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Vincent Rajkumar Profile picture
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20 Sep, 8 tweets, 3 min read
Canada is almost 70% fully vaccinated. Only 5 states are close to that level in the US. Why?

% Fully vaccinated disparity:
12 states 60-70%
19 states 50-60%
19 states 40-50%
nytimes.com/interactive/20…
How it looks for COVID related deaths since vaccinations started.
Too 12 states. Note only few are at the level of Canada.
Middle 19
19 states under 50% fully vaccinated.
The 15% disparity between US and Canada is 50 million people. Not trivial difference.
Now let's see what happens in well vaccinated country which also is a role model for adherence to other protective measures.
Basically we have overwhelming data, not just from the randomized trials, but also from multiple real world studies that vaccines are highly effective in preventing severe disease. Why we cannot translate this information into getting our vaccination rates to >70% is just sad.

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Vincent Rajkumar Profile picture
19 Sep
We are heading in a dangerous direction in the US, and the rise is steep.

3 things we must do to change this trajectory:

1) Improve vaccination in states that are lagging. All states need to be at 70%+
2) Improve mask adherence
3) Booster for elderly and immunocompromised
How do we improve vaccination in states that are lagging?

I'm afraid at this point we need more employer enforced vaccine mandates. Too many lives are at risk, including those of people unable to get care for other diseases because the health care system is overwhelmed.
We also need leaders to come together and send a clear message that vaccines work in every possible study that has been done and that they are extremely safe.
Read 6 tweets
Vincent Rajkumar Profile picture
6 Sep
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.
Read 4 tweets
Vincent Rajkumar Profile picture
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
Vincent Rajkumar Profile picture
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
Vincent Rajkumar Profile picture
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
Vincent Rajkumar Profile picture
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

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