1) Do vaccines prevent infection? Including delta.
Yes. Unvaccinated 5 times more likely to be infected in LA county study. cdc.gov/mmwr/volumes/7…
2) Do vaccines work as well against delta variant as we hoped?
No. Based on UK studies efficacy is lower against symptomatic infection (see table) but still extremely high against severe disease (>90%).
3) Do vaccines prevent hospitalization and death, including against delta variant.
Yes. Unvaccinated 29 times more likely to be hospitalized due to COVID than vaccinated in LA county study.
4) Why are countries which have high vaccination rates having spike in cases?
Because there are still a number of unvaccinated people even in well vaccinated countries. delta is also vaccine evasive. But deaths this time around are much lower. @FT
5) Do we need to be concerned that vaccine efficacy may be too low in some groups?
Yes. In elderly nursing home residents and immunocompromised. cdc.gov/mmwr/volumes/7… Boosters are recommended.
6) FDA just approved Pfizer. Were the vaccines rushed?
No. Research on the technology used was developed over years. Double blind randomized placebo controlled trials were done and showed high efficacy. We had a huge pandemic so trials enrolled patients very quickly.
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Officials said that "it's clear" that protection from mRNA COVID vaccines decreases over time, and that the US will recommend boosters for all, 8 months after primary vaccination
Let’s look at the evidence for boosters for ALL
Thread
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2/ In a NY Health Dept study of 10 million NY residents VE against hospitalization remained >90% in May to July 21 when delta comprised 80% of infections cdc.gov/mmwr/volumes/7…
3/ mRNA vaccines remain effective at preventing hospitalizations at 24 weeks after vaccination
2/ This study was done between Feb - May 2021. No deaths were seen in 8958 vaccinated healthcare workers. One death in 1609 unvaccinated healthcare workers.
3/ Protection began even after first dose. Single dose provided 95% protection from ICU admission. However, note that we don't know what proportion of cases @OffCMCVellore were due to B.1.617.2 (delta variant) or B.1.617.1 variant or wild type.
COVID associated Mucor is increasingly being reported in India.
Spores of fungi are common in the environment. Infection occurs when circumstances are right.
Immunosuppression and uncontrolled diabetes are main culprits
2/ Spores of mucor are breathed in and cause infection
Risk factors
- Prolonged/high dose steroids suppress the immune system and elevate blood sugars, which further increase risk
- uncontrolled diabetes
- Widespread antibiotics may contribute via overgrowth of fungi
3/ Two main forms of post Covid mucor: rhinocerebral and pulmonary.
In one case series:
- 95% of pts had diabetes, mean HbA1C was 10.5
- Onset at median of 22 days after onset of Covid symptoms
Vaccine hesitancy: My responses to the main concerns.
1) Vaccines were developed too fast.
Although developed at warp speed, none of the essential steps were skipped. The huge number of cases made accrual to trials much faster
2. Vaccines are not effective
In large trials, vaccines were 80-95% effective at preventing infection. They are even more effective at preventing hospitalization and death
Yes. They are not perfect, but are highly effective. Real world data confirms data from clinical trials.
3. Vaccines are not safe:
There is a small risk of severe allergic reactions (1 in 1 million for mRNA vaccines). There is a small risk of severe blood clots with J& J (1 in 500,000). Other side-effects are mild. Risk of serious side effects is small compared to risk from COVID
I am getting calls from friends/ family in India about COVID. From neurosurgeons to urologists, doctors are being roped in to handle the crisis.
1/ Having managed pts with COVID for the last year & having the luxury of time, here are my thoughts for those new to this battle.
2/ Diagnosed COVID? What next ?
Check oxygen sats.
If sats > 90%, reassure
-Paracetamol as needed for fever
-Inhaled steroids (budesonide)
-Continue to follow sats
-No need for hospitalization
-No need for chest CT
3/ if O2 Sats < 90%
-Supplemental oxygen
-Dexamethasone 6 mg/day or equivalent steroid (prednisone 40 mg, methylprednisolone 30 mg; hydrocortisone 150 mg
Steroid preparation/route does not make a difference
-Prone positioning ( sleeping on stomach)