Thread by @MonicaGandhi9

I see new debate is going to be whether the fact that the severe disease outcomes from #COVID19 occurred in the placebo arms (not vaccine) is notable or not, including biostatisticians on secondary outcomes & powering. You may see a bent on here from #MDs who are very happy

about this as they are the ones who worked in the hospital this year. But let's actually discuss for a minute why rolling out a vaccine in the middle of a pandemic is SO different than previous pandemics. You see on timeline above that 1st flu vaccine was introduced in 1936

18 years after the influenza pandemic. Vaccine not rolled out smack-dab in midst of pandemic before this! And look what is happening in UK with such fast roll-out of 2 mRNA vaccines AND an adenovirus/DNA vaccine (AstraZeneca) that also (like J&J) doesn't have the same efficacy

against mild disease as the mRNA vaccines. However, by providing their country THREE vaccines (like the US has now done by adding J&J), their route to herd immunity is going so much faster than here. So, understand Detroit Mayor and others concerned about J&J but our

each of our immunity is informed by immunity in the population so let's consider the lessons of the UK while we argue too much (as we always do!) in the US. Finally, I have realized why MD perspective so different than PhD on twitter: if you are seeing patents, you

HATED severe disease from #covid19 and are delighted by the ability of these vaccines to defang the virus. You also see patients in your clinic whose depression, anxiety, misery, loneliness has been so incredibly awful during this time of lockdown & you want diseases, not cases,

to drive our decisions on alleviating the conditions (lockdown) that led to this pain. So, I am providing context for you why an MD's perspective may be different than a PhD epidemiologist on twitter who has numbers and p-values but not patients in their heads. And then please

all decide what you think is important in a society and what should drive what happened this last year to cause so much collateral damage- from my perspective, it was severe disease from #covid19. Fine to disagree! And that is my position on J&J vaccine.
wired.com/story/covid-19…

So going to deviate from some colleagues here and look at hospitalizations from #COVID19 with vaccine roll out as my FIRST metric when I wake up in morning to see how things are going (not cases): so amazed to see the trajectory in UK & Israel. Nothing better than real-world lab!

And I do recognize that UK still has restrictions which makes sense to me as vaccines roll out to keep transmission down as much as possible as you are applying veneer of final solution which are vaccines. Same with California, gradual easing over time with roll-out vaccines