I have idea that could decrease cases right now in states that have increasing cases, which is to switch to giving out the 1st dose now & wait on 2nd dose to immediately expand number vaccinated in each of those states now. Let me explain: map of US cases
Here is the WaPo tracking site on vaccination rates by county. 4 reasons for giving 1st dose now in those counties & waiting on 2nd are 1) "Based on immunologic principles, sensitization with single doses would still allow boosting with a 2nd dose
several months later" (please see great Dr. Plotkin article). 2) "B-cell memory after mRNA vaccination has been clearly demonstrated, which supports the idea that antibodies will be boosted by a second mRNA dose given months later" (remember B cell paper)
3) "Priming of the immune system generates good responses to second doses of most vaccines for at least 6 months and perhaps longer" 4) "three doses of hepatitis B vaccines administered at yearly intervals were equally effective as the recommended 1-, 2-, and 6-week schedule".
The AZ vaccine shows us that longer between doses the better for immunogenicity & shouldn't be any different for mRNA or J&J vaccines.
And finally, a really nice article that explains to us that giving 1 dose now and 2nd later won't make virus more likely to escape immune response but, instead, will "slow the rate of viral escape from vaccine or naturally induced immunity".
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More from @MonicaGandhi9

4 Apr
Wanted to address question of "should I get vaccinated if I have had #covid19"?. Fair question given that immunity likely long-lived from natural infection per this study from Drs. Weiskopf, Sette, & Shane Crotty from the La Jolla Institute for Immunology
And other evidence laid out in this thread. However, I would take the vaccine (1 dose) if I had COVID-19 in the past personally. Why? Because I hate COVID and vax can serve as major immune response booster when a virus is still circulating at high rates
See difference between now & any other time in history is that we are giving out vaccine AS CASES are still circulating high rates. So unprecedented! In fact those who had chickenpox as child (like me, I am old enough!) were not offered VZV vax because I have natural immunity
Read 6 tweets
4 Apr
4 reasons Giants stadium should not ask for random testing of fans in SF to come to games (fans have to pay for their tickets and tests too!):
1) Masks, distancing, ventilation (being outside!) work
2) Being outside is safe
Remember, outside transmission is rare (20x less than inside transmission and likely much less). In fact, the WHO does not even recommend masking outside unless you can't distance and the Giants stadium is planning on masks, small pods
3) We are all getting vax or at least whoever wants vax >16 can get one as of April 15. We have learned by now that your viral load in your nose if you have exposure after vaccination is very low and non-infectious. Fans + noninfectious test = anxiety
Read 4 tweets
3 Apr
Still trying figure out that "inflection" point where vaccines given out enough to population that cases decrease (again, irrespective of lockdown in a way, right, because nursing homes very locked down in US & cases plummeted after vaccine roll-out reached certain threshold) Image
This article in Nature from very early on in the Israel roll-out (they were far & away ahead of us by then though), says "You need to vaccinate much more than a third of the population to really see a reduction in transmission"
US is right now at 31.4% first dose, 18% fully vaccinated per CDC vaccine tracker but that of course wildly fluctuates per county & state since our public health system is so local-based (federal responses work better in pandemics but not how US built)
Read 18 tweets
2 Apr
4th surge in California unlikely to happen because of 1) our natural immunity with likely more than 30% of naturally infected given this seroprevalence study + 2) our rate of vaccination is high and going well (more than national average)
In fact, 31.4% of Californians have received a first dose This is why I think Gov Newsom will lift state mask mandate by its 1-year anniversary (June 18) since that is the best time to lift a mask mandate- when everyone who wants vax fully vaccinated
So, in response to that, state has opened up more events like sports, indoor concerts, etc. in response & based on very low cases in California, seems very reasonable to me.
Read 4 tweets
2 Apr
Michigan - let's look closely at their data here. Look at hospitalizations by age. Currently, COVID hospitalizations are less than the 2018-2019 Flu Season, especially telling in the 65+ Age Bracket
COVID-Net -- MMWR Week 11 -week of 3/20/21
Overall -- 8.0 per 100k
18-49 -- 4.3 per 100k
50-64 -- 11.0 per 100k
65+ -- 22.8 per 100k
2018-2019 Flu Season- MMWR Week 11 -week of 3/16/19
Overall -- 8.3 per 100k
18-49 -- 2.6 per 100k
50-64 -- 14.7 per 100k
65+ -- 23.5 per 100k
Michigan hospitalizations from COVID-19 now mimicking those from flu two years ago represents "defanging of the virus" with vaccines among older. Would recommend faster vax:
Here were the cumulative vax rates as of March 27, 2021 from the WaPo Vax County Tracking Map:
Read 8 tweets
2 Apr
Want to tweet more good news about hospitalizations in US and effect of vaccines. Data source here. I am sad today. Every time you are given some good news (vaccines stop transmission; T cells work against variants), someone tries to frighten you again.
Okay so remember I told you that there was an "inflection point" in Israel at which cases started coming down with a certain rate of vaccination? And of course hospitalizations were not occurring in those vaccinated. So, let's look at U.S. and compare
3/31/21 vs. 2/24/21:
In the last 7 Day Cases reduced by -4%
Last 7 Day Hospital Admissions reduced by -24%
U.S. Total Inpatient Hospital Beds reduced by -39%
U.S. Total ICU Hospital Beds reduced by -43%
(All data broken down, below by age- it's crazy how well the vaccines work)
Read 10 tweets

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