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Vincent Rajkumar Profile picture
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4 Aug, 4 tweets, 1 min read
Slow and steady may not win the race in this case. If they are going to approve why wait so long?
Someone show the FDA this. We will have over 2 million new cases by Sept 1.
Is there even the slightest possibility that mRNA vaccines are not safe and effective? The slightest possibility that the FDA won't approve? Is process really that much more important than saving lives?
Approval helps vaccination rates in 3 ways:

-Convince some skeptics
-Help with mandates
-Allow CDC and docs to use their judgment and provide boosters for those who need.

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Vincent Rajkumar Profile picture
4 Aug
Florida has only ~50% fully vaccinated and no mask mandates. A rise in cases in this setting leads to a rise in deaths. About 12,000 people in the hospital now. Worrisome. ImageImage
I had a patient who said today "I'm calling from the COVID epicenter in the US". Made me pause.
With so much vaccines we should not have an epicenter.
Read 4 tweets
Vincent Rajkumar Profile picture
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 Profile picture
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 Profile picture
2 Aug
We are in a long holding pattern with CDC, FDA, ACIP. Our immunocompromised patients are getting increasingly concerned with the rise in COVID cases.

US based docs: Are you ready to recommend a booster shot to selected immunocompromised patients?
Meanwhile in Germany:
In UK
Read 5 tweets
Vincent Rajkumar Profile picture
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 Profile picture
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

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