Everyday I hear about someone very young in India, in the best of health, dying or critically ill with COVID. In many, the clinical course is one of rapid progression.
Added to what's going on in the UK, makes me nervous about B.1.617 variants.
Get vaccinated. That does work.
Ask anyone in India, and most will know of someone like this. It's real.
In some one can blame lack of resources or steroid related complications. But in most it's pretty significant lung damage due to COVID.
In many cases, the severe lung damage and vascular events are happening despite the doctors doing the best they can. It's a feeling of being defenseless against this virus.
We've seen similar incidents in the US, but the scale at which it is occurring in India is something else
In my opinion, in addition to the "increased transmissibility is an exponential threat" described by @zeynep, the severity in young people in India, & the frequent occurrence of 2 or more young people in same family critically ill or dying indicates increased virulence as well.
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~60% of eligible population (166 million of ~280 million age >12) have had at least 1 dose of COVID vaccine
To reach herd immunity:
100 million more to go. (80% threshold)
(60 million if we consider recovery from COVID as immune)
What can disrupt the math?
Factors that affect the math and goals:
1) Extent of protection from current vaccines in immunocompromised individuals and very elderly. Neutralizing antibody levels can be a biomarker that helps predict extent of protection from vaccination. See thread.
2) Extent of protection from current vaccines against the B.1.617 variants. Thankfully data so far indicate that current vaccines are highly protective against symptomatic disease from B.1.617 variant. See thread. 👇
Important to realize that we use steroids like dexamethasone as anticancer drugs (for myeloma) to kill the same cells that make antibodies & help us fight infection.
They are not antivirals. They are anti immune system. They help the COVID virus if given early or inappropriately
When treating the cancer multiple myeloma, we have found that giving high doses of dexamethasone cause more deaths than low doses. More steroids is NOT better. Less is more. @TheLancetOncolthelancet.com/journals/lanon…
Dexamethasone and other steroids will make any kind of fever disappear and make people feel better, but behind the scenes they cause harm when used incorrectly.
We found all kinds of side effects are higher with higher dose of dexamethasone. From blood clots to infections.
Evidence that current vaccines protect against B1.617 variants seen in India. #VaccinesWork
1/ Although 7 fold more resistant to neutralizing antibodies from convalescent or Pfizer/Moderna vaccinated people, ALL vaccinated sera still able to neutralize. biorxiv.org/content/10.110…
2/ UK study: 88% efficacy with Pfizer, & 60% with AZ against symptomatic COVID. This is only slightly lower than original RCTs of these vaccines, & when compared to B.1.1.7. in this study.
3/ Full vaccinated healthcare workers in India seem to be protected from severe COVID and deaths to a high degree. There are definitely some reports of loss of life in fully vaccinated, but I think these are rare. See thread.
How and why I treat high risk smoldering multiple myeloma (SMM). Thread.
1/ Based on the progression risk curve over time, and genomic analysis, SMM is now considered a heterogenous clinical entity in which 50% of patients have premalignancy and 50% asymptomatic malignancy.
2/ These two groups can be considered as high risk SMM (asymptomatic malignancy) and intermediate/low risk SMM (premalignancy).
We are specifically concerned about high risk SMM, defined as 50% risk of progression to myeloma over 2 years.
3/ Patients with high risk SMM can be identified by the Mayo 2018 criteria: Also called the 20-2-20 criteria.
Besides vaccination status, the other consideration is viral dose. Healthcare workers are at risk of high viral dose exposures and multiple repeated exposures which puts them at higher risk. The loss of life described below is tragic. Some are very young doctors.
Worth remembering that people who have raised alarm and advocated caution have been more right on COVID.
It has been a hard year trying to project appropriate level of caution and worry, when faced with some who didn't like masks, some who felt it's just the flu, and some who felt we can just let people get herd immunity by natural infection. @dwallacewellsnymag.com/intelligencer/…
I keep thinking of the times I have been wrong. Where I tried to project optimism: cross reactive immunity protecting India, variants unlikely to be more transmissible & lethal, dismissal of importance of neutralizing antibody levels, potential severity of reinfections.