Hantavirus: A Primer
Thread.

1/Hantavirus is a zoonotic infection, Transmitted to humans from infected rodents - via aerosolization from their droppings/other secretions/excretions 2/Causes two syndromes - Hemorrhagic fever with kidney injury (Hemorrhagic fever with renal syndrome HFRS) or a respiratory illness - hantavirus pulmonary syndrome (HPS)

3/Incubation period usually around 3 weeks

1/ How does monkeypox spread? #MedTwitter
Through close, personal, contact:
•Direct contact with monkeypox rash, scabs, or body fluids
•Touching objects, fabrics (clothing, bedding, towels) used by someone with monkeypox.
•Contact with respiratory secretions 2/ PPE to prevent monkeypox transmission
Healthcare workers: gloves, gowns, mask and eye protection.
N95/respirators for activity that involves aerosol generation

Patients: Keep lesions covered and wear a mask when around others

What is monkey pox? A 🧵

Monkey pox is a zoonosis (infection from animals) caused by a virus closely related to the smallpox virus

First cases in macaques in 1958

First human case reported in 1970 from DRC

Prior cases may have been mistaken for smallpox 2/
- Transmission from animals to humans through scratches or bites from infected animals (rodents/nonhuman primates) or eating bush meat

- Human to human transmission usually limited to close family contacts or HCWs. Contact/droplets main modes of transmission

So you’ve tested positive for COVID-19. What do you do now?

With case rates soaring, and more contagious variants circulating in the US - it is likely that many of us will be facing this question

Thread
1/ 2/ Assess whether you have risk factors for progression
⁃Age >65
⁃Immunosuppression
⁃Obesity
⁃Chronic kidney, lung, liver or heart disease
⁃Pregnancy
⁃Unvaccinated

cdc.gov/coronavirus/20…

COVID cases in India rising rapidly, heralding a probable third wave. While India needs to prepare for the worst, there are hopeful signs that this wave will not be associated with the high death rate of the delta wave

Why?
1/ Two main reasons

- Larger proportion of the population immune through vaccination or past infection

- Omicron does not cause the severe lung inflammation and oxygen need seen with delta

2/

What we know and don't know about #Omicron (B 1.1.529)

1/ Reported in S. Africa Nov 24 from a sample from Nov 9. So it has been around for at least 3 weeks, possibly longer.

2/ Classified as Variant of Concern (VOC) on Nov 26

3/ Several mutations on the spike protein 4/ As of Nov 27, found in many other countries including Belgium, Botswana, Germany, Hong Kong, Israel, Italy, UK.

Seems widespread already.

Vaccine Efficacy updated FAQ:

1) Do vaccines prevent infection? Including delta.

Yes. Unvaccinated 5 times more likely to be infected in LA county study. cdc.gov/mmwr/volumes/7… 2) Do vaccines work as well against delta variant as we hoped?

No. Based on UK studies efficacy is lower against symptomatic infection (see table) but still extremely high against severe disease (>90%).

Officials said that "it's clear" that protection from mRNA COVID vaccines decreases over time, and that the US will recommend boosters for all, 8 months after primary vaccination
Let’s look at the evidence for boosters for ALL

Thread
1/ 2/ In a NY Health Dept study of 10 million NY residents VE against hospitalization remained >90% in May to July 21 when delta comprised 80% of infections cdc.gov/mmwr/volumes/7…

Just out: Study of 10,567 health care workers in India @OffCMCVellore

2 doses of COVISHIELD (Astra Zeneca) was 94% protective against need for ICU care. 77% protection from hospitalization.

#VaccinesWork #GetVaccinated @GKangInd @DrEricDing @MayoProceedings 2/ This study was done between Feb - May 2021. No deaths were seen in 8958 vaccinated healthcare workers. One death in 1609 unvaccinated healthcare workers.

1/ 🧵on Mucormycosis (Black fungus)

COVID associated Mucor is increasingly being reported in India.

Spores of fungi are common in the environment. Infection occurs when circumstances are right.
Immunosuppression and uncontrolled diabetes are main culprits 2/ Spores of mucor are breathed in and cause infection

Risk factors

- Prolonged/high dose steroids suppress the immune system and elevate blood sugars, which further increase risk

- uncontrolled diabetes

- Widespread antibiotics may contribute via overgrowth of fungi

Vaccine hesitancy: My responses to the main concerns.

1) Vaccines were developed too fast.

Although developed at warp speed, none of the essential steps were skipped. The huge number of cases made accrual to trials much faster 2. Vaccines are not effective

In large trials, vaccines were 80-95% effective at preventing infection. They are even more effective at preventing hospitalization and death
Yes. They are not perfect, but are highly effective. Real world data confirms data from clinical trials.

Tips for managing COVID at home. Infographics in English & multiple Indian languages with more coming ⁦@VincentRK⁩ ⁦@nramind⁩ ⁦@ShirleySetia⁩ ⁦⁦@iamsrk⁩ ⁦@VijaySethuOffl⁩ #covidindia. Please retweet and amplify indiacovidsos.org/home-care How to manage COVID at home. English version.

I am getting calls from friends/ family in India about COVID. From neurosurgeons to urologists, doctors are being roped in to handle the crisis.

1/ Having managed pts with COVID for the last year & having the luxury of time, here are my thoughts for those new to this battle. 2/ Diagnosed COVID? What next ?

Check oxygen sats.
If sats > 90%, reassure
-Paracetamol as needed for fever
-Inhaled steroids (budesonide)
-Continue to follow sats
-No need for hospitalization
-No need for chest CT

Astra Zeneca vaccine has been paused in many European countries due to concerns about blood clots. What do we know. What does this mean?

1/ 17 million doses in UK and EU - To date 15 cases of deep vein thrombosis & 22 cases of pulmonary embolism. Rate is not higher than expected 2/However cases of blood clots veins in the brain, called central venous sinus thrombosis have been reported. These are very rare occurrences and this is concerning

COVID outcomes at Mayo Clinic.

1/ Outcomes in 7217 adults and 674 children published in @MayoProceedings

2/ In adults:
897 of 7217 (12%) needed hospitalization

354 of 7217 (5%) needed ICU

94 of 7217 (1.3%) died

@MayoClinic @MayoClinicINFD mayoclinicproceedings.org/article/S0025-… 3/ Risk of hospitalization by age:

<18: 2%
18-34: 3.5%
35-49: 10%
50-64: 18%
65-74: 30%
>=75: 46%

50 million people in the US have received a COVID vaccine.
What changes after vaccination? 

FAQ Thread
1. Do vaccinated people still need to wear masks around others?

Yes. For the time being, until enough people in the population are vaccinated. There is concern that vaccinated people can still get asymptomatic COVID and then transmit it to others. Until a large proportion of the population is vaccinated please wear a mask to protect others.

FAQs on Pfizer COVID vaccine.
Thread

1.Which COVID vaccine should I get? Is one better than others?

You should get the vaccine you are offered. Getting a large number of people vaccinated is more important than differences in vaccine efficacy 2.Who cannot get the Pfizer COVID Vaccine?

Under the current EUA - those younger than 16 years cannot get the vaccine.

Pfizer-BioNTech COVID-19 VACCINE UPDATE

Thread
Pfizer-BioNTech and Moderna, have applied for @US_FDA Emergency Use Authorization for their mRNA based vaccines.

Here is what we know about the Pfizer vaccine and what it means. @MayoClinic @MayoClinicINFD

1/ The Pfizer vaccine has received Emergency Use Authorization in the UK and Canada and the vaccination campaign in the UK has commenced. An FDA expert panel has recommended approval of the Pfizer vaccine.

2/

COVID vaccines. A primer.

1/
Vaccines may be the solution to ending the COVID-19 pandemic. Vaccines typically take several years to develop. But COVID vaccines are being developed at warp speed. More than 200 vaccines are in development. 2/

COVID vaccines in development are using different approaches

What are the stages of development of a vaccine?

Preclinical stage: Lab and animal studies to evaluate whether the candidate vaccine can trigger immune response

1/ Fascinating insights from Iquitos, Loreto Region, Peru. #COVID19 #COVID

1) They have achieved the 70% seroprevalence threshold for herd immunity.

Cases have dropped now in the region, as expected.

@VincentRK @paimadhu 2/ Population of Iquitos is 470,000.
71% seroprevalence, the highest reported so far i~ 333000 cases

But confirmed cases are only 14711 (4.4%)

This means even assuming major undercounting, a lot of COVID, probably 80%, as expected is asymptomatic. @DrSidMukherjee

Cross reactive immunity to COVID?

Several studies now suggest that T cells reactive to COVID may be present even in persons without prior exposure to SARS CoV-2 suggesting presence of cross reactive immunity presumably from prior corona virus infections.

Thread with links
1/ La Jolla: 40-60% samples from persons with no prior exposure to COVID had T cell responses. @CellPressNews
cell.com/cell/fulltext/…

2/