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Anupam Singh Profile picture
Anupam Singh
@anupampom
Doctor,MD,Internal Medicine . Interests: Clinical research,Hobbyist coder, Public Health, Data science-R,Python,Bayesian inference,old Hindi songs.
Jun 13, 2021 • 16 tweets • 4 min read
My (?hot ) take on Vaccine Choice currently as of now -
1. If you don't get a Choice ,take first one available.
2. People With Comorbidities , elderly >50, continuous high risk exposure -> Get Covishield.
3. People <50 (especially females) with no comorbidities> Get Covaxin. 4. If People in category 2 have got Covaxin -> can get Antibody Checked (this is not recommended as of now by guidelines though.) Just to be sure that they have decent titres. Might need boosters later (if poor seroconversion).
Jun 12, 2021 • 6 tweets • 2 min read
Our 2 Vaccines , Covishield and Covaxin were granted Authorisation based on Bridging trial (comparing immunogenicity to AZ Vaccine) and Phase 3 trial results. Yet Despite 6 months after Bridging Trial and 3 months after Covaxin interim analysis. Companies refuse to publish . Only press release for Covaxin and not even press release for Covishield.
Jan 27, 2021 • 13 tweets • 4 min read
Currently Vaccination are being done at ~ 3 Lakh per day. Ratio is 9:1 for Covishield : Covaxin. Hence Covaxin is indeed being used as a "back up" in a way
Why? Because Covaxin can be used only at bigger centres ,which r equipped to give Covaxin in Clinical Trial Mode(monitor) So, If you work at a smaller centre/Hospital . Most likely you will be receiving Covishield.
Also important to remember given the news of side effects reported ,most of these are post Covishield Vaccination (given 10:1 ratio in favour of Covishield) .
Jan 4, 2021 • 16 tweets • 3 min read
Common FAQs about COVAXIN approval.

Q. Emergency Authorisation Based on Phase 2 Data of a traditional Platform in a Pandemic is OK and global Standard -Krishna Ella ,Bharat Biotech A. Yes, emergency approvals given for Drugs (Hydroxychloroquine, Plasma, Tocilizumab in US) , Favipiravir/Itolizumab in India (controversial) but we had no potent oral Antiviral (still don't have ) and it was early pandemic and Drugs are given to diseased people.
Jan 3, 2021 • 10 tweets • 2 min read
Personal thoughts on how to choose Vaccine as of date in India given tremendous uncertainty about approval/availability of Vaccines. If you can get it "somehow" .Get a Pfizer/Moderna Vaccine . Previously it appeared that Pfizer Vaccine would come in Private Market and will be administered in Metros.
Jan 2, 2021 • 4 tweets • 2 min read
Disappointed by Approval for COVAXIN.They were running a good large phase 3 trial,already half enrolled.1st Interim analysis was planned at 43 events. With some luck n recruitment in high Infection rate centres, possible within a month.So what was the rush? Given Oxford Vaccine already approved. It had given us time to run a credible trial and ensure trust. Now with haste , credibility damaged like Vaccines from China n Russia which were given faster approval.
Oct 18, 2020 • 4 tweets • 1 min read
The current Standard of Care in COVID is to let people Suffer with Fever,Cough with Supportive Care(paracetamol,cough syrups) till it become Severe enough that Oxygen levels fall and Patient has to be admitted or they spontaneously recover (at which stage steroids can be given) This is not how we practice Medicine.
To let Lung Injury go on unabated will have consequences.
Early treatment is also prevention from Deterioration or long term COVID Symptoms after Recovery.
Unfortunately HCQS has largely failed in early treatment/post exposure trials
Oct 18, 2020 • 18 tweets • 4 min read
A thread on Remdesivir and its role post SOLIDARITY trial. There have been 4 trials of Remdesivir so far.(Two predominantly in US/Two outside)
First was Wuhan trial(published Mid April) which was cut short due to lack of cases ,which showed no mortality benefit with Remdesivir and a trend towards faster recovery.
thelancet.com/journals/lance…
Jul 22, 2020 • 25 tweets • 6 min read
A recent serosurvey by NCDC at start of July of Delhi suggests ,that 23.48% of Delhi population had IgG antibodies against SARS-COV2 .(implying thia many were exposed till 2 weeks back mid of
June)
Commercial lab Antibody tests suggest similar Estimates
This implies wider spread than previously thought. However Infection fatality rate (Deaths typically taken 7-10 days back after Antibody formation or modelled as log normal distribution) has been estimated at 0.07% (3700 death/ 43-45 lakh affected out of 1.9 crore)..
Jul 12, 2020 • 10 tweets • 3 min read
A thread on Rapid Antigen testing in community.

All members of Bachhan Household were tested by Rapid Antigen test when Amitabh, Abhishek became Symptomatic.Rest were ASymptomatic Amitabh, Abhishek turned Positive and were taken to Hospital. Aishwarya and her daughter tested negative and RT-PCR was repeated which came out to be positive. Jaya Bachhan tested negative in both.
english.jagran.com/entertainment/…
Jun 25, 2020 • 6 tweets • 2 min read
While Favipravir and Coronil Trial are being criticized for lack of Blinding and gaining approval via Press Release. Have major drug trials done better?
1. RECOVERY. Open label(No blinding). Evidence dexamethasone + . HCQ arm-(press release, pre-prints 2 week later) 2. SOLIDARITY Trial(WH0). No Blinding(open label)
3. Lopinavir/Ritonavir for Severe COVID. No Blinding.(responsible for dropping Lopinavir/Ritonavir from Indian guidelines in march)
Jun 24, 2020 • 18 tweets • 5 min read
A dive into'Patanjali Clinical Study'

According to registration on CTRI, Initial sample size was planned for 60 in each group (placebo and Coronil).Primary Endpoint was Virological "Cure" at 14 days.(PCR negative)for mild/moderate severity COVID Patients
ctri.nic.in/Clinicaltrials… However when trial results were launched n Coronil Market blitz rolled out. It turned out only ASymptomatic and mild Patients recruited. And no moderate ones . (45 Coronil,50 Placebo). Also they stopped trial at 7 days only.
theprint.in/india/just-45-…
May 30, 2020 • 14 tweets • 4 min read
ICMR has published a good epidemiological summary paper of COVID-19 cases from Jan22-April30 in India
I encourage you to read it at
ijmr.org.in/temp/IndianJMe…

Here are key insights for me from this paper Only 60% of COVID-19 cases have Fever at point of testing(thermal screening less likely to work in 40%). 31% have breathlessness (they present late in Moderate COVID stage). Many have atypical Symptoms .
May 27, 2020 • 4 tweets • 2 min read
Another controversial paper from Surgisphere gp which published in Lancet on HCQ assoc. mortality
1. Highly implausible Massive Mortality benefit for Ivermectin HR 0.2(0.11-0.37)
2. Didn't know 407 Patients in US used Ivermectin before 31st March? (I saw first reports in April) Unless this group at least gives access to data (which they have refused) ,I refuse to trust any analysis from this group. Paper here..

papers.ssrn.com/sol3/papers.cf…
Apr 12, 2020 • 8 tweets • 3 min read
Can we "Science" this Problem?
Problem Statement: How do Health Care Workers resume operations without getting infected?
A. Mines and Aviation Industry after hundreds of Accidents built a safety culture while continuing the Work Every day hundreds of engineers go inside mines with Protective Equipment (mask/helmets/shields) and do their job.
NIOSH safety guidelines emanate from engineering/mining industry.
Why we in medicine are afraid/scared/paralysed at change/challenge?May be new normal till vaccine.
Apr 9, 2020 • 14 tweets • 4 min read
A new research shows- COVID-19 could easily escape even surgical mask in case of explosive cough and and there is increased transmission/aersolisatiom with loud singing.So this virus is a lot more transmissible.
In absence of working treatment ; No Good Antivirals, Vaccine . We are just Fending the Coronavirus Scare. Our Hospitals becoming a Health Care risk due to risk of cross infection.
So what we don't do is as important as what we do.
Mar 31, 2020 • 8 tweets • 3 min read
Power of a False negative test:
10 doctors qurantined entire Medicine ward exposed

indiatoday.in/amp/india/stor… Fellow doctors . Kindly keep Coronavirus Suspects in isolation for minimum of 14 days regardless of first test results. The False negative rate is 30-40% as I have repeatedly described on Twitter.The test might be helpful in tracing not so much in observation/treatment Image
Mar 27, 2020 • 10 tweets • 4 min read
A thread on epidemiology/distribution of COVID-19 cases in India. I extracted data from API of @covid19indiaorg and ran some analysis on it What is male/female distribution of cases?
According to literature Male:Female ratio is 60:40.
In known patients (with gender details)
Males higher in India as well around 65*
Nov 18, 2018 • 19 tweets • 7 min read
A thread about how internet revolution(3G/4G/Jio) have brought a significant cultural/regional shift in India. We will assess the cultural shift by you tube views (consumption) of Hindi and regional language songs and how they have changed over time. In a recent visit to my hometown in bihar i found that Jio had changed the entire media consumption pattern.. Most of the youngsters were hooked on dubbed Telugu/Tamil movies and were avidly watching Bhojpuri songs. None of this was case when i visited my village 10 years back.
Oct 22, 2018 • 4 tweets • 3 min read
@DrManojGrover @yates_rob Your conclusion that RSBY doesn't decrease OOP is informed by pre-post design or quasi randomised studies . Some studies (Karnataka) did so decrease OOPE as well as mortality. Others didn't account for health inflation.
Let's look at OOPE across Indian states. @DrManojGrover @yates_rob Now Tamil Nadu and Kerala have good health parameters,govt investment and still the OOPE of households are higher than BMARU states, indicating we can't compare apples to oranges.
Oct 2, 2018 • 13 tweets • 7 min read
Editor of Business Standard India.. using a "source" based story to accuse an independently overseen sanitation survey to say Modi Sarkar conducted a biased NARSS survey (from design stage) to inflate it's open defecation free data. Cc @ShamikaRavi @dravirmani @ShamikaRavi @dravirmani The allegation is pretty serious ,considering the survey was overseen by experts from WHO,UNICEF and gates Foundation.
WHO did a glowing report later on using GBD modelling on NARSS data as well as other surveys

searo.who.int/india/mediacen…