Myocarditis can occur with other symptoms like palpitations, shortness of breath or may not cause overt symptoms.
Myocarditis might only cause ECG or ECHO cardiogram abnormalities or isolated elevation in cardiac enzymes like Troponin.
This means we could be missing cases.
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Thus, it is possible that isolated myocarditis - that is without accompanying pericarditis - might not always be detected.
Note: pericarditis is inflammation of the membrane covering the heart, which is a painful condition. Hence it is more likely to get attention.
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Without doing “routine” cardiac tests on all people the true number of cardiac side-effects cannot be determined. It is perhaps not feasible to check cardiac tests in a million people.
Why not? Because these events occur in about 130 per million young males (published rate).
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This means that the reported cases of myocarditis is by default an underestimation.
It is only based on those who develop and report chest pain.
The true number is unknown.
We also know that the higher the dose of vaccine used, the greater the incidence of myocarditis.
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For instance, Moderna (100 mcg) has higher incidence than Pfizer (30 mcg).
This suggests that the condition might be dose-related.
Early reports on myocarditis after boosters indicate that the risk is lower by about 2-fold in the young male subgroup.
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1. The original efficacy study on Covaxin was a randomised controlled trial involving over 25,798 people.
This showed 77.8% efficacy against symptomatic disease, 93.4% against severe disease, 63.6% for asymptomatic and 65.2% at delta variant. Had tweeted in detail earlier.
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A randomised study starts with 2 groups of people. One gets vaccine, the other gets placebo. They are observed “prospectively” that is looking forward-during a study period. Disease outcomes are measured & compared between the groups. The % difference is reported as efficacy.
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From our weekly COVID-19 meetings that had been going on ever since the pandemic started, we issued several advisories to policy makers, media, doctors and the general public.
From this week:
🚩Ignoring early symptoms (e.g. fever) can lead to severe outcomes.
Thread 👇
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COVID-19 has established treatments available such as
1. dexamethasone (saved more lives than all other drugs in COVID-19; but ONLY when used in the right patient, at the right time, in the right dose)
and
2. monoclonal antibodies (only for select indications)
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If the diagnosis is delayed, these medications cannot be given, we call it “the window of therapeutic opportunity”
Which means the drugs don’t produce the desired effect once that window has passed
Which means our delay is allowing preventable complications to set in
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The presence of long lived memory B cells had previously been established in several papers, see my tweets. This paper focuses on memory T cells in response to 2 doses of mRNA vaccine.
I will discuss some basic immunology first, to help understand the context of this paper.
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Following the innate response, the adaptive immulogical response to a virus infection is basically two pronged.
The two arms are T cells and B cells.
B cells make antibodies which work like security guards OUTSIDE our gate, preventing the thief from entering the premises.
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The most powerful graph that I have seen of the pandemic.
This calls for a rethink of vaccination strategy.
Note the sharp demarcation around age 40-45.
Vaccination of this 40+ segment needs priority.
Below that age, it could even be made optional. Here’s why👇
(Thread)
Although vaccines were launched with a hope of stopping transmission and further waves, we have seen that high % vaccination coverage does not stop subsequent waves. This is because they are ineffective in providing mucosal immunity; virus is silently spreading in communities.
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At the same time, we have found that vaccines are not 100% benign products as is often suggested by certain academics.
They have failed to acknowledge the small but significant number of serious and fatal outcomes is that occurred - particularly among younger individuals.
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