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Vincent Rajkumar Profile picture
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29 May, 7 tweets, 3 min read
US Vaccine Progress

~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. 👇
3) Whether people who had COVID & recovered should be counted in herd immunity calculations given the variants of concern. In this study, 80% of convalescent sera were able to neutralize the B.1.617 variant versus 100% of sera from vaccinated individuals. biorxiv.org/content/10.110…
4) How many people will fail to get the second shot in order to be fully vaccinated. I hope this number is very low.

5) Duration of protection from current COVID vaccines. So far studies suggest long lasting protection. google.com/amp/s/www.nyti…
I had explained last year that the duration of protection (especially against severe disease) will likely be long lasting even if antibody titers go down. (unless we end up with variants with sufficient mutations that allow them to escape the immune response). @LouRaguse
6) The effect of viral exposure dose. High viral dose exposures, especially healthcare workers who can get multiple simultaneous exposures, may be able to overcome protective effect of vaccination. Need more data.

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More from @VincentRK

Vincent Rajkumar Profile picture
29 May
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.

#GetVaccinated
Read 7 tweets
Vincent Rajkumar Profile picture
28 May
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. @TheLancetOncol thelancet.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.
Read 8 tweets
Vincent Rajkumar Profile picture
27 May
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.

Likely much more efficacy against severe COVID.

Link to preprint: khub.net/documents/1359…
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.
Read 7 tweets
Vincent Rajkumar Profile picture
26 May
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.

BMPC >20%
M spike >2
FLC Ratio >20

Any 2 of the 3 risk factors is considered high risk SMM. @MayoMyeloma @MayoCancerCare @myelomaMD
Read 13 tweets
Vincent Rajkumar Profile picture
25 May
Over 500 doctors have reportedly died of COVID in India in the second wave. Can someone confirm report here that >95% were not yet vaccinated? @DailyhuntApp @IMAIndiaOrg @Milan_reports @soutikBBC @PSampathkumarMD

H/T @amitsurg
m.dailyhunt.in/news/india/eng…
In my discussions with leaders of 3 large hospitals, fully vaccinated healthcare workers got COVID but didn't get serious illness. @spkalantri

There are some deaths despite full vaccination. But my sense so far is fully vaccinated are highly protected from severe disease.
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.
Read 5 tweets
Vincent Rajkumar Profile picture
24 May
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. @dwallacewells nymag.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.
Read 5 tweets

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