Fascinating preprint (H/T @zeynep ) - in host diversity is quite limited (i.e. variants aren't emerging from typical infections spreading)
This really brings up the concept of making sure our immunocompromised patients are followed up appropriately, and vaccines are pushedhttps://twitter.com/KATarinambraun/status/1388312255222124544 …
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Replying to @zchagla
Also, from what I can tell, in many countries, convalescent plasma is still used broadly and without a lot of checks/controls. I checked with a few doctors I know elsewhere and they did not know of this issue:https://www.nature.com/articles/s41586-021-03291-y …
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Replying to @zeynep
Yes - much of our messaging for india (despite everything) has been stop using plasma. Even the indiscriminate use of monoclonal antibodies may lead to big trouble - and these patients likely need specialized care and followup.https://academic.oup.com/cid/advance-article-abstract/doi/10.1093/cid/ciab392/6261427#.YI0_pHm4AQo.twitter …
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Replying to @zchagla
What's the best guideline for this I can forward to doctors etc. in other countries? (not India) Ideally, WHO but accessible ones from other countries could work too. Especially during surges (Turkey has one now), all of that can get fairly indiscriminate in practice.
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Replying to @zeynep
we put together this document in http://indiacovidsos.org with
@paimadhu@KrutikaKuppalli for just pragmatic care at home and eliminating therapies that don't work. There is also a great evidence review at https://www.covid19treatmentguidelines.nih.gov/whats-new/ including plasma.1 reply 2 retweets 4 likes -
WHO guidance is here: https://www.bmj.com/content/370/bmj.m3379 … They're a bit behind on some therapies (tociluzimab, plasma) but from what I hear it's coming soon!
@Bram_Rochwerg2 replies 0 retweets 2 likes -
Great visual chart! But doesn't seem address use of convalescent plasma or monoclonal antibodies especially for immunocompromised patients. Hope soon. Especially the latter is... just used in a "what's the harm" kinda way.
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For sure - the FDA I believed just revoked EUA for BAM for this particular reason. But you're right no one has put a practice point out there (outside some of the discussion in NIH) and certainly nothing on how to treat/monitor pts with severe immunocompromised.
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Yeah, something on clinical practice on all this would probably be pretty useful now. (More so than just scary headlines about variants... Here's one thing that really can spring new ones for which we need globally accessible clinical guidance!) Did you say one was coming soon?
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I think BMJ/WHO is going to hopefully weigh in on this given the multiple negative trials (RECOVERY, REMAP-CAP, CONCOR-1) for convalescent plasma to formally not recommend it's use period - as it doesn't seem to have any benefit.
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Great. I hope they don't just say "not useful" but strongly point out this issue as well. In many LMIC countries "not useful" isn't enough to stop widespread use if seen as "can't hurt" especially if there aren't many alternative effective therapeutics. Need strong language.
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