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Monica Gandhi MD, MPH

@MonicaGandhi9

17 Jan

Oh dear. I didn't read the post that had incited such confusion on here from a fellow scientist because I think polemics against fellow scientists is unmerited but I am beginning to get a hint that she slandered me (which happened before on a hypothesis our group had that reduced

viral #inoculum reduces severity of disease). I will take a small break from Twitter now as I have so much work. But please remember this. Scientists usually write academically and their "fame" is very circumscribed within academic circles & they usually don't get listened to

by anyone else! So, it is tempting and exciting to become "famous" in a pandemic and be listened to by so many. And any scientist right now is as lonely and miserable as anyone else during COVID-19 because we are all human and connection is a part of human existence. So, that

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Monica Gandhi MD, MPH

@MonicaGandhi9

17 Jan

I am confused by twitter flurry. Let me message very clearly. Only healthcare workers and residents of long-term care facilities (and not all) will be mass vaccinated soon. After vaccination (3-4 weeks after 2nd dose), what two vaccinated people do around each other

is unlikely to be dictated by public health (safe). The vaccinated person (e.g. a health care worker) should mask/distance from their unvaccinated patients and out in public until mass vaccination is achieved for those unvaccinated. This is why getting more and more vaccinated

is the more important thing we can do right now. Nothing else is this important. Yes, the Moderna phase 3 trial data (Table S18, NEJM paper) and the Aztrazeneca/U of Oxford data (LD/SD group, Lancet paper) shows decrease in asymptomatic transmission, as does Israel real-world

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Monica Gandhi MD, MPH

@MonicaGandhi9

16 Jan

I am going to make time later today to please write out the history of measles to this group as I think it will be illustrative. We do not test for "asymptomatic infection" in ID for other viruses because they generally spread from person-to-person when they are symptomatic

(e.g. influenza which you know well; SARS, MERS - the 2 earlier coronaviruses that caused severe disease in humans in 2002-3, 2012 but went away from syndromic surveillance). Once there is a herd immunity reached from COVID-19 from widespread vaccination (& natural infection)

there would be no reason to test asymptomatic individuals anymore to see if they have SARS-CoV-2 in their nose and should isolate from others because vaccination prevents 95% (95%!) of symptomatic COVID-19 and nearly 100% of severe illness. Mass testing will cease after mass vax

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Monica Gandhi MD, MPH

@MonicaGandhi9

15 Jan

Wanted to summarize my favorite article which gives us data on how long immunity to natural infection or vaccination is expected to last (hint: years). Had chance to look at closely (sorry picture shows sperm, that is not related!). Dan J. Science. science.sciencemag.org/content/early/…

okay, so to remind us, there is innate immunity (non-specific immune response to infection that can actually get us in trouble with COVID-19 if too much) and adaptive immunity (humoral means antibodies; long-lived memory cells are B cells and T cells (CD4+ and CD8+) that will

protect us if we see the infection again. This study looked at 188 (80 male; 108 female) patients recovered from COVID-19 (93% mild; 7% hospitalized) over 8 months. Longitudinal samples assessed circulating antibodies, memory B cells, CD8+ T cells, and CD4+ T cells

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Monica Gandhi MD, MPH

@MonicaGandhi9

14 Jan

Johnson&Johnson published results of phase I/II study of vaccine today. This trial not designed to look at vaccine efficacy yet (not high enough #'s enrolled) - just safety & "immunogenicity" (defined by antibodies but we know memory T/B cells last long)
nejm.org/doi/full/10.10…

J&J product also an adenovirus vector (replication-incompetent so won't give you cold!) encoding FULL-LENGTH spike protein of #SARS-CoV-2. Like the full length so that pesky mutations shouldn't get in way. Enrolled in Belgium/U.S. and cohorts given either low dose or high-dose

vaccine, either 1 or 2 doses given 56 days apart. 805 people evaluated. Bottom line? Safe with 40% injection site reactions; very mild other reactions. Neutralizing-antibody titers in 90% on day 29 after the first dose, 100% by day 57 (2nd dose increased titer). Also measured

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Monica Gandhi MD, MPH

@MonicaGandhi9

13 Jan

Ok, let's do thought experiment. Why is #COVID-19 terrible and wreaked havoc? Because it can cause severe disease in some (vulnerable) unlike its cousins- the coronaviruses that cause colds. Say you don't believe the suggestive AztraZeneca nor Moderna data that shows asymptomatic

infection reduced. Say you don't think there is biological plausibility that a robust immune response blocks nasal infection. However, with vaccine >95% of population did not even get symptoms from COVID and nearly 100% did not get severe disease.

You have just turned this new virus into even less than a cold. How can we not be messaging hope and optimism after mass vaccination and pushing as hard as we can go get there? How can we not be messaging close contact after mass vaccination, crowds, in-person, etc.?

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