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Vincent Rajkumar Profile picture
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19 May, 6 tweets, 3 min read
The 4 COVID variants considered variants of concern by the WHO.

Of these, B.1.617 worries me the most. This is the variant that is sweeping across India. It appears more contagious, and likely more virulent.
who.int/docs/default-s…
Here is an update on how B.1.617 is becoming more dominant in India. @MohanaBasu @ThePrintIndia google.com/amp/s/theprint…
There are 3 subtypes of this variants. B.1.617.1, B1.617.2, and B1.617.3.

Preliminary studies suggest it is more contagious. Although the vaccine induced neutralizing antibody activity appears lower, it is still more than enough to neutralize the virus. google.com/amp/s/www.cnbc…
Anecdotally, from friends, family, and media contacts in India, it does appear more contagious. Able to spread easily to all family contacts. @doctorsoumya google.com/amp/s/www.wsj.…
Based on the number of younger people getting seriously ill and dying in India, in addition to the overwhelmed health care system, viral dose, and overuse of steroids, I worry that the B.1.617 variant may be also playing a role in being more virulent & causing more severe disease
Data on increased virulence potential are limited. However, I think it's better to be careful. And consider the potential when formulating policy. This article has some good insights on how this variant differs. scientificeuropean.co.uk/covid-19/b-1-6…

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Vincent Rajkumar Profile picture
20 May
3 reasons why I'm worried the pandemic in India is different:

-Rapidity with which the disease seems to progress
-High transmissibility in family contacts
-Severe disease & deaths in young people

I wish we had hard numbers. This my opinion based on following events closely.
Qualitatively the way COVID has behaved in India in the last 2 months is very different from India's first wave. It is therefore prudent to assume we are dealing with one or more extremely bad variants.

Of the variants listed below, B.1.617 is the one of major concern in India.
Implications:

1) We have to monitor and determine efficacy of vaccines, especially mRNA vaccines, against B.1.617 variants.

2) It is in the best interests of all nations with resources to help with huge amounts of vaccines ASAP to prevent the rise of even more serious variants.
Read 4 tweets
Vincent Rajkumar Profile picture
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 8 tweets
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
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 6 tweets
Vincent Rajkumar Profile picture
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
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

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