Almost 25% of daily US COVID deaths are in Florida. This wave is striking because it is pretty hard to go above pre-vaccination waves. It's almost double.

Thankfully has not happened in any other state. In fact, very few countries have had this happen either.
We saw it in India: it's a combination of delta variant, policies, lack of masks and protective measures, crowding, overwhelmed hospitals.

India unfortunately did not have vaccines. Florida does. So it's all the more tragic.
The closest a US state has come so far to being in Florida's situation is Louisiana.
Even in countries with bad waves now, daily deaths per 100k are much lower, about half as much or lower in most.

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More from @VincentRK

6 Sep
Pandemic decision making is not a journal club or an academic exercise of who can poke the most holes in a study.

It's a series of risk benefit judgment calls based on imperfect data. Choose the right people to make those calls, & it is more likely that the right calls are made.
The judgment call is not based on what the academic puristic dogma dictates. It's based in judging the consequences of what if you are right versus what if you are wrong.
This is an unusual medical situation in which we all have skin in the game in the sense we are all affected by what decisions are made. But the people making the call for healthcare policy have more skin in the game in the decision than a doctor like me sitting at home.
Read 5 tweets
4 Sep
After generally tracking together since the start of the pandemic, and having similar overall vaccination rates, EU & USA are diverging now. Why?

Our well vaccinated states are doing just like the EU. But we have about 10 states with fully vaccinated rate of only ~40%.
We basically have too many states that are not well vaccinated. 24 states in September 2021 that have a fully vaccinated rate of less than 50%.

We need to first fix what we can and must fix which is the vaccination rate. That's on the leaders.
It's not like we are suffering from a huge vaccine shortage. Or that a vaccine is a major hardship or violation of freedom. It's one more vaccine. We take so many already. The messaging from state leaders has to be persistent and consistent.
Read 8 tweets
3 Sep
US oncologists got a letter from @TakedaPharma on 2 RCTs of ixazomib maintenance in myeloma noting a decrease in overall survival in this setting

As a lead investigator of one of the RCTs, my thoughts.
1) Decrease in survival seen post conventional treatment not post transplant
2) Overall survival benefit is needed in maintenance setting. Which is why we have not recommended ixazomib maintenance so far except in patients who needed oral maintenance therapy but unable to take Lenalidomide for some reason.
3) Ixazomib is not FDA approved for post transplant maintenance. Current data at median follow up of 5 years shows no difference in overall survival as shown in the figure. My recommendation stays the same. Use it only if you need maintenance but cannot give len or bortezomib.
Read 5 tweets
2 Sep
We hear "Follow the science" frequently. But what does it mean?

1/ If you shadow a doctor for a few days, you will see countless decisions for patients that we make which are not supported by randomized trials. It's a lot of risk benefit judgment calls using imperfect data.
2/ The science we know in medicine is tiny and fragmented compared to how complex human bodies and the diseases that affect us are. The science is also very slow in coming. But death is irreversible, and we can't always wait for perfect data.
3/ What's "follow the science" to an epidemiologist is different than what it is to an oncologist or intensive care doc. What it is to a policy maker is different than what it is to a statistician.
Read 11 tweets
1 Sep
Florida's vaccination rate is puzzling. There are 5 states in the US with daily death rate twice the national average or higher. Four of these have vaccination rate of around or below 40%.

Florida is the odd man out with 53% fully vaccinated. @FT @nytimes
The next closest death rate in a comparably vaccinated state is Delaware with a rate of 0.34. In fact, Florida's daily death rate is >3 times higher than all 23 odd states with similar or better vaccination rates.

nytimes.com/interactive/20…
Daily death rates do change based on when we are checking them in terms of the wave. But in this post vaccination wave (the 4th wave since the pandemic started in the US), I think a similar analysis by cumulative deaths per 100k will give a similar picture.
Read 6 tweets
31 Aug
COVID outcomes 1 year after diagnosis. Study from Wuhan. @TheLancet #LongCovid

Note this is for hospitalized patients. Rates in mild patients will be different.

At 12 months:
30% short of breath
26% anxiety/depression
12% unable to return to work
thelancet.com/journals/lance…
Please note that as I have previously discussed long term health problems after COVID, often called Long COVID, is a mix of distinct disorders. So shortness of breath is often a consequence of lung damage, whereas why some have cognitive impairment or severe fatigue is unclear.
So as this study shows there are a variety of symptoms that can persist or occur 6 months or 12 months after COVID. See table.

The article breaks these down based on how ill patients were when they got COVID, oxygen requirements etc. thelancet.com/journals/lance…
Read 4 tweets

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