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Monica Gandhi MD, MPH Profile picture
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13 Mar, 7 tweets, 3 min read
This is my last tweet on SF school openings since Pediatrics ID Division at UCSF is taking on science-based approach to this. I know parents trust pediatricians to do what is best for children. Clearly, pediatricians want children/staff to stay healthy
sfchronicle.com/education/arti…
But poignant article from teen about how hybrid school can feel like compared to full in-person learning which can be informed by safety measures (3 feet distance - see academic.oup.com/cid/advance-ar…, masks, opening windows as we get into spring).
washingtonpost.com/opinions/if-th…
But I will give you an example from a clinic where I serve as medical director in SF. We were instructed by city to shut down for non-essential in-person visits on March 17 and soon found our vulnerable patients, SFGH with digital divide issues, marginal
journals.lww.com/aidsonline/Ful…
housing did not fare well with telehealth; needed in-person care for many especially those who were marginally housed. Otherwise, we were seeing virologic suppression rates in our clinic drop as above & we knew how terrible that was for our vulnerable HIV patients. So, we
maintained masks by staff & patients, distancing (3 feet), opened our windows in our outdated building (!) - no ventilation system and saw our patients in-person. And we had no #covid19 transmission but did help our patients (even vulnerable homeless)
journals.lww.com/aidsonline/Ful…
maintain health goals, virologic suppression, primary care goals. We are proud at Ward 86 we worked hard to see patients, maintain our safety and help navigate this pandemic with a focus on other health concerns. Now, SF has HIV on priority list for vax!! Thank you @SF_DPH !
Mask, distancing, simple ventilation and asking people to say home when sick (with good sick leave policies) work and allow society to function until we get to mass vaccination, herd immunity which we are approaching
academic.oup.com/ofid/advance-a…

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More from @MonicaGandhi9

Monica Gandhi MD, MPH Profile picture
14 Mar
I see there is a circulating concern here that SARS-CoV-2 will mutate into a more virulent virus from vaccines. That is not what usually happens. The reason that #HIV researchers/physicians think about mutations/variants a lot is that HIV's polymerase
journals.plos.org/plosbiology/ar…
has a very high mutation rate. SARS-CoV-2 and other coronaviruses on the other hand don't actually mutate that fast; their polymerase has a high fidelity to "proofreading" when they mutate. You just have been hearing about mutations lately in news.
pubmed.ncbi.nlm.nih.gov/21593585/
HIV doctors think about mutations a lot because HIV mutates readily to evade medications we use commonly so we have to always think about how to combine medications for HIV to avoid or overcome those mutations. But mutations come with a cost to virus
jvi.asm.org/content/81/6/3…
Read 4 tweets
Monica Gandhi MD, MPH Profile picture
13 Mar
Thread on transmission after vaccination without references since put in my previous thread- we may be determining our ideas on transmission after vax from rotavirus & other viruses without looking at unique features of SARS-CoV-2 & all the real world data we have:
While the clinical trials for the vaccines were not designed to assess whether vaccines reduced asymptomatic infection (and, thereby, transmission), there is biological plausibility that the antibodies and T-cell responses blocking symptomatic disease will also block asymptomatic
infection in the nasal passages. IgG immunoglobulins (generated and measured by the vaccine trials) enter the nasal mucosa. Moreover, SARS-CoV-2 vaccines also generate IgA (immunoglobulins at mucosa surface) which protect nasal passages from infection
researchsquare.com/article/rs-310…
Read 10 tweets
Monica Gandhi MD, MPH Profile picture
12 Mar
Reviewing this paper again gives us 2 insights on why #covid19 seem so good at 1) reducing transmission (multiple studies now) & 2) likely to give long-last immunity. In terms of #1, protection against mucosal (e.g. nasal) asymptomatic infection
researchsquare.com/article/rs-310…
researchers have commented to you - it would be nice if vaccines make IgA antibodies. IgA antibodies are those that predominantly protect us against nasal infection/colonization but weren't measured in vaccine trials. This study shows vaccines induce plasmablasts which make high
levels of IgA after vaccination. So likely why we are seeing so many incredible real-world example that asymptomatic infection so reduced after vaccination & why CDC said no quarantine (ergo testing) if you are exposed after vaccination (if asymptomatic). No need for teachers
Read 6 tweets
Monica Gandhi MD, MPH Profile picture
12 Mar
Great discussion today with me, Dr. Paul Offit, @EricTopol, @DrOnyemaOgbuagu and me on the 1-year anniversary of the date WHO declared @covid19 a pandemic about "COVID-19 Vaccines and the Return to Life".@leaps_org and @aspeninstitute
leaps.org/covid-vaccines…
Still working on recording but highlights we all agreed upon
-@DrOnyemaOgbuagu and I agreed how amazing it was to work in a hospital as ID doctors and to see the plunging hospitalization rates from #covid19 (we had 1 admission last week) in real-time from vaccines
-We agreed with
@EricTopol on his coined term of "scariants" for variants and were reassured by falling numbers in S. Africa, despite the scary variant.
-We reviewed the accumulating data of viruses reducing asymptomatic infection and @DrOnyemaOgbuagu and I agreed the CID paper I tweeted this am
Read 6 tweets
Monica Gandhi MD, MPH Profile picture
11 Mar
Wonderful article that puts 3 feet vs 6 feet issue to rest in schools (e.g. 3 ft fine for distancing if teachers not vaccinated, then likely less). WHO recommends 1 meter for distancing (3.28 ft), rumor is we miscalculated that to 6 feet! Study from MA
academic.oup.com/cid/advance-ar…
that looked at public schools in the state that opened with any in-person learning in fall 2020. Data was from publicly available district infection control plans & variables of interest were school model type (full in-person or hybrid), physical distancing of ≥3 versus ≥6 ft,
masking policies, ventilation upgrades if done and (sigh) disinfection protocols even though this is spread by respiratory route and not surfaces. Because of practicality in public schools, minimum of ≥3 feet of distancing often put into infection control plans. SARS-CoV-2
Read 5 tweets
Monica Gandhi MD, MPH Profile picture
9 Mar
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
Read 4 tweets

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