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Vincent Rajkumar Profile picture
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4 Oct, 7 tweets, 3 min read
Study of 3.4 million people @aboutKP @TheLancet

Vaccine efficacy against infections:
- First month post: 88%
- 5 months post: 47%

But vaccine efficacy against hospitalization (Figure):
- First month post: 87%
- 5 months post: 88 %

thelancet.com/journals/lance…
No significant difference in rate of decline in vaccine effectiveness between delta and other variants.

Vaccine efficacy against hospitalizations 93% for delta and 95% for other variants.

thelancet.com/journals/lance…
Bottomline is that some drop in efficacy against infections is seen over time, but protection against severe illness remains constant. Vaccines are working great in this study as in multiple others which have demonstrated the same thing.

#GetVaccinated
The decline in efficacy against infections explains spikes with delta seen in many well vaccinated countries. The remarkably constant protection against severe illness explains why these countries have not seen an increase in deaths to match the increase in infections.
For any vaccine, these and other data we have would be just amazing results. For vaccines which were made, tested in RCTs, and administered to hundreds of millions within months of the start of a worldwide pandemic: these are beyond amazing.
I do realize that since ~100 million remain not fully vaccinated in USA, the drop in efficacy for infections over time means potential spread from vaccinated to unvaccinated increases. Also realize the risk of long covid even if initial infection is mild. Which is why I advocate:
No we are not changing goal posts.

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More from @VincentRK

Vincent Rajkumar Profile picture
4 Oct
Top 10 drugs for Medicare Part D spending in 2019. The list and the $ amounts are worrisome:

1 is used for a cancer that's 1% of all cancers.
2 are expensive blood thinners more convenient, but only marginally better than older drugs.
4 are diabetes drugs.
Insulins should not be on that list. It's 2021.

A drug that's a cousin I thalidomide, that has been used for over 15 years to treat a cancer that's only 1% of all cancers should not be on the list.

I don't think new oral blood thinners should be so highly priced.
Medicare does get back some money back for these drugs as rebates so we don't know the exact dollar amount which Medicare actually spends. But the spending is high regardless.
Read 4 tweets
Vincent Rajkumar Profile picture
4 Oct
We have 280 million people eligible for COVID vaccines in the US.

The first 140 million got fully vaccinated ASAP. The final stretch will be the hardest.

See the rocket take off and then slow to a crawl.
I thought some people may be reluctant. But not this much: 95 million eligible but not yet fully vaccinated.

30 million of these have had one dose. So I am hopeful they will get fully vaccinated soon.

That leave 65 million eligible people who have not had even one dose yet.
Out of these even if one third has some degree of immunity from prior COVID, it still leaves 40 million eligible people completely susceptible. That is a lot of people.

Which is why we cannot relax yet. What we can do below:
Read 6 tweets
Vincent Rajkumar Profile picture
2 Oct
Medicare Part D spends 60% of its money on 250 drugs that have only one manufacturer and no generic or biosimilar competitors. #UnregulatedMonopoly

13% on 2,208 other drugs with only one manufacturer

27% on 1,078 drugs with more than one manufacturer.
kff.org/medicare/issue… Image
Not all drugs with only one manufacturer are a monopoly. That's why some of single source drugs are lower priced. If an alternative drug is available from another manufacturer, there's competition; many equivalent drugs, especially generic equivalents, means real competition.
On the other hand, if a new cancer drug works for only a few months or years, and then stops working - the case with most cancer medicines - then even if there are multiple meds EACH drug remains a monopoly. Because we want to try each drug and prolong life the most we can.
Read 5 tweets
Vincent Rajkumar Profile picture
1 Oct
Of >51,000 Covid deaths in England between January and July 2021, only 256 occurred after full vaccination.

That is 256 out of 25-35 million fully vaccinated. Compared to >38,000 deaths in 20-30 million unvaccinated people.

1/ google.com/amp/s/www.bbc.…
The denominators are hard to nail down because vaccinations occurred over a 6 month period. But you get the idea.

2/
Caveats that affect direct comparisons:

- Older /high risk people were vaccinated first.

- Unvaccinated include children who cannot get a vaccine but are also less likely to have severe disease.

- Deaths that occurred early on before people had a chance to get vaccinated.
Read 4 tweets
Vincent Rajkumar Profile picture
30 Sep
The 7 most well vaccinated countries (all>75% fully vaccinated) are competing for the lowest death rates from COVID. #VaccinesWork Image
I could only have 6 countries in the graph. Singapore is same as well.
Some of these had recent spike in cases. But it didn't result in the type of loss of lives they had experienced with COVID in prior waves. ImageImage
Read 4 tweets
Vincent Rajkumar Profile picture
29 Sep
How a variant can change everything.

We had 5 months of declining deaths after vaccines. After all, the proportion who were unvaccinated & susceptible existed during these months as well. But delta was just settling in

Once delta established itself, we are at >2000 deaths/day.
Whatever protection we had against original strain of Covid, disappeared with delta. delta was more transmissible. Taking off masks too early didn't help.

Deaths are very high with delta, but we would have faced a much bigger crisis without vaccines.
Based on Israel study on effect of vaccines in reducing deaths and hospitalizations, and knowing what happened in India, we probably saved >100,000 lives in the US because of vaccinations. thelancet.com/journals/lanin…
Read 5 tweets

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