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Monica Gandhi MD, MPH Profile picture
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9 Mar, 4 tweets, 2 min read
Taking break from @CROI to tell you one thing from @CROI regarding COVID-19 medication (since tweeting for me is only for COVID-19 and can't WAIT until this is over, which is soon). Med is molnupiravir and is general antiviral (makes virus mutate; btw,
medscape.com/viewarticle/94…
viruses cannot mutate too much or they mutate themselves out of fitness; a key point when you worry about variants). In this phase 2a RCT, 202 adults with outpatient SARS-CoV-2 randomized (not 1:1:1 though) to 200 mg, 400 mg; or 800 mg of molnupiravir. Pill twice daily x 5 days
and then followed x 28 days with PCR swabbing at 3, 5, 7, 14, and 28, with sequencing and culture. 182 had swabs that could be evaluated, of which 78 had infection at baseline. By day 3, 28% of patients in the placebo arm had SARS-CoV-2 in their nasopharynx, compared to 20.4% of
patients receiving any dose of molnupiravir. Day 5-no participants on molnupiravir had SARS-CoV-2 in their nasopharynx, but 24% of people in placebo arm still had detectable virus. Phase 3 study next. Intriguing. Though please get vaccine.

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More from @MonicaGandhi9

Monica Gandhi MD, MPH Profile picture
9 Mar
Can't imagine a more pressing issue of the day as to get schools open full-time for children. This op-ed I wrote with the excellent @TracyBethHoeg and @doctortara stresses that the CDC misinterpreted their own MMWR-published study on WI schools in guidance
usatoday.com/story/opinion/…
Four points:
1) Children are not at significant risk of poor outcomes from COVID-19. As of March 3, 2021, 286 children have died from COVID in the U.S. (similar to number who die of influenza) compared to >520,000 adults. MIS-C rare, treatable
2) Viral spread in schools
with appropriate mitigation rare. Dr. Hoeg led study of > 4,876 grade K-12 students & 654 staff members in Wisconsin school districts in the fall of 2020 during time of high community prevalence (up to 41.6% in the community). during the study. Despite majority of ventilation
Read 6 tweets
Monica Gandhi MD, MPH Profile picture
7 Mar
How long will immunity from COVID-19 vaccine last? Let's remember from papers tweeted before, immunity from natural infection & vaccinations across viruses lasts long. Remember: survivors of 1918 flu: memory B cells can stimulate Abs to fight same strain
nature.com/articles/natur…
Then immunity from pertussis, measles vaccinations lasts long long time - look at those T-cells (CD4 and CD8) from measles vaccination continue strong, measured out to 34 years after vaccination
ncbi.nlm.nih.gov/pmc/articles/P…
Then let's turn to the RNA viruses that are coronaviruses (influenza, measles both RNA viruses too). There are coronaviruses that cause colds (229E, NL63, OC43, HKU1) for instance & coronaviruses (SARS-CoV-1, MERS) that - like SARS-CoV-2 cause more severe symptoms. Behooves us to
Read 15 tweets
Monica Gandhi MD, MPH Profile picture
7 Mar
hi - will be posting thread on how long immunity should last to vaccine later today & then off twitter x 3 days due to huge HIV meeting! But wanted to make one plea to #covid19 experts. It behooves us to look at vaccine clinical trial data carefully and memorize every detail. BUT
let's incorporate data from real-world roll-out that is coming in droves when we discuss the vaccines on 2 points: 1) Transmission: Already tweeted all those papers/analyses from real-world (NEJM, Lancet no slouches!) that asymptomatic infection reduced after vaccines.
2) Real-world data since trials has shown repeatedly that severe disease/deaths plummeting in populations who are vaccinated. So, if one is concerned about sample sizes in the clinical trials for a secondary outcome, incorporate that data!
Read 4 tweets
Monica Gandhi MD, MPH Profile picture
6 Mar
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
Read 10 tweets
Monica Gandhi MD, MPH Profile picture
2 Mar
What are 3 immediate consequences of vaccines preventing asymptomatic infection (e.g. prevent forward transmission?): 1) vaccinated told they don't need to quarantine by CDC after exposure; 2) schools don't need distancing after teacher vax; 3) I would discourage surveillance
testing of asymptomatic individuals after vaccination with PCR tests. Why? Let's remember reason we do asymptomatic screening-to prevent transmission to others. A vaccinated person is safe from symptomatic infection so won't need routine screening for SARS-CoV-2 unless symptoms
Hope the data that, after vaccination- if you are exposed to SARS-CoV-2- the viral load in your nose will be low is convincing to you (two papers: medrxiv.org/content/10.110…
medrxiv.org/content/10.110…). If so, then you don't want to use a high sensitivity test like PCR for surveillance
Read 4 tweets
Monica Gandhi MD, MPH Profile picture
2 Mar
Two arms of the immune system- antibodies (from B cells) and T cells (two types, cytotoxic T cells or CD8+ and helper T cells or CD4+). Th1-CD4 cells and CD8 cells are the main immune defenses against viruses. Antibodies will rise & fall with time (depending on severity #covax1
Paper looked at SARS-CoV-2-specific CD4+ & CD8+ T cell responses from those who had natural infection with non-variant, compared to variants B.1.1.7, B.1.351, P.1, CAL.20C. Also looked at those vaccinated with Pfizer/Moderna against variants #covax1
biorxiv.org/content/10.110…
Several of these variants can affect antibody binding and function (either monoclonal or polyclonal), especially B.1.351 & P.1 (remember prevalence in J&J trial where severe disease outcomes unaffected). T cell responses affect disease severity, #covax1
sciencedirect.com/science/articl…
Read 9 tweets

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