Should Covid vaccines have been 3 doses from the start? Perhaps. But remember it was a miracle we got highly effective vaccines developed, tested, approved & administered within a year of the pandemic.

Science is not magic. We did better than anyone hoped for. I'm thankful.
Science is continuous learning. Science means we are guided by the best research data we have in the moment. Not what we may have in the future.

If we learn something new, or if the virus changes, we adapt.

We now know a booster is better. So we recommend one. Simple as that
So yes, next year we may recommend another booster or a modified variant specific vaccine. We don't know. It depends on what the research shows. Depends on what the risks look like at the time.

That's the way medicine works.
Data supporting a booster dose is in this thread.

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More from @VincentRK

9 Dec
Reminder: You cannot compare seriousness of Omicron with delta or wild strain by comparing crude rates of hospitalization or deaths

Omicron faces a different, more immune population: half the world is vaccinated and/or had Covid. Millions of vulnerable have died due to COVID.
1/
Vaccination rates are very high in age >65 population. So the most susceptible now are younger & more fit. So Omicron even if intrinsically more serious will appear milder.

Even age adjusted comparisons won't account for pre-existing immunity from prior Covid or vaccination.
2/
Even if omicron causes less serious disease, the high transmissibility is itself a concern because:

a) more rapid spread will cause more people to be affected in a short period of time: A smaller % of a larger number getting very ill will take up hospital & ICU beds
3/
Read 7 tweets
2 Dec
Thread on financial conflict of interest.

1/My 2018 Dollars for Docs: $0

This was enormously difficult & is not sustainable. Coz if you lead trials some small amount gets invariably reported.

$0 is possible only for people who don't lead therapeutic trials. #MedTwitter
2/ I had to go through all kinds of contortions to get to $0, including taking my name off many papers even though I was an investigator. Ride separately from other investigators to meetings. Avoid drinking even bottled water in long meetings to get zero dollars reported.
3/So we have a problem. If you want experts with zero $ conflicts you will end up with people who don't lead clinical trials.

The $ amounts reported do not mean that investigators are enriching themselves: it can be meetings, being authors on papers. Actual cost to do the trial
Read 19 tweets
1 Dec
FDA advisory panel votes in favor of EUA for molnupiravir for treatment of COVID. @Merck

Molnupiravir is a pill taken twice a day for 5 days starting within 5 days from onset of symptoms. @Merck
The main issue with this drug is that in the interim analysis there was a 50% reduction in risk of hospitalization and death. In full analysis the benefit narrowed to 30%.

Is a 30% decrease in risk of severe Covid good enough? Yes in my opinion.
Read 4 tweets
30 Nov
People are counting waves differently. Some say we are in our 5th wave.

We are a big country so as a wave spreads it looks like 2 waves, but it's one wave sequentially in 2 places.

Initial 2 peaks is first wave Apr-Sep 20.
2nd wave Nov 20-May 21.
3rd wave is the current one. Image
Easier to appreciate when you look at deaths because with cases, numbers over time have been affected by test availability.

So looking at deaths, the first two peaks are one wave, affecting separate parts of the country as COVID spread initially. We are now in end of 3rd wave. Image
When you look at individual states easier to appreciate 3 waves. New York and Texas below. ImageImage
Read 4 tweets
30 Nov
Here are my Top 5 #ASH21 @ASH_hematology myeloma abstracts. #ASH21VR
Links to the full abstract. As in the past, I left out studies where similar results were already presented or published before. Top 5 based on new data, clinical impact & methodology

Thread with countdown👇
#5 Outcome of patients with refractory myeloma treated with bispecific antibodies.
64 patients. Median 7 prior regimens. 58% response rate. Importantly median survival 18 months — brings hope. @tarekmd91 @JoshuaRichterMD @MountSinaiNYC #ASH21 #ASH21VR ash.confex.com/ash/2021/webpr…
#4 Prevalence of smoldering myeloma (SMM) in the general population.
75,000 person RCT iStopMM estimates prevalence at 0.5% of population age >=40 #ASH21 #ASH21VR @SigrunThorstei1 @sykristinsson @DrOlaLandgren @TBSsteharding @BrianDurieMD @MalinHultcrantz ash.confex.com/ash/2021/webpr… Image
Read 7 tweets
28 Nov
I was just thinking of flying to see family. #OmicronVariant threatens plans because we have no idea what countries and airlines will do at the last minute.

The last thing you want is to be stuck for days in a quarantine hotel.
Like what happened to passengers on these two flights.
Airline websites give a lot of unhelpful disclaimers: "We have no idea what the rules may be. Requirements may change at last minute." Right.

Can we not have a worldwide consensus policy requirements for air travel that will be enough for Covid and any new variant?
Read 4 tweets

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