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Rajeev Jayadevan Profile picture
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3 Jun, 4 tweets, 2 min read
mRNA vaccines linked with myocarditis in young people.

Both Pfizer & Moderna are being looked at. Israel reported the link, which has since been under CDC & EMA’s scrutiny.

Cases are mild, except for ? 2 fatalities in Israel. Details awaited.

1/2
sciencemag.org/news/2021/06/i…
CDC’s position on myocarditis following mRNA vaccination.

“More in male adolescents, 4 days after 2nd dose, cases are mild”

This is an evolving story and could impact decisions to vaccinate children - if “signal” found to be >> “noise”.

2/2
cdc.gov/vaccines/acip/…
Thread on the topic by @andrewbostom has the details emerging from Israel
Tweet by Dr Dror Mevorach who has been seeing myocarditis in Israel following Pfizer vaccine

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More from @RajeevJayadevan

Rajeev Jayadevan Profile picture
4 Jun
Among 506 healthcare worker infections from a cohort of 12,248 at PGI Chandigarh, 64% were unvaccinated, 9.5% were fully vaccinated (>2 weeks past II dose)

However, the shorter follow up post 2nd dose (time bias) means the real % could be higher.

1/10

nejm.org/doi/pdf/10.105…
Cont’d

The graph does not factor in the duration of follow up. During an ongoing vaccination process, those who are unvaccinated “get longer time” (compared to the vaccinated healthcare workers) to pick up the infection.

2/10
Cont’d

Since vaccination takes time, those who were 2 weeks past second dose in the pie chart would have had fewer days of observation, than others.

This means that the odds of picking up infection will be smaller by default. This also gets reflected in the pie chart.

3/10
Read 10 tweets
Rajeev Jayadevan Profile picture
2 Jun
How are COVID-19 deaths defined?

It is not a straightforward process like deciding between 'pregnant & non-pregnant'. It is easy to under-count (a frequent complaint), and also over-count.

Let's take a look at WHO, ICMR & Public Health England's definitions. See thread.

1/9 ImageImageImageImage
2/9 (see whole thread)

This is the WHO's definition of COVID-19 death.

It was written on 16 April 2020, at a time when the complete picture of COVID-19 was not known.

We now know that COVID-19 is much more than a viral illness; delayed deaths occur.

who.int/classification…
3/9
These delayed deaths may follow a period of apparent clinical recovery, that is when the patient feels better.

The ongoing immune process inside the body could last for weeks, when vascular events such as stroke, heart attacks and pulmonary emboli have been well-described. Image
Read 9 tweets
Rajeev Jayadevan Profile picture
31 May
Immunity against COVID-19 can be long-lasting.

Rare study that demonstrates long-lived plasma cells (that make antibodies) in the bone marrow of those who recovered from COVID-19, after 7-11 months.

From Washington University, St Louis.

Thread:

1/13
nature.com/articles/s4158…
2/13

-This study looked the body's ability to generate antibodies long-term.

-We know that S-specific antibody levels in blood drop for about 4 months, & then level off.

-That however does not mean we 'lost' the ability to make antibodies.

-Let us look @ some basics first.
3/13

-During infection, B cells pick up the antigens of the virus and present them on Class II MHC to CD4 T cells in the germinal centres in lymph node or spleen. This activates B cells, generating memory cells and plasmablasts. Some of these mature into long-lived plasma cells.
Read 13 tweets
Rajeev Jayadevan Profile picture
31 May
Only 7 out of 28,184 healthcare workers who received both doses tested positive >2 weeks after 2nd dose (0.0046%).

One of the authors Dr Torriani stated in a video that such people had milder symptoms than the unvaccinated. | NEJM

1/2
nejm.org/doi/full/10.10…
This study involved 36,659 HCW who had easy access to testing, was done during a surge and involved relatively younger people.

Of these, 28,184 completed 2nd dose by the time of publication, of these, 14,990 were 2 weeks past 2nd dose.

See research letter attached above.

2/2
We must also remember that the age profile of this cohort is young; their baseline risk of developing severe disease is relatively low. The key point in this study is that they had some level of mandatory testing, which means lower chance of missing infections.

3/3
Read 4 tweets
Rajeev Jayadevan Profile picture
30 May
From Doctors, to Doctors.
25 Practical Tips for Doctors Treating COVID-19.

These pearls are based on the collective experience of several doctors who have been meeting every Tuesday 8 PM @ IMA Cochin, ever since the pandemic started.

These are PDF screenshots. Links on thread. ImageImageImageImage
Link to e-Book on palliative care in COVID-19 (see tip No. 24 in the series above) Thanks @palliumindia @mrraj47 @palliumchair

It is very important to keep our patients comfortable-even when they are critically ill; and also to reduce work of breathing.

palliumindia.org/wp-content/upl…
Link to FOGSI statement to start vaccinating pregnant women in India, see tip no.15 in the series above

fogsi.org/wp-content/upl…
Read 7 tweets
Rajeev Jayadevan Profile picture
30 May
Surge in Vietnam 🇻🇳 coincides with the discovery of B.1.617.2 with an additional mutation: Y144 deletion which had been seen in various settings (B.1.1.7 variant, and also in immunosuppressed patients who harboured longer SARS-CoV-2 virus infections)

1/3
e.vnexpress.net/news/news/viet…
Multiple mutations occurred while the SARS-CoV-2 virus lived for a long time in a immunocompromised B-cell-depleted patient. Such studies provide a rare opportunity to follow viral adaptive evolution. The Y144 deletion was first spotted ~a year ago.

2/3
medrxiv.org/content/10.110…
Paper describing the mutations in B.1.1.7

3/3
virological.org/t/preliminary-…
Read 4 tweets

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