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.
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.
The effects of a bad variant in India further amplified by:
1) Population size 2) High viral exposure dose & easier transmission (crowds and lack of masks) 3) Overwhelmed healthcare system 4) Oxygen shortage 5) Inappropriate use of steroids 6) Only 3% fully vaccinated
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Monoclonal Gammopathy of Undetermined Significance (MGUS) is present in ~5% of the population age >50. MGUS carries a lifelong risk of the cancer multiple myeloma at a rate of 1% per year.
iSTOPMM has enrolled more than 80,000 people living in Iceland, 40 years of age and older. The trial asks 2 questions: Does screening provide benefit? Does intensive follow up of MGUS provide benefit. @SaemundurMD@sykristinsson
Here is an excellent thread by the first author @SaemundurMD on the iSTOPMM trial.
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…
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…
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.
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.