settings. Exceptions noted below. @nytimes
google.com/amp/s/www.nyti…
This is possible because:

1) >70% of people age 65 and older in the US are FULLY vaccinated
2) 83% people age 65 and older have had at least one dose.
3) Almost 50% of adults in the US have had at least one dose.
4) Of the rest 1/3 have had COVID and recovered.
@ASlavitt
Read 10 tweets
Vincent Rajkumar Profile picture
13 May
This tweet sent on the same day the CDC director was worried about "impending doom" was based on my confidence in COVID vaccines. Americans did heed the director's advise and followed precautions. I'm glad it was a ripple, not a wave. We are making steady progress. #GetVaccinated
Most countries in the world would love to be in our position: more than enough COVID vaccines for every resident. Vaccines approved even for children 12-18.

But we have a problem. To prevent cases and deaths in the fall, we must overcome vaccine hesitancy and reach herd immunity
Vaccines work only if people take them.
Read 4 tweets

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