More from @VincentRK

Vincent Rajkumar

@VincentRK

3 Aug

What on earth is long COVID?

1/ Long Covid is loosely defined as symptoms persisting weeks after COVID. Everyone has their own definition.

First, there is no single disease called "Long COVID".
Its a colloquial term given to a variety of conditions following COVID.

See thread

2/ There is a whole lot of problems and diseases that can occur after COVID. Unless we define which exact problem among this heterogenous group of conditions we are talking about we will get absolutely nonsense results.

3/ For some people "long covid" consists of continuation of symptoms of covid lung infection and resultant decrease in lung function: shortness of breath, fatigue, cough.

Read 8 tweets

Vincent Rajkumar

@VincentRK

2 Aug

More is not always better in cancer. Maximum tolerated dose doesn't make sense for many new treatments.

In a lot of the consults I do for second opinions, I'm not changing the recommended regimen. My advice centers on the appropriate dose.

Dosing in initial cancer trials are based on Western populations, and in patients with good performance status and organ function.

Extrapolating them to other settings can lead to severe toxicity.

Even in the tested population, Pharma companies worried about missing out on efficacy tend to push the dose up as high as possible. For some of these drugs studies subsequently show that a lower dose/schedule can be safer and more effective.

Read 8 tweets

Vincent Rajkumar

@VincentRK

30 Jul

Barnstable, Massachusetts COVID outbreak:

~70% vaccination rate
469 got COVID, 90% delta variant.

Of the 469:
-346 (74%) fully vaccinated
-274 symptomatic
- 4 hospitalized
- No deaths

cdc.gov/mmwr/volumes/7…

The focus of the story has been that the viral load in vaccinated and unvaccinated was similar. And this was partly the reason for CDC changing mask guidance. Since it raises the possibility that vaccinated people may be able to transmit COVID to others.

But the study does not change current understanding that while breakthroughs can occur with delta, current vaccines protect against severe disease.

We cannot compare to "unvaccinated group" due to confounders. Also note unvaccinated group includes partially vaccinated.

Read 4 tweets

Vincent Rajkumar

@VincentRK

30 Jul

COVID vaccines are not perfect. But they are darn good, and keep you alive. Even with delta, alpha, gamma, kappa, lambda, etc.

I'm following Malta (90% vaccinated) and the UK. Look how deaths have stayed low. Couple more weeks to be sure. #GetVaccinated

Malta is almost fully vaccinated. 75% mRNA vaccines.

Of 2060 active cases, 33 are in the hospital, including 2 in ICU. A little over half the hospitalized patients are unvaccinated even though unvaccinated are only a small % of the population.

google.com/amp/s/timesofm…

They must also be hospitalizing on some precautionary basis. Coz 25% of hospitalized are asymptomatic per the report.

Read 4 tweets

Vincent Rajkumar

@VincentRK

29 Jul

New guidelines for federal workers and contractors:

•Get vaccinated

OR

•Masks +
•Weekly/Twice weekly testing +
•Practice social distancing +
•Restrictions on travel

Pro tip: Vaccines are easy, and will keep you safe and free. reuters.com/article/us-hea…

No one likes mandates. But no one wants to go to the hospital because someone else is not being careful either.

We have seen the mandates roll in, and I'm pretty sure there will be more each day as everyone wants to keep their employees and customers safe.