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29 Nov, 4 tweets, 1 min read
In terms of type of mask, seems to be 3 types of masks that work well for the public (after asking physical scientists!) in terms of comfort and protection (both filtration efficiency for wearer and "source control" for others):
1) Surgical mask-melt-blown non-woven polypropylene
2) 3-ply with outer and inner layer made of cotton and middle layer of a filter material (many masks have places to inert that filter- like a vacuum bag filter)
3) At least 2-ply but with high thread cotton like tested by CBC Marketplace: cbc.ca/news/canada/ma…
Agree that standardization of masks may help increase protective efficacy but also help convince public to wear. I don't buy this argument that it makes you "cavalier" or "take risks" to wear a mask; giving someone a sense of self-protection (masks protect you and others) is a
empowering public health message, not disempowering. San Francisco just closed down more but I think the young (who feel their youth being interrupted) are sick of it; I get it; just a little while longer. The end of this long period is in sight with these vaccines - promise!

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More from @MonicaGandhi9

Monica Gandhi Profile picture
29 Nov
Wanted to explain a bit about the vaccine trials (Pfizer/BioNTech, Moderna, Astrozeneca) endpoints and what people mean when they say "we don't know if vaccines will prevent asymptomatic disease" (and why we need to wear masks until we reach equitable widespread vaccination).
The endpoints of Pfizer (full trial results Nov 18 via press release) and Moderna (interim results Nov 16) were both symptomatic COVID-19 cases - they didn't say they were swabbing weekly (like Astrozeneca) did to rule out asymptomatic disease.
So, can't tell if prevented infection altogether or prevented symptomatic cases only. At end of day, latter is what matters for individual but former can have implications for asymptomatic spread so continuing NPIs until we get to mass vaccination will be helpful
Read 7 tweets
Monica Gandhi Profile picture
18 Nov
Our group including the very smart @MattSpinelliMD was asked to comment on the DANMASK study found here: acpjournals.org/doi/10.7326/M2…. Others have already smartly commented that implementation science is the way to study mask wearing but here goes:
First the study team (many cardiologists in Denmark) should be commended for performing a randomized controlled trial of a non-pharmaceutical intervention (mask-wearing) in the early days of a pandemic; there are study design flaws that will impair our ability to draw conclusions
The study was a non-blinded study of providing 50 surgical face masks tor community participants spending >3; hours outside of the home in April-May (intervention group) versus the standard of care of Denmark not recommending widespread use of face masks in the community at time
Read 21 tweets
Monica Gandhi Profile picture
17 Nov
Got a call from science reporter about what we hope & expect from Biden administration on COVID19 response, should be organized and consistent on NPIs and testing. But HIV expertise from advisors is essential to inform public health messaging, I think.
Why? Because HIV doctors have learned over many years and in close contact with their patients to NOT use stigmatizing messaging ("you got COVID? what were you doing??!) and to use kind, harm-reduction-based ways to message on prevention and adherence
I have so many patients right now (I treat patients with HIV) who are totally traumatized by the punitive and harsh aspect of public health messaging right now and make suggestions on how to make messaging more effective via gentleness, kindness, acknowledging loneliness and pain
Read 4 tweets
Monica Gandhi Profile picture
16 Nov
The interim results of the Moderna vaccine trial released this morning are thrilling. Like the Pfizer/BioNTech vaccine, the Moderna vaccine (called mRNA-1273) is an mRNA vaccine and this trial enrolled 30,000 participants, 42% of whom were high-risk (7000 over 65 years and 5000
<65 years old with comorbid conditions) and 11,000 of whom were from communities of color. The press release of the interim results of the phase 3 trial of the Moderna vaccine shows a 94.5% efficacy rate at 95 infections (e.g. 5 infections in the vaccine group; 90 in the placebo
group). Vaccine trials often have a secondary endpoint of mitigating severe disease and all 11 of the severe cases of COVID-19 occurred in the placebo group. The vaccine trial will go up to 151 infections and 2 months for safety data before Moderna will file for an emergency use
Read 6 tweets
Monica Gandhi Profile picture
12 Nov
HI all, we submitted a paper on this today but we want to go from cheapest interventions to most expensive in our response. Cheapest are NPIs (masks, hand hygiene, distancing, ventilation), then more expensive (testing, I&Q, contact tracing), then most expensive (treatments).
Cheapest are "easiest" to enact and yet take behavior change (e.g. masking) so is that so easy? Not really, it is why we came up with prevention strategies for HIV ("biomedical prevention strategies" like PrEP) that didn't rely solely on behavior (condoms)- then it turns out
PrEP ALSO relies on behavior (mainly daily pill taking- this is what I study, adherence in HIV). So, I am not saying behavior change (masks) is easy, I am saying that we as a populace have to trust tbose who recommend them and I so I think we have to turn to building trust
Read 9 tweets
Monica Gandhi Profile picture
12 Nov
The word "lockdown" is really disturbing. San Francisco has essentially been locked down x 8 months. Testing is helpful but acknowledge limitations of each test. Non-pharmaceutical interventions (distance, masks, hand hygiene, ventilation) work.
and everyone has to decide for themselves their level of fear (I call it "strata of fear", stratosphere) which will determine what they do in terms of being with each other (e.g. is it more ethical to stay away from demented elderly relative or more ethical to see them with NPI?)
No one has seen a movie or performance in 8 months; very few things open (at least in SF) so lockdown hard. What you do to behave "ethically" towards family/friends should be a personal decision, right? The elderly, widows, orphans may be more scared of no contact than contact.
Read 7 tweets

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