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Vincent Rajkumar Profile picture
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14 Dec, 5 tweets, 2 min read
We are back up to nearly 120,000 cases a day in the US.

A small % getting seriously ill out of a large number is a large number. #Omicron Image
Healthcare workers are tired and weary. Another big wave when we have the tools to prevent and to mitigate will be sad.

Get vaccinated if you haven't.
Get your booster if you haven't
Wear masks
Continue other precautions.
You can see what Omicron can do here.
And here.
Important to note that we cannot conclude omicron is mild easily. The rates of hospitalizations will appear lower especially because the population is more immune. But there still many who are fully susceptible

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Vincent Rajkumar Profile picture
15 Dec
In the global race to vaccinate against COVID, the US is lagging behind most developed countries. ig.ft.com/coronavirus-va…
In fact, countries which have lower vaccination rates than us are mainly those with inadequate access to vaccines.

Overall we are at #93 of about ~225 countries in %fully vaccinated. Excluding small countries with less than 200,000 population, we are at still >#60 in the race.
This is not due to limited vaccinate availability but vaccine hesitancy.

Vaccine hesitancy is not due to a uniform cause. There are many reasons. But mostly it is due to misinformation about Covid and Covid vaccines spread on media and social media.
Read 5 tweets
Vincent Rajkumar Profile picture
14 Dec
Clinical trials:

See one
Do one
Teach one

Without leading a trial it's hard for you to realize how hard it is to do one and you may end up throwing stones at investigators trying to do their best. #ASH21
See this thread on how many people control the design of a trial. Most of this thread applies also to investigator initiated non randomized trials also. #ASH21
When you have this brilliant idea on how a trial should have been designed, in many cases the PI is also brilliant enough to know the same but they often had to make the hard choice of putting their foot down and not have a trial at all or compromise.
#ASH21
Read 8 tweets
Vincent Rajkumar Profile picture
13 Dec
Besides my Top 5 picks in myeloma at #ASH21 listed below the 3 most important findings being presented in myeloma this year are:

1) A variety of bispecifics showing high single agent activity
2) CAR-T efficacy
3) PFS improvement with Dara-VRd in GRIFFIN

#ASH21VR
Bispecifics and CART single agent activity is more than double of the single agent activity seen with existing drugs. Slide from @TomBmt133 #ASH21
Cilta-cel efficacy presented by @TomBmt133 is also outstanding and well summarized in this tweet by @ninashah33 #ASH21
Read 5 tweets
Vincent Rajkumar Profile picture
13 Dec
The same insulin that was sold for $21 in 1996 sells for $275 in 2021.

We must provide relief to patients whose lives depend on insulin, and fix the broken system. @MayoProceedings mayoclinicproceedings.org/article/S0025-…
Only in a broken system can you increase prices like this. Every time your competitor increases price you do on the same day. Because you can. Because there is no completion. Because there is no law that prevents hikes like this on the exact same product.
The price hikes succeed because there is a vulnerable population that needs the drug to stay alive and so has to spend whatever it takes. It is government that needs to step in and protect them. @t1international #Insulin4all
Read 6 tweets
Vincent Rajkumar Profile picture
12 Dec
Recs for using free light chains (FLC) in practice. #ASH21

1) We get a lot of consults for abnormal FLC ratios /levels. If FLCs are the only abnormality, you don't need to do much unless involved/uninvolved ratio is >8.

Don't chase minor abnormalities.

ashpublications.org/blood/article/…
2/ If there is clinical concern for light chain process like amyloid or if there is intact immunoglobulin M spike, u can do more. But uncomplicated FLC ratio <8 is almost never going to be high risk SMM. #ASH21

Light chain MGUS with FLC ratio <8 is managed like low risk MGUS.
3/ When we first established the normal FLC range it was a new test and the consequences of abnormal value was not known. A very strict cut off was used. We know now that the normal ratio is affected by age and creatinine. @sykristinsson #ASH21 ash.confex.com/ash/2021/webpr…
Read 5 tweets
Vincent Rajkumar Profile picture
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

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