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
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.
I hope the vaccine supply for India increases greatly so that they can get out of this humanitarian crisis.

I also hope health care resources and oxygen needs improve so we don't lose lives that should not be lost.
Linking to this thread which speaks to the spread of the virus from the cities to rural areas.
Since people asked. Second figure has all countries. And also EU as a block

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More from @VincentRK

18 May
Just heard that it only costs $3 per dose for Pfizer and Moderna to make their COVID vaccine. But they sell it for $15-40 to the world.

Given the amount of publicly funded research that went into development of these vaccines, & the current crisis, this is unacceptable.
I'm ok with profits. But not on this scale, where it places many countries at huge financial and public health crisis. google.com/amp/s/www.nyti…
Moderna had $1.7 billion in sales, and $1.2 billion in profit. google.com/amp/s/www.mark…
Read 7 tweets
15 May
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.
Read 4 tweets
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
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
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 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
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

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