Fix what's in your control: 1) Avoid steroids unless there is hypoxia 2) When indicated, use steroids at right dose and right duration. 3) Check & control blood sugars 4) Avoid antibiotics
There will be hardly anyone who gets mucor without at least one of these 4 factors.
Sure there may be something else going on in addition because we do have a lot people taking steroids and antibiotics for other reasons, and people who have diabetes who hardly ever get mucor.
But it will take time to investigate these additional factors and see if they can be fixed.
If someone is urgently in need of oxygen now, you have to give whatever oxygen is available. No choice. But you could control sugars, and use steroids at right dose for right duration.
Bottomline: If the fungus is in the air or in the oxygen or water it's hard to fix quickly. If the fungus is caused by the immunosuppression from the virus itself it's hard to fix. What's fixable are: blood sugars, indiscriminate steroid use, and unnecessary antibiotics.
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I am aware of anecdotes of fully vaccinated people get seriously ill and even die in India. But these are exceptions. Anecdotes don't give you a sense of the denominator. Exceptions will occur based on level of neutralizing antibody response & the vaccine used. See thread.
Why are prescription drug prices so high in the US?
Let us start with insulin as an example. Insulin is the Achilles heel. If we understand insulin, we understand why it's so hard to fix our broken system.
1/ Existence of a vulnerable population needing a lifesaving medicine
2/ Monopoly
3 companies control the market for insulin. In a monopoly with significant regulatory and legal barriers to entry of competing products, the seller can set the price however high they want.
Here, the monopoly is not over a luxury item, but a lifesaving medicine.
3/ Patent Evergreening:
Making patent life extremely long & preventing competition.
Covert: By making newer version of a drug and patenting it (see insulin below)
Overt: Filing multiple new patents on same drug to stretch patent life, pay for delay schemes, lawsuits.
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.
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.