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Vinay Prasad, MD MPH 🎙️📷 Profile picture
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Jan 16,, 11 tweets, 1 min read
Being pro vaccine means optimizing the # of doses (3,2,1), interval & specific product to maximize benefit and min harm

Let's consider some examples and you decide
🧵🧵THREAD
80 yo in nursing home (starting easy)
The best # of mrna is
20 year old healthy college student. Star soccer player. Already had 2 of Pfizer, and just had Omicron how many more shots is best?
60 year old. HTN, DM and overweight. Never had COVID
5 year old with immunocompromised status
Healthy 5 year old just had COVID (omicron)
40 year old. Healthy Fit.
20 year old IT worker healthy
What brand should HE get
16 year old boy, athlete, got first dose. Wants dose 2. How long should he wait for dose 2?
Knowing the precise risks or myocarditis by product and schedule and dose number;

And debating the evidence for boosters in young men is vital to make safer vaccine decisions

= Provax

If you make decisions that could have been better you will lose trust

That's devastating
Disappointing to see many people cannot have this discussion, and as a result needless human suffering happens
Preliminary answers already reveal another reason mandates are not good. Does not allow doctors and patients to work together to figure out the right answers.

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More from @VPrasadMDMPH

Vinay Prasad, MD MPH 🎙️📷 Profile picture
Jan 16,
The two biggest failures in COVID19 policy were
1. Hubris to think humans were all powerful & could entirely change mother nature
2. Not subjecting our interventions to empirical testing, creating bitter tribal disputes, based on no credible data & never learning the answer 🧵🧵
Zero randomized trials on masking in school
Zero randomized trials on masking kids
Zero randomized trials on masking adults in high income nations
Zero randomized trials on masking anyone in cities
Zero randomized trials of school closure
Zero randomized trials business closures
Zero randomized trials of 3 vs 6 ft
Zero randomized trials of cohorting
Zero randomized trials of installing HEPA filters
Zero randomized trials of masking, post vaccine
Zero randomized trials testing alternative dosing strategies of vax (post phase 3)
Read 6 tweets
Vinay Prasad, MD MPH 🎙️📷 Profile picture
Jan 14,
Some think that this Fig. from UK group does not prove myocarditis post vax > myocarditis post infection because only 2.3 mil/3 mil people in the RED bar had infection prior to vax 👇 (ergo the pure myocarditis from infection risk)

here is their error
🧵
vinayprasadmdmph.substack.com/p/uk-now-repor…
For the sake of argument assume the worst case scenario that vax made them completely invulnerable to post infec. myocarditis and all the myocarditis being divided by 3 mil should be divided by 2.3 mil.

That is worst case scenario, and not likely true (almost certainly not)
It would increase the red bar 1.3x, which will still pale in comparison to the Blue bar for Moderna dose 2

Next, consider the biases present in the other direction

The red bar uses documented cases as the denominator NOT SEROPREVALANCE...
Read 8 tweets
Vinay Prasad, MD MPH 🎙️📷 Profile picture
Jan 14,
Joe Rogan is right. At some ages, for Men, for some doses of specific mRNA shots, the risk of vaccine induced myocarditis exceeds the risk of myocarditis from infection. It was proven by the UK group 👇

We have to be honest about this fact to have productive conversations
If people were less dismissive of @joerogan (who is correct on this issue) the USA might actually

1. Suspend Moderna in Men < 40 like lots of European Nations (higher risk)
2. Further space out dose 1 and 2 in young men (as other nations do)

This would immediately lower harm
PS we wrote this in JUNE!
medpagetoday.com/opinion/second…
Read 4 tweets
Vinay Prasad, MD MPH 🎙️📷 Profile picture
Jan 12,
All of health care policy falls like dominos when you accept this FACT about mother nature & omicron

🧵
Wearing an n95 is pointless
You won't do it the rest of your life
Exposure is inevitable
It merely delays the inevitable at personal inconvenience & anchors the mind in fear mode

vinayprasadmdmph.substack.com/p/should-you-w…
Vaccine mandates are now intellectually bankrupt
All the boosters mandates in the world cannot halt spread
A key prerequisite to mandates is gone
They are a personal health choice (which BTW you should opt for, esp. if you are an older adult!)
vinayprasadmdmph.substack.com/p/vaccine-effe…
Read 7 tweets
Vinay Prasad, MD MPH 🎙️📷 Profile picture
Jan 12,
COVID didn't do this; We did 1/4
1. No data supported day care workers wearing cloth masks w infants all day
2. Masking kids 2-4 was contradicted by WHO, but American Peds Assc. did it anyway
3. Keeping kids without playdates had no data
4. We closed playgrounds!
5. risk to kids was always much lower than risks we routinely tolerate
6. School closure did massive harm/ had no upside/ strangely occurred in liberal urban strongholds w strong unions & had nothing to do with virus factors
2/4
7. We rushed into boosting adolescents despite the resignations of top 2 FDA officials & dissent of Offit, man who makes vax
8. we imposed vax mandate for school & activities, under promise it would return life to normal
9. we then escalated demands to make kids wear n95s
3/4
Read 7 tweets
Vinay Prasad, MD MPH 🎙️📷 Profile picture
Jan 11,
👇👇x1000
A couple journals had a couple sessions, and one seminar at Hopkins, but besides that, universities largely abdicated the role as a forum for debate.

Huge disservice to the public.
Jama had a session, before Howard was terminated

BMJ had a few sessions, before. Fiona left.

@sdbaral hosted one session, And there was an early angry one at Stanford.

But besides this, institutions nearly abdicated this responsibility entirely
I suspect they did so for the same reason so many people engage in preference qualification, or are scared to comment on issues. Which is that the culture among elites is so hostile to differences of opinion.

Universities probably worried that they would offend their donors.
Read 5 tweets

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