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Kashif Pirzada, MD Profile picture
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25 Oct, 8 tweets, 5 min read
Today many hospitals in the Toronto area will start to offer the Regeneron Monoclonal cocktail for the treatment of Covid-19. This is a ‘passive vaccination’ - providing artificial antibodies that otherwise develop naturally in vaccinated people.
I went over in some detail how these treatments are created last year. They are produced in a process that shares many steps with production of mRNA vaccines. One of them, @AbCelleraBio's Bamlanivimab, is designed in Canada and marketed by Eli Lilly.
They also represent a crucial part of an ‘immune system for society’ where we can handle new threats and variants that evade our vaccines. These are local companies that are going to help us fight these threats: @IncResilience @AbCelleraBio @PrecisionNano @Novavax @medicagoinc
It's unfortunate it took so long to use these drugs, they have been used for 8 months in the US. Our gatekeepers keep searching for ‘perfect’ evidence of effectiveness, as they did for masks & ventilation upgrades. Perfection can often be the enemy of good
theglobeandmail.com/canada/article…
I’ve been advocating for their use for the better part of the year, and worked with colleagues to build interest in them last summer. Sadly there wasn't much uptake.
Many of the patients that we saw succumb in the third wave in Toronto could have benefited from this treatment, but across the border in the US it was easily available. Thanks to @peesker for covering this story in the CBC:

cbc.ca/news/canada/ha…
Lilly’s enhanced antibody cocktail is still awaiting approval in Canada, but, ironically for a Canadian-made drug, has emergency use authorization in the US but not here.
canada.ca/en/health-cana…
Criteria differ at different hospitals, this is one from a Toronto hospital.
Regardless if you are unvaxxed or vaxxed, if you get sick and are within the treatment window, check with your local hospital if you qualify for 'passive immunization' with monoclonals ASAP

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More from @KashPrime

Kashif Pirzada, MD Profile picture
20 Sep
It's not well known outside of medical circles, but there's been a long-running fight between cautious physicians and a libertarian group who have been advocating allowing the virus to run rampant to produce natural immunity in the population - no matter the cost in lives.
They signed a document called the 'Great Barrington Declaration' (GBD) - much criticized for its 'let nature run its course' or 'let the weak die off' take on pandemic management. @tylercowen writes a strong critique here:
bloomberg.com/opinion/articl…
A few things that astonish me about the GBD:
- It's from Oct/2020 - little was known about long-covid and new strains. How could they be so certain this was the best way forward without data to back it up?
- It's backers constantly declare the pandemic over, and are always wrong.
Read 7 tweets
Kashif Pirzada, MD Profile picture
14 Sep
Really strong case for 3rd doses, especially for those over age 60:
This should be the biggest priority for decision makers in the coming weeks.
I'll go over why in this thread ->
Waning immunity is being observed in multiple studies, in elderly populations, and needs to be addressed. It's too bad our federal authorities are paralyzed by the election, a decision needs to be made soon.
Vaccine equity is an issue, but:
- the world is swiftly catching up
- Median age in Africa is 19.7 years, its 45+ in most Western countries, and death/ICU risk increases exponentially with age
Read 8 tweets
Kashif Pirzada, MD Profile picture
5 Sep
How is it that 18m after the first mRNA vaccine was developed we still don’t have an approved vaccine for kids?
This will be one of the greatest preventable public health failures in history, and it is happening in real time right before our eyes
What can we do? Some ideas: Image
The stakes are massive; cases in children in the US are rising exponentially. Given how infectious Delta is, and the lack of mitigations in most schools, we can expect many, perhaps most, children to be infected in the next few months. aap.org/en/pages/2019-… Image
And it must be emphasized, as seen above, children can get seriously ill from this virus; 1/100 will need hospital admission, 1/10000 will die. 24 died in the US last week out of 200k new infections
1/50 will get Long Covid:
covid.joinzoe.com/post/long-covi…
Read 21 tweets
Kashif Pirzada, MD Profile picture
18 Aug
Listening to this phenomenal seminar by @kprather88 and others on what's at stake on the return of kids back to school this month.

@denise_dewald explains that the ICU system for kids if fragile and not designed for big shocks

Letting children get infected (and 1% of them will need hospitalization) will overwhelm this system quickly, and opens the prospect of triaging which child gets life-saving care.
@kprather88 explains that aerosol spread is the primary mode of spread of SARS2, and can float and linger in a room. Indoor spaces need to be filtered, masks need to be worn.
Read 16 tweets
Kashif Pirzada, MD Profile picture
18 Aug
Going through US data on children and Covid from @AmerAcadPeds is pretty alarming reading. Cases and hospitalizations are accelerating quickly.
aap.org/en/pages/2019-…
It looks like a pediatric hospitalization rate of 0.9% is consistent across 23 US states (Texas, Florida, Arkansas and many others are refusing to report this data)
If you extrapolate roughly from the rate of new pediatric cases every week, which is at 120K children last week (and accelerating), that's >1000 kids needing admission this week alone.
Read 5 tweets
Kashif Pirzada, MD Profile picture
17 Aug
Happy to see that teachers will be required to vaccinate (or get rapid tests). Ontario's plan is probably the best in the country now, but there's still some big gaps:
- Require masks from JK up
- Eliminate unmasked indoor activities
- Come up with a safe plan for lunch-time
Some great ideas on making lunch-time safer, especially when the weather gets colder:
Overall our children need a circle of protection around them. Vaccinated parents, teachers, rapid tests, ventilation upgrades. We have the resources and time to get this right.
Read 7 tweets

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