The U.S. has been the epicenter of the pandemic since March 26, since two weeks after COVID-19 was declared a pandemic by the WHO on March 11. This is due to failed federal response, but not all because of that but because of structure of this country, which fractures responses
and decisions to counties/states/local levels. Everyone had different responses but we are all connected so one response affects another. Also, we failed to protect workers &poor so when openings occurred or even during shutdown, people of course had to work to survive
These weaknesses of our system will hopefully be strengths when it comes to vaccine distribution as that is the only way to get out of this now and local/state/counties distributing will hopefully be effective. Remember, #Moderna vaccine had 36.5% representation from communities
of color so that may help communities decide that this vaccine was really studied in a diverse group and help acceptability (Pfizer 18.1% communities of color). Here are some slides on history of #COVID & vaccines - hopeful distribution will be equitable as poor affect rich here
How do new infectious disea...
Our first coronavirus outbr...
Second coronavirus that cau...
This one (SARS-CoV-2) comin...
And here is the pandemic as...
And here were are in the U....
Although ICU and hospitaliz...
Dr. John-Laurent Rosenthal,...
Effects of pandemic not onl...
Closures absolutely require...
Image
Covid-19 is devastating communities of color. Can vaccines counter racial inequity?
washingtonpost.com/health/2020/12…
Reminder of distribution of...
Image
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this trial enrolled more di...
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More from @MonicaGandhi9

21 Dec
Have been musing on ACIP recs all day. To be clear, 1a is health care workers & long-term care facilities (maybe 5 weeks); 1b is those >75 yrs and front-line essential workers (firefighters/police; teachers; food & agriculture like processing plants/farm labor; public transit,
grocery store, postal service, correction workers, manufacturing (out to 10 weeks maybe but 1c will start before); 1c is those 65-74 years; those 16-64 years with high-risk conditions (on other CDC website listed as cancer, chronic kidney disease, COPD, heart conditions, organ
transplant, obesity, sickle cell disease, smoking, pregnancy, type II diabetes); and essential workers not represented in 1b (transportation, food service, construction, finance, IT and communications, energy, media, legal, public safety, water/wastewater); phase 2- all else
Read 4 tweets
17 Dec
More on #vaccines e.g. the full report on the Moderna vaccine which is likely to be authorized this week! By the way, there was a ? asked about vials of the Pfizer vaccine being fuller than one dose. FDA says "At this point, it is acceptable to use every full dose obtainable"
So, if each pack is 5 doses with 5 vials but you can get a 6th or 7th dose out of a vial because they are highly filled, do it, says FDA (could mean we could have 40% more doses than we thought although company may cut back from overfilling).
In terms of #Moderna vaccine, the full FDA brief was released yesterday and the meeting is tomorrow. Brief is here. fda.gov/media/144434/d…. I put the data into these few slides which I will now upload as pictures. Image
Read 8 tweets
5 Dec
My concern about the almost-complete lockdown order in 5 counties in Bay Area is that it is similar to March, but we have learned so much about the virus since March! In March, a complete lockdown was indicated because we didn’t know if the virus was spread from surfaces;
we didn’t know if it was spread from asymptomatic individuals (it is); we essentially treated the infection as if it was radioactive. At this point, we have learned a lot about how to mitigate spread, including masks, distancing, ventilation and hand hygiene.
Therefore, to institute the same measures as in March, including shutting down of playgrounds (despite lack of evidence on surface transmission), outdoor dining (where there has been no data to show that this is unsafe), and prohibiting members of different households to gather
Read 7 tweets
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
29 Nov
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
Read 4 tweets
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

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