Vincent Rajkumar
@VincentRK
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Editor-in-Chief, Blood Cancer Journal; Oncologist; Chair, Board of Directors @IMFmyeloma; Cancer Research; Opinions solely personal views https://t.co/HOGYJSpsoG
Rochester, MN, USA
Joined March 2009
I would like to share the story of how a patient with cancer came up with the idea for a randomized trial, & how listening to him saved a lot of lives. 1/ In 2002, I had just completed a randomized trial with the notorious drug thalidomide for the cancer, multiple myeloma.
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South Korea followed the textbook principles of epidemiology. Kept deaths 40 times lower all the way till 75% of population fully vaccinated. This is success.
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Just heard that it only costs $3 per dose for Pfizer and Moderna to make their COVID vaccine. But they sell it for $15-40 to the world. Given the amount of publicly funded research that went into development of these vaccines, & the current crisis, this is unacceptable.
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India has more confirmed COVID cases per day than πππ other countries in the world ππ€π’πππ£ππ.
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A lot of COVID deaths in India in young people who should be doing well & recovering. I am making a plea to doctors in India to cut down the use of STEROIDS. Please. Steroids are only useful after the patient is hypoxic. Harmful if given early, or given for too long.
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Florida becomes first US state where the daily deaths in current wave have exceeded previous waves.
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This is a plea to the US government to help India. What you can do:. -Help with Oxygen & Oxygen generators.-Release Astra Zeneca vaccine supplies .-Lift the export ban & send them raw materials for vaccines . As bad as this looks. It's 10 times worse. The Indian people need you.
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Singapore should be a warning to us. They had COVID under excellent control. Now itβs out of control: 728 new cases yesterday. When we relax social distancing measures prematurely we risk a second wave. Places where groups of people work/live close to each other are at high risk.
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Omicron who?. South Korea continues to be the role model. I hope they can sustain their science driven strategy which so far has saved hundreds of thousands of lives.
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India has 1.3 billion people. 4 times that of the US. Whatβs going on is just amazing and needs in depth immunologic studies. These are raw numbers!
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There are at least 4 possible reasons why some people with COVID have little or no symptoms. 1) A rapid immune response that conquers the virus.2) Pre-existing cross reactive immunity.3) Genetic factors.4) Low viral load at time of infection. We have emerging data for each. π.
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One piece of positive news speaking to leaders of 2 large hospitals in India where most healthcare workers were fully vaccinated: No serious COVID cases among any of the vaccinated healthcare workers during this current crisis. The vaccines are working.
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In randomized trials with 6 different COVID vaccines involving ~175000 persons:. 0 hospitalizations for COVID in persons who received the recommended schedule of vaccine. That is ZERO.
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The only people who have been consistently right on Covid have been those who have consistently raised the alarm.
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You hear COVID vaccines are highly effective, & protection will last years. But you also hear people are getting COVID even after 2 doses of vaccines, & some have died. What gives? Here are 4 reasons why excellent vaccines sometimes appear not to work:. Thread below π.
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After 11 years of med school and residency training, and >20 additional years of research on the cells that make antibodies & help us fight infection, I'm not as confident as some people seem to be on how the immune system works and how natural immunity protects them from COVID.
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I've written about how South Korea controlled the pandemic. But nothing captures the dramatic difference like cumulative deaths over 2 years. It's a painful watch.
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Almost 25% of daily US COVID deaths are in Florida. This wave is striking because it is pretty hard to go above pre-vaccination waves. It's almost double. Thankfully has not happened in any other state. In fact, very few countries have had this happen either.
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When someone says get vaccinated and someone else says no need to get vaccinated, the truth is not in the middle. One is right. One is not. So don't look for false balance: it's true versus not true.
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What caused this massive difference in COVID deaths?. Not lockdowns; not lack of democracy; not new treatments. It was testing, contact tracing, avoiding crowds, masks, controlling new cases entering the country, leadership, clear strategy, & unified messaging to public.
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Mother of a young ICU doctor in Missouri told me today that 5 young patients died of COVID in their unit, and doctors and nurses are at their breaking point. Fatigued, worn out. Folks please get vaccinated. The vaccines we have are incredibly effective.
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It is too early to remove recommendations for masks in the US. I will continue to mask.
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This drop in confirmed COVID cases in India is an illusion. First, due to limited testing, the total number of cases is a huge underestimate. Second, confirmed cases can only occur where you can confirm: the urban areas. Rural areas are not getting counted. @BDUTT
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On Jan 24, 2020 @DrEricDing posted a massive warning about the impending pandemic: The Holy Mother of God thread. "We are now faced with the most virulent virus π¦ epidemic the world has ever seen," Eric wrote. As I read his thread again today, all of it has sadly come true.1/.
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Since I praised South Korea's handling of COVID 4 months ago, I should also comment on the Covid crisis that is happening there now. 1) We see what omicron can truly do when it enters a country where very very few have had COVID before.
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1/ When you get vaccinated you donβt make just one type of antibody. You make a whole portfolio of antibodies against various epitopes. So unless there is a huge number of mutations, vaccines will protect you, especially from severe disease. #VaccinesWork #Covid_19.
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If we have more COVID vaccines than people, but cannot get to herd immunity due to vaccine hesitancy then we have messed up the messaging. The message should be clear and should come from every leader in the country.
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Revised CDC guidance on COVID does not make sense. We are still losing 500 people a day to COVID. Itβs a big risk. Itβs like we are giving up. As a cancer doctor I am also worried for my vulnerable patients. #CovidIsNotOver
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Covid vaccines represent one of the greatest medical advances of all time. They have dramatically reduced risk of severe disease and death. But they have worked less well in terms of preventing infections, transmission, or durability. Why? . 1/.
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This is not a curve or a wave. It's a rocket. A straight vertical line. If this is a bad COVID variant causing this, it will be prudent for all countries to help India with vaccines and raw materials for vaccines. I'm not aware of the details. I just hope we do the right thing
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On being a good doctor. The number of research publications donβt tell you how good a doctor is at being a doctor. Neither do the number of book chapters or grants. Or academic rank. Itβs a different skill set. Good doctors have stellar clinical acumen & empathy. #MedTwitter.
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When the CDC said vaccinated people can take off their masks in May, I supported the move (thinking it may encourage people to get vaccinated). Well. I was wrong. Eric disagreed with me strongly at the time. He was right. With cases soaring, please wear masks even if vaccinated.
5) βGrave mistakeβ - this @JohnsHopkins trained epidemiologist you know has been arguing against the CDC since they announced their mask relaxation in May.
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What's happening in India now is prima facie evidence of what this virus can do to a susceptible population when there is premature breakdown of social distancing and universal masks. (Rise of variants doesn't help this cause either). Vaccinate first. Relax next.
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Do not miss what's glaring at us: COVID vaccines are among the best that medicine has accomplished EVER. Nothing short of a miracle. From completing trials with tens of thousands of volunteers in a matter of months to the spectacular results. Thankful now.
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I remember CDC deciding in June that fully vaccinated can take off their masks. I like many thought it was a reasonable call. Eric disagreed strongly. Turned out he was right. He is one of the people I'm glad I follow coz he is up to date on everything COVID. Thanks Eric. 6/.
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Worth remembering that people who have raised alarm and advocated caution have been more right on COVID.
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There are 3 likely factors lowering death rate in India:. -Younger age.-Lower obesity .-Cross reactive immunity from prior corona virus and other infections . The first two alone cannot explain lower severity. There are enough older people to overwhelm the health care system.
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Mistake 1: Don't test so our cases don't look so high. (Early 2020). Mistake 2: Treating tests like drugs and being too rigid with approval. Mistake 3: Not ramping up production of tests. Mistake 4: Recommending not to test before ending isolation. Mistake 5: You are on your own.
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I made my career on Dexamethasone. And how a lower dose saves lives. This is truly a double edge sword that when used without care can cause tremendous harm.
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Well we have the Covaxin results from @BharatBiotech now. Excellent efficacy. Congrats India.
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Astra Zeneca vaccine & blood clots. Summary. Rare form of blood clots plus low platelets. ~60% involve veins of brain. Almost all after 1st dose. Risk (UK MHRA): 1 in 250,000 people.Risk (EU EMA): 1 in 100,000 people . Risk of dying: 20-25% of people with these clots have died.
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Did COVID cause remission of an advanced cancer?. 61 year old man was diagnosed with Hodgkin Lymphoma. He then developed COVID. Only got supportive care. No steroids or immunotherapy. 4 months later, cancer had mostly resolved (left image vs right) πͺ’.
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What about natural immunity? A thread. I'm not a virologist or vaccinologist. I'm addressing this issue as someone whose career has been focused on plasma cells, the cells that make antibodies, for over 20 years. π.
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India needs help. Unimaginable humanitarian crisis occurring at an unprecedented speed and scale.
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Shock and Awe. What omicron can do (Left). What vaccines do (Right). 1/
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Top 5 worst declarations during the COVID pandemic. 5. It's harmless in young people .4. Masks cause hypoxia .3. Vaccines have microchips.2. Ivermectin .1. Great Barrington Declaration . Feel free to add.
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In the first week of the illness when the virus is dividing, the use of steroids can suppress the immune response and make the virus divide even more. Steroids are not antivirals. There was a trend to more deaths in RECOVERY trial in patients who were not hypoxic.
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Looking back it was not one lucky prediction. Throughout the pandemic @DrEricDing has been right numerous times while many other experts who were a lot more optimistic ended up being wrong. From duration of vaccine efficacy to variants to issue of masks. 5/.
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Two headlines, 6 months apart. Want a good economy? Control COVID first. @ASlavitt @DrEricDing
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This is a disaster waiting to happen. How can Indian regulators allow this?. A teratogenic cancer drug and a diabetes pill with the same name. cc: @nramind @nambath @ramyakannan
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If someone asks, do you know the risk of the vaccine long term, ask do you know the risk of the virus long term.
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When I adjust to population, the differences are even more striking.
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Now consider that the number of confirmed cases is a fraction of the true cases to get a sense of the humanitarian crisis.
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I'm beginning to worry that COVID mutant variants may be playing a significant role in the crisis in India, causing infections even in people who may have escaped with mild COVID during the 1st wave. This has implications for the world on how soon vaccine boosters may be needed.
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Kerala (population 35 million) was the first state in India to get COVID. Today for the 2nd day in a row they have ZERO new cases! @nramind @nambath @ramyakannan . How did they do it?.1/.
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3 reasons why I'm worried the pandemic in India is different: . -Rapidity with which the disease seems to progress.-High transmissibility in family contacts .-Severe disease & deaths in young people. I wish we had hard numbers. This my opinion based on following events closely.
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The current vaccines are outstanding but not perfect. They give excellent protection against severe COVID. They save lives. Do not be worried about reports of vaccine failures which may occur due to one or more of the reasons I listed. They are the exception. #GetVaccinated.
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My earlier thread on Florida and why this is happening. Some not in our direct control: delta variant. Some in our control: 50% fully vaccinated is simply not enough. Relaxing mask requirements and preventing mask mandates is not good policy. #GetVaccinated #WearAMask.
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BREAKING: The US will immediately make available raw materials that India needs for COVISHIELD. Emergency supplies will be also made available. Grateful beyond words. Thanks on behalf of a billion people.
Important statement regarding support for India in combatting COVID-19.
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Want to control COVID? The Top 3 things we can do. Individuals .-Wear a mask when indoors with people u donβt live with .-Social distance as much as possible .-Good ventilation indoors . Governments.-Communicate above 3 measures clearly.-Provide tests & PPE.-Leaders set examples.
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Yesterday someone who is on Medicare Part D asked in disbelief: Will my annual prescription drug costs really be capped because of the new Senate bill? . Yes.All drugs .Every drug .All drugs combined.Total $2000 for whole year . Shout it from the rooftops. #MedTwitter.
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What's different in Florida is that relative to the vaccination rate (~50%) the relaxation of distancing and masking was disproportionately high. Leaders expressed disdain for masks and mask mandates. The total number of people unvaccinated is high. And hospitals got overwhelmed.
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This saddens me. ALL of the news media should be non-stop highlighting how so many other countries have crushed COVID. And how everyone is doing way better than us.
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The #1 purpose of vaccines is to prevent deaths and serious morbidity. COVID vaccines are almost 100% effective in doing that. That's the message.
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In patients who have hypoxia, it signals that there is lung involvement. By now the virus is likely controlled by the body and the damage is from the immune system. Only at this stage are steroids useful: at small dose (Dex 6 mg) and short duration (5 days).
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There are 4 other factors people have hypothesized but I donβt think they play a big role . -BCG vaccination .-High temperature .-Vitamin D levels .-Use of chloroquine, ivermectin etc.
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You cannot undercount ten times the death rate. That would also mean also undercounting 20 times the hospitalizations. With friends& reporters Iβm in touch with across the country, India has had nowhere near the deaths the US has per capita. Life is normal even in big cities.
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Monoclonal antibodies are like the chemo we give after the cancer occurs. Vaccines and masks are like stopping smoking so you reduce the risk of getting cancer. Monoclonal antibodies don't help the poor, the uninsured, & don't prevent transmission. Vaccines and masks do.
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Pfizer COVID Vaccine. Amazing! The numbers speak for themselves. Iβm sure Moderna has similar numbers. One of the greatest achievements in medicine of all time. Iβm all in. @ASlavitt
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Even if Omicron causes a problem in South Korea, they have already won. At this point 93% of adults are fully vaccinated. Over 40% have been boosted. So their deaths and hospitalizations will stay much lower than here.
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Stunning fact: Not even one single developed country has >1000 COVID cases per day. We have >50,000 per day in the United States. Epic failure of leadership at National level, as well as at the State level in many states. @ASlavitt @choo_ek @MelissaJPeltier @jeremyphoward
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5) But all is not failure or despair. This is only the first real wave in South Korea. The wave in terms of deaths is much less than 4 of the waves in the US. Total deaths is much lower. How well South Korea handled the pandemic for 2 years has still saved a huge number of lives
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Some have noted that the marked disparity was apparent very early on in April of 2020. Yes. See how we responded when this was pointed out then.
With all due respect: This is South Korea. Not North Korea. Making test available .Rapidly identifying people who need isolation .Quarantining contacts.Having enough masks. This is what a free country should do. We should not blame our freedom and democracy for mistakes made.
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From a doctor who does clinical trials for a living: Not true.
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Dr. Fauci has a H index of 227. Which means he has 227 papers that have been cited 227 times or more. There are few people in the history of medicine who have a higher H index. It speaks to how much he has contributed to medicine. Be respectful.
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Less than 10% of people in India have had one dose of vaccine. Although the number of people who have received 1 dose of vaccine is not that much lower than the US, the sheer population size of India makes the task much harder. It is why India needs help with vaccine supplies.
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I recognize that part of the problem in India may be a more virulent virus or a totally overwhelmed health care system. That's not in our immediate control. But we can do things in our control: Use steroids only when necessary, at the right time, for the right duration.
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Everyday I hear about someone very young in India, in the best of health, dying or critically ill with COVID. In many, the clinical course is one of rapid progression. Added to what's going on in the UK, makes me nervous about B.1.617 variants. Get vaccinated. That does work.
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Giving steroids at high dose, or steroids for prolonged duration can cause secondary infections from mucor, drug resistant candida, and drug resistant bacteria. Add to it muscle weakness and high blood sugars and any number of other problems.
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In every age group, COVID vaccines reduce the risk of severe disease or death by >90%.
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I don't have a book to sell, job to secure, or money from Pharma. If I'm promoting vaccines it's because they save lives and I became a doctor to do just that.
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70% vaccinated Netherlands had a bad wave in July. Deaths hardly budged. Need more proof that COVID vaccines work? #GetVaccinated
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He wrote:. "possibly an unchecked pandemic that the world has not seen since the 1918 Spanish Influenza. Letβs hope it doesnβt reach that level but we now live in the modern world π with faster βοΈ+ π than 1918. @WHO and @CDCgov needs to declare public health emergency ASAP!".2/.
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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/.
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I'm ok with profits. But not on this scale, where it places many countries at huge financial and public health crisis.
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We saw it in India: it's a combination of delta variant, policies, lack of masks and protective measures, crowding, overwhelmed hospitals. India unfortunately did not have vaccines. Florida does. So it's all the more tragic.
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If omicron appears milder, you can thank vaccines for that to a large part. Data from Switzerland.
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3) It shows how a country can completely shut out Covid for 2 years. It can get 75% of its population fully vaccinated. But it's still not safe from COVID. When precautions are relaxed, COVID is just lying in wait. It's disheartening. It shows the nature of the enemy we face.
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Please don't blame vaccines not working as the cause for rising death rate in Florida. Vaccines are working to prevent deaths in many other countries that have seen post vaccine spike in cases; and most other states in the US as well. Florida is different.
COVID Vaccines work in preventing severe disease and deaths. This is best demonstrated by massive real world data in populations by comparing deaths relative to cases in post vaccine wave to prior waves. Exhibit 1: Iceland and UK. Note low deaths this time around.
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165 million people (50% of the country) vaccinated within 6 months. A huge lifesaving accomplishment.
Bidenβs accelerated vaccine rollout has saved over 1 million people from being hospitalized & hundreds of thousands of lives based on a new Yale study. More work to do but vaccines save lives.
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Controlling COVID until the public is well vaccinated saves a huge number of lives. See the huge difference between cases and deaths depending on when COVID occurred. ππ
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This is not only the right thing to do. It is also wise. If this absolutely stunning and dramatic spike is due to a bad COVID variant, then it is going to affect us. It will be self defeating to crush COVID only to let a bad COVID variant get us again. Please act urgently.
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I am thrilled with the news that @ASlavitt is joining the Biden Administration COVID 19 task force. Throughout the pandemic Andy has been a person many of us trusted and looked up to. I trust him 100%. Letβs turn this thing around. #LeadershipMatters
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And of course this is happening exactly when it shouldn't: when delta is at its peak. Familiar? Yes. We have seen this before. We just didn't quite think it will happen in a vaccine rich, resource rich state in 2021.
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USA with the best vaccine supply has now 17% of the worlds daily new COVID cases. In number of cases per day we are in a different level and trajectory than every other country in the world. Again.
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I just think it would be wise to do in depth scientific studies in India and neighboring countries so we better understand resistance to severe COVID that seems to occur in these parts. Looking at the seroprevalence a huge proportion must have been asymptomatic. Question is how?.
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40,000 deaths in the last 3 months. 400 deaths a day. No. Covid is not over.
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This is concerning since Israel has been ahead of other countries on COVID boosters and also a huge omicron wave. It means despite all this 1) some people remain vulnerable due to inadequate or waning immunity and 2) new variants are immune evasive. 1/
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People quarreled with the R0 that was in @DrEricDing's thread, but most epidemiologists and leaders and organizations missed the forest for the trees. We know what happened since:. 240 million cases worldwide .5 million deaths . 46 million cases in the US.>750,000 deaths . 3/.
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