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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🚩Hence, if there are typical COVID-19 symptoms, we recommend prompt testing and seeking medical attention.
Note: Anyone over 40 is MUCH MORE likely to develop complications from this biphasic illness.
Many of these can be prevented by cheap and effective treatment.
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Caveat: as we wrote earlier, dexamethasone can WORSEN outcomes if used too early, or in the wrong patient.
It has to be clinical decision based on the individual patient’s presentation.
Early diagnosis is the most critical part of this decision. Hence the advisory.
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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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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👇
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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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