I have a different take. In both Iceland & Malta, both 90% fully vaccinated, a rise in cases has not resulted in a similar rise in deaths. We don't have herd immunity against flu or the common cold. Vaccines work. I am confident COVID will be reduced to the cold with vaccines. 1/
Now we are only in year one of vaccines and we will have boosters that help against variants.

I am not discounting the ability of Mild non life threatening COVID to cause long COVID type symptoms. A lot of viral infections do that. We have to find ways around it and treatments.
The reason we see a spike in cases is because the virus is mutating. And the variants are more vaccine evasive. This happens because we simply couldn't make or vaccinate 7 billion people overnight.

As more and more of the world is vaccinated this problem will reduce.
It's possible that we need boosters once a year if nasty variants keep emerging. Only time will tell. But we should not aim for some miraculous endpoint that's not humanly possible without permanent lockdown.

Vaccinate fast. The world. Reduce number of completely naive hosts.
In each country masks and all other precautions will need to continue until one can be confident that Covid infections are no longer occurring or until the rate of occurrence or complications is what's acceptable or feasible for that society— whatever saves the most lives.
I really love what @chrisfearne said.
The world would not have shut down if COVID deaths seen in July in Iceland & Malta relative to number of cases was all there was to COVID. (Note difference between cases/deaths in Malta in March vs July). Our goal should be to get the world as well vaccinated as Malta & Iceland
For reference: At its peak US had new daily deaths of >1 per 100,000 population due to COVID.
@sykristinsson — please give insights if I'm reading Iceland correctly. It's not as well vaccinated as Malta — 75% fully vaccinated vs 90%. But in both places COVID deaths during recent wave is much less than previous waves. Fully vaccinated seem well protected against deaths.

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More from @VincentRK

8 Aug
USA with the best vaccine supply has now 17% of the worlds daily new COVID cases. In number of cases per day we are in a different level and trajectory than every other country in the world. Again.
115 million eligible adults are still not fully unvaccinated. Includes 90 million who haven't had a single dose.

#GetVaccinatedNow
If everyone was vaccinated, a spike doesn't lead to deaths and hospitalizations. The fact that 80% of the elderly in the US are fully vaccinated has kept deaths low.

More than 90-95% of hospitalizations and deaths we see in the US are almost all in people who are not vaccinated
Read 7 tweets
8 Aug
If you are unvaccinated and think why get a vaccine because even vaccinated people are getting infections... Wrong idea!

For vaccinated, breakthrough infection is like getting another booster dose of COVID vaccine.

For the unvaccinated, it is risk of hospitalization, death.
The purpose of the tweet is to convey to unvaccinated people not to take reports of breakthrough infections in vaccinated people as a reason to stay unvaccinated.

If you are vaccinated & taking appropriate precautions, you are doing everything you can thats is in our control.
Please read my pinned tweet on why breakthrough infections sometimes happen.

Concerned about long COVID? Best way to prevent long COVID is to not get COVID in the first place. Vaccines greatly reduce probability of getting COVID. Highly effective in preventing hospitalization.
Read 6 tweets
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.
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
4 Aug
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?
Read 4 tweets
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
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

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