Menaka Pai, MSc MD FRCPC Profile picture
Chief of Lab Med @HamHealthSci & @STJOESHAMILTON. Medical Director HRLMP. Assoc Prof Hematology & Thrombo @McMasterU 🧠 Quality, guidelines, equity ❤️ Wife, mom
Mar 27 25 tweets 9 min read
A thread about about paxlovid - the “early treatment” pill for COVID-19 that’s been all over the news. Who is eligible? Who decided who is eligible?. Why aren’t more people eligible? (Are YOU eligible?) 🧵1/n This thread is inspired by one from my friend & colleague Dr @kgrindrod, whose expertise in pharmacy and knowledge translation (getting science out to people who need to know about it) is superb. Read the whole thing! (Then come back 😉) 2/n
Mar 9 14 tweets 3 min read
Hastily dropping masks in schools - an easy thing that helps protect staff and kids (inc JKs who can’t get vaxxed, and many eligible kids who aren’t vaxxed) - seems like such a callous, thoughtless “end” to the pandemic. Here’s what my 6 year old said when we discussed it: 1/n🧵 This morning at breakfast, while my husband wrangled the preschooler, I told my 6 year old that on Mar 21, there likely would NOT be a mask rule in his school. I asked him how he felt about it, and what he wanted to do. Because now he had a choice. 2/n
Jan 18 27 tweets 7 min read
News today of shortages of life-saving Covid drugs & HC approval of paxlovid (which will initially be in v short supply too). As a methodologist & a clinician, I wonder… how do you follow evidence-based guidance on drugs when you don’t have any drugs? 🧵 thestar.com/news/gta/2022/… As Co-Chairs of @COVIDSciOntario’s clinical practice guideline working group, @ASPphysician and I have been thinking a lot about this. Here are our practical suggestions on how to treat COVID-19 patients during periods of drug shortage. 2/n
Aug 22, 2021 10 tweets 3 min read
Going to take a Twitter break for the next 6 weeks, to conserve energy for myself and the people I love! Most of my life happens OFF SoMe, and that’s where I’d like to focus my attention right now. Here’s some parting thoughts: 🧵 1. Please mask up and get your vaccine. We are in wave 4. After a week on call, I don’t even need modeling to tell you - the unvaccinated are getting sick, intubated, dying. COVID is unrelenting and cruel.
Aug 21, 2021 5 tweets 2 min read
Ontario’s COVID-19 Science Advisory Table ⁦@COVIDSciOntario⁩ has just released important new analysis, showing changes in COVID-19 cases, hospital and ICU occupancy, deaths… 🧵 covid19-sciencetable.ca/ontario-dashbo… The modelling group has added many new indicators and graphs, and all are pointing towards a difficult fall. After 5 straight days on call in hospital (2 more to go!), I can confirm: we are seeing these worrisome changes on the frontlines…
Jul 14, 2021 13 tweets 3 min read
I’ve been following the conversation around #OntEd’s destreamed math curriculum. Today I read this thoughtful thread from @realJ_Mitchell. Please take a look, then come on back for my take as a mom, an Ontario voter, and a university educator. My students are well past school-age, but my kids aren’t. And my work exposes me to the direct impacts of structural racism, sexism, and colonialism on adults. Here’s what I’ve learned in my career, and how I think it intersects with the issue Jamie discusses:
Jul 12, 2021 4 tweets 2 min read
This headline is misleading. @doctorsoumya from @WHO warned against individuals "vaccine shopping" outside of public health regulations (and in some cases, getting 3rd 4th doses on their own). She did NOT say that individual countries' vaccine policies were "dangerous." 1/3 By cutting and pasting quotes & providing zero background, these click-bait headlines cause tremendous harm. There's a huge amount of solid vaccine science & global experience that support mixing vaccines. Please don't give in to the click bait. Get fully vaccinated. 2/3
Jun 17, 2021 7 tweets 2 min read
#NACI (Canada's advisory board of vaccine scientists) has summarized the latest science: they recommend mRNA over AstraZeneca as the 2nd dose of #COVID19 vaccine. Here's why... 1/n canada.ca/en/public-heal… 1) It seems to be more EFFECTIVE. AZ-mRNA and mRNA-mRNA appear to give a more effective immune response against variants of concern (and the delta variant is spreading in Canada), based on small studies + big real world experience. 2/n
Jun 14, 2021 7 tweets 2 min read
The vaccine rollout is spreading - and so is the delta variant. Lots of folks are concerned about the risk of myocarditis in young people who receive mRNA. My advice: make sure your sources include true experts - in this case, doctors who look after heart disease in kids. 1/n My experience with #VITT left me shaken, as misinformation about blood #clots was amplified (often by other MDs). Science & medicine are a big tent. BUT within those tents are people with specialized training and experience - and their words should carry weight! 2/n
Jun 11, 2021 11 tweets 7 min read
A word on #AstraZeneca (making the decision about your 2nd shot, and when the 🤬 you can get your 2nd shot)... 1/x The frustration of Ontarians who got AZ for dose #1, and now feel hung out to dry since their 2nd dose hasn't been accelerated, is palpable. Think the insistence on a 12 week gap isn't science based? You're right. It sucks, and it's scary (esp if you're in a hotspot!) 2/x
May 22, 2021 12 tweets 3 min read
Lots of AZ questions swirling. I can’t answer them all (1. Don’t actually have all the answers; 2. Need a Twitter break for my 🧠 health!) But @JHMustapha’s tweet resonated: yes, info on AZ and VITT changing DAILY. If this makes you anxious, you may elect not take AZ again. 1/n To give informed consent to AZ you must appreciate seriousness of these clots (they’re serious), risk of waiting for a different vaccine (moot, as mRNA supply ⬆️), and risk of getting VITT w 2nd dose. UK data is evolving so risk of 1:1mill has ⬇️ to 1:600thou and may ⬇️ more. 2/n
May 10, 2021 10 tweets 4 min read
Okay one more thread before bed! Lots of Qs asking "what IS VITT?" Before I get to that, if you'd like an AWESOME metaphor about vaccine choice, please read my buddy @DrKateJMiller's, then read on for some FACTS about VITT clots caused by AZ and J&J... @COVIDSciOntario has published an evidence based brief on VITT (which includes a lay summary). All science, no spin. (Seriously, no spin.) @heysciencesam has helped us break the VITT facts down into tasty evidence bites. covid19-sciencetable.ca/sciencebrief/v…
May 10, 2021 10 tweets 4 min read
LONG week on call @HamHealthSci. Lots of calls about #VITT post AZ vaccine. I'm transparent w my patients - I believe empowerment leads to earlier detection, better outcomes, less stress. So I'm grateful to @heysciencesam for creating tools to help me be transparent with YOU! 🧵 If you've had AZ 4-28 days ago, be on the lookout for the following symptoms. If you have them, seek medical attention! (Sam, thx for making the doctor in this graphic look JUST LIKE ME 😜 #GenXZeneca #WomenInMedicine)
May 7, 2021 6 tweets 4 min read
⭐️ @COVIDSciOntario’s UPDATED guide to Vaccine-Induced Immune Thrombotic Thrombocytopenia #VITT Following Adenovirus Vector COVID-19 Vaccination! covid19-sciencetable.ca/sciencebrief/v… Image If you’re NOT a healthcare professional, we have a lay summary for you here: covid19-sciencetable.ca/sciencebrief/v…
May 3, 2021 22 tweets 5 min read
There have been a lot of… thoughts about NACI’s statement on “preferred vaccines” today. Many feel angry/bewildered/tricked/confused/all of the above. I get it. I still stand by this thread. As my friend @ASPphysician has said, not much has changed. Let me elaborate... 1/n FIRST, I must emphasize the clotting issue. Clots associated with the adenovirus vector COVID-19 vaccines (“VITT”) are SERIOUS. If you have weird symptoms that start 4-28 days post shot, seek medical care. A doc can order a complete blood count to see if you could have VITT. 2/n
Apr 23, 2021 23 tweets 5 min read
So you read today’s NACI advice - AZ ok if you’re 30+! Unless you can wait for mRNA 💉! And then you read the MANY hot takes from experts, non-experts, and para-experts. And you are SCARED. Let’s work through it. (The required reading is below). 1/n ema.europa.eu/en/documents/c… Disclaimer: I’m a blood clot doctor. I am not a public health expert. Or an ID doc. But you wouldn’t believe how much I talk to people about weighing their risk of clots. (So much.) I can help you make good choices for you (and be less petrified if you just got AZ yesterday.) 2/n
Apr 17, 2021 14 tweets 4 min read
I’ve spent my whole life being a rules follower. Imagine my surprise when one of my tweets from earlier today turned out, at 5 pm, to be a call for civil disobedience in Ontario, where unsafe nonessential work is okay but safer outdoor socializing isn’t. 1/n As a WOC, my advocacy has had to be subtle, and my voice has had to be quiet. Burning it all down, leaving the table, throwing a tantrum and getting my way… these are privileges I actually don’t have if I want to have any impact. 2/n
Apr 16, 2021 7 tweets 3 min read
Hey Ontario. Our healthcare system (and all the good things that flow from it, including the economy) is about to collapse. It's about powerful people not making hard choices that ultimately benefit everyone they are supposed to serve. What can YOU do? Empower YOURSELF. Read on: 1. Don’t spend time with people indoors if they're not in your household. If you have the privilege to follow this rule, follow it! Cosy up with your hunny bunny. Cuddle your kids. Facetime with all the people you love who are ?NOT in your household.
Apr 7, 2021 6 tweets 2 min read
The UK vaccine advisory group, the JCVI, recommends that people aged 18 to 29 be offered an alternative vaccine where available. This graphic (UK risks) illustrates why. Note the importance of balancing harms. What about if your exposure risk isn't low, but MEDIUM? Frontline workers, HCWs... The harms are static, but now COVID causes more harms. Vaccine benefit becomes more pronounced.
Apr 7, 2021 4 tweets 2 min read
62 cerebral sinus (brain) clots, 24 splanchnic (abdominal) clots out of ~25 million AZ vaccine recipients. Serious clots, but rare. Europe's @EMA_News says benefits of AZ vaccines outweigh risks - pertinent for 🇨🇦 as we struggle with wave 3. Waiting for @MHRAgovuk to weigh in now Above cases came from EU and UK reporting in March. However as of April 4th there were reports of 169 CSVT, 53 splanchnic clots out of 34 million AZ vaccine. @EMA_News states these updated numbers did not change their appraisal of risk:benefit.
Mar 26, 2021 11 tweets 6 min read
🚨🚨🚨 @COVIDSciOntario Science Brief and layperson’s guide for vaccine-induced prothrombotic immune thrombocytopenia (aka. VIPIT) following AstraZeneca #COVID19 #vaccination. Read the 🧵! 1/n AZ #COVID19 #vaccine appears to be associated with immune thrombosis that mimics heparin induced thrombocytopenia. It’s rare: 1/125K to 1/1 mill @EMA_News @uni_greifswald @PEI_Germany 2/n