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Monica Gandhi MD, MPH

@MonicaGandhi9

19 Dec

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

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Monica Gandhi MD, MPH

@MonicaGandhi9

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.

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Monica Gandhi MD, MPH

@MonicaGandhi9

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

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Monica Gandhi MD, MPH

@MonicaGandhi9

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

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Monica Gandhi MD, MPH

@MonicaGandhi9

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

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Monica Gandhi MD, MPH

@MonicaGandhi9

18 Nov

@MattSpinelliMD

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

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More from @MonicaGandhi9

Monica Gandhi MD, MPH

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Monica Gandhi MD, MPH

Monica Gandhi MD, MPH

Monica Gandhi MD, MPH

Monica Gandhi MD, MPH

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