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Monica Gandhi MD, MPH

@MonicaGandhi9

31 Dec 20

Back to testing and the paper from my excellent colleagues at UCSF! Mass testing campaign- Among 3,302 persons tested for SARS-CoV-2 by rapid antigen (BinaxNOW) & RT-PCR, rapid assay sensitivity 100% using RT-PCR Ct thresholds of 30- specificity 99.9%.
pubmed.ncbi.nlm.nih.gov/33367619/

This think is SUCH an important pivotal paper! Discussion "SARS-CoV-2 pandemic control calls for fast, low-barrier, high-performing field assays.. US has purchased 150 million BinaxNOWTM cards, yet ..use to date has been limited.. our data show that these tests are readily ..."

deployed in a field setting at scale for children & adults.. can rapidly identify persons with high levels of virus including thosewho are asymptomatic..leading to immediate public health action". Okay so if this has a very low false positive rate (0.01%) and high sensitivity

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Monica Gandhi MD, MPH

@MonicaGandhi9

21 Dec 20

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

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Monica Gandhi MD, MPH

@MonicaGandhi9

19 Dec 20

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 20

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 20

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 20

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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More from @MonicaGandhi9

Monica Gandhi MD, MPH

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Monica Gandhi MD, MPH

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