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Céline Gounder, MD, ScM, FIDSA 🇺🇦

@celinegounder

Feb 3, 2020 • 13 tweets • 13 min read • Read on X

THREAD: When you don't have #drugs or #vaccines, you've got to rely on containment strategies. But how well do they work? pnas.org/content/114/15… #nCoV19 #coronavirus #CoronavirusOutbreak

Contact tracing: Who are all the people who may have been in contact with someone with the disease? These are "contacts." pnas.org/content/114/15… #nCoV19 #coronavirus #CoronavirusOutbreak

Active symptom monitoring: Check on contacts 1-2x/d. Isolate them if symptoms develop. pnas.org/content/114/15… #nCoV19 #coronavirus #CoronavirusOutbreak

Quarantine: Isolate all potential contacts even if healthy. pnas.org/content/114/15… #nCoV19 #coronavirus #CoronavirusOutbreak Costs: enforcement, human rights restrictions, stigma, interruptions to travel/trade, economic impact.

Quarantine makes sense IF:
- fast progression from infection to symptoms of disease
pnas.org/content/114/15… #nCoV19 #coronavirus #CoronavirusOutbreak

Symptom monitoring makes sense IF:
- can trace most contacts
- slow progression from infection to symptoms of disease pnas.org/content/114/15… #nCoV19 #coronavirus #CoronavirusOutbreak

Quarantine also makes sense IF:
- highly infectious pathogen
- asymptomatic transmission
- cannot identify contacts
- cannot identify symptomatic persons
pnas.org/content/114/15… #nCoV19 #coronavirus #CoronavirusOutbreak

"quarantine was inefficient for a respiratory disease like #SARS" pnas.org/content/114/15… #nCoV19 #coronavirus #CoronavirusOutbreak

"for SARS, our analysis indicates that effective isolation of symptomatic patients is sufficient to control an outbreak"
pnas.org/content/101/16… #nCoV19 #coronavirus #CoronavirusOutbreak

"Influenza...predicted to be very difficult to control even with 90% quarantining & contact tracing b/c of high level of presymptomatic transmission." pnas.org/content/101/16… #nCoV19 #coronavirus #CoronavirusOutbreak

"quarantining and contact tracing for influenza would probably be unfeasible because of the very short incubation (2 days) and infectious (3–4 days) periods of that disease." pnas.org/content/101/16… #nCoV19 #coronavirus #CoronavirusOutbreak

So is #coronavirus more like #SARS or #influenza when it comes to controlling it?
Incubation periods:
- flu 1-4 days
- SARS 2-7 days
- #nCoV19 ~5 days
#CoronavirusOutbreak

When infectious?
- #Influenza: 1 day before symptoms develop & up to 7 days after getting sick
- #SARS: only with symptoms
- #nCoV19: before symptoms develop (unclear how significant), unclear for how long after symptoms develop
#coronavirus #CoronavirusOutbreak

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More from @celinegounder

Céline Gounder, MD, ScM, FIDSA 🇺🇦

@celinegounder

May 23

1/ What’s fueling the surge in childhood chronic illness in the US?

The MAHA Commission blames ultra-processed foods (UPFs)—& their assessment offers a sweeping critique of America’s food system.

2/ Nearly 70% of American children's calories now come from UPFs—foods high in added sugars, refined grains & industrial fats, but low in nutrients.

The MAHA report links this to obesity, diabetes, even behavioral health.

3/ UPFs are designed to override satiety signals (i.e. feeling full).

Kids eat more & gain weight faster.

Plus, many UPFs contain additives that may affect metabolism, mood & gut health.

Think: emulsifiers, artificial colors & sweeteners.

Read 15 tweets

Céline Gounder, MD, ScM, FIDSA 🇺🇦

@celinegounder

May 11

1/ A new study from South Korea suggests the shingles vaccine may do more than just prevent shingles—it might also protect your heart 🫀.
on @CBSMornings with @GayleKing @vladduthiersCBS @nateburleson

2/ Researchers followed over 2 million adults for a decade.

Those who got Zostavax—the older, live shingles vaccine—had a 23% lower risk of heart disease, including heart attacks, strokes & heart failure.

3/ That cardiovascular protection wasn’t short-lived.

It lasted for up to 8 years after vaccination.

Read 14 tweets

Céline Gounder, MD, ScM, FIDSA 🇺🇦

@celinegounder

Apr 9

1/ My colleague @DrLaPook's interview with @HHSGov @SecKennedy raised critical questions about public health, vaccines & government responsibility.

on @CBSMornings

2/ RFK Jr, a longtime vaccine skeptic, now recommends the measles vaccine during an outbreak.

This is a significant shift, but his statements on vaccine safety testing need clarification.

3/ Vaccines undergo rigorous testing in Phase 3 & 4 clinical trials, often lasting years to decades.

Claims that vaccines are tested for only "3-4 days" without placebos are misleading.

Read 16 tweets

Céline Gounder, MD, ScM, FIDSA 🇺🇦

@celinegounder

Mar 21

1/ Billions of dollars in @NIH medical research at risk amid Trump cuts
with @jdickerson on @CBSEveningNews
cbsnews.com/video/billions…

2/ The total @NIH budget is $48.6B.

It's hard to say how much will be cut in total as the cuts are still in progress, but BILLIONS of dollars will be cut.

3/ This is in addition to NIH dollars that have been held up by delays in approval processes.

If universities can't make payroll, they can't hire & have to let people go.

Read 32 tweets

Céline Gounder, MD, ScM, FIDSA 🇺🇦

@celinegounder

Mar 7

1/ A lesser-known fact about measles is how the virus can damage the immune system, leaving someone at greater risk of other infections even after a person has recovered.
with @nateburleson @GayleKing @AdrianaDiaz on @CBSMornings

It's called MEASLES IMMUNE AMNESIA.
pmc.ncbi.nlm.nih.gov/articles/PMC85…

2/ Let’s say you have 2 babies.

As they grow, their immune systems mature & they both gain immunity to different infections – as represented by the different colored marbles.

3/ One baby gets vaccinated against measles at age 1 & later at age 4.

It's recommended that babies get their 1st dose at 12-15 months (when antibodies from mom fade away) & 2nd dose at 4-6 years (when kids start school).

Read 12 tweets

Céline Gounder, MD, ScM, FIDSA 🇺🇦

@celinegounder

Nov 17, 2024

1/ I explain how RFK Jr's plans could affect Americans' health.

He is known for falsely claiming that vaccines cause autism & other health issues.

cbsnews.com/video/doctor-e…

2/ RFK Jr: "The problem with the measles vaccine is that it's a leaky vaccine. It doesn't provide sterilizing immunity."

It's true that the measles vaccine doesn't prevent ALL infections.

It's ~97% effective after 2 doses.

3/ In rare cases, vaccinated people may get infected & transmit the virus to others.

This is all the more reason for vaccinating everyone in a community, not just those who feel like it.

Read 13 tweets

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