Monica Gandhi MD, MPH Profile picture
Apr 3, 2021 19 tweets 8 min read Read on X
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"
nature.com/articles/d4158…
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)
covid.cdc.gov/covid-data-tra…
But helpful to have WaPo tool that breaks down vaccination rates by county & I like WaPo article from yesterday that says this is a time of colliding hope and dread in the USA with excellent @bylenasun & @LennyBernstein1
washingtonpost.com/health/as-coro…
Okay, so let's now remember a few things. Israel looked like it released lockdown on Feb 7, 2021 because the hospitalizations among those who were vaccinated & those most vulnerable were so low (see figure in this paper with lockdown date)
nature.com/articles/s4157…
Oh sorry, can you see figure, here it is. So, look at 07/02 which of course means February 7, 2021 to us in the U.S. Now in next tweet look at when cases started plummeting in Israel which wasn't until March 6 or so when a certain proportion of their population vaccinated Image
Here is the figure and here is the source ourworldindata.org/coronavirus/co…
So please check out by hovering over the date to see the plummet around March 8. And look at the next tweet where I found a story from EuroNews that Israel opened its economy that day because 40% Image
repeat 40% of their population had been vaccinated. Is that the inflection point in countries with varying levels of lockdown like Israel (UK pretty locked down & didn't have this longish period where cases weren't coming down like US/Israel): 40% vax
euronews.com/2021/03/07/isr…
Okay, so let's now remember a few things. Israel looked like it released lockdown on Feb 7, 2021 because the hospitalizations among those who were vaccinated & those most vulnerable were so low (see figure in this paper with lockdown date)
nature.com/articles/s4157…
Oh sorry, can you see figure, here it is. So, look at 07/02 which of course means February 7, 2021 to us in the U.S. Now in next tweet look at when cases started plummeting in Israel which wasn't until March 6 or so when a certain proportion of their population vaccinated Image
Here is the figure and here is the source ourworldindata.org/coronavirus/co…
So please check out by hovering over the date to see the plummet around March 8. And look at the next tweet where I found a story from EuroNews that Israel opened its economy that day because 40% Image
repeat 40% of their population had been vaccinated. Is that the inflection point in countries with varying levels of lockdown like Israel (UK pretty locked down & didn't have this longish period where cases weren't coming down like US/Israel): 40% vax
euronews.com/2021/03/07/isr…
So, again, never rolled out vaccine in middle of raging pandemic before- crazy times. Usually a pandemic has to get to 50 million deaths sadly instead of 2.84 million deaths worldwide like #covid19 before vaccines came to rescue. Tipping point 40% vax rate
cdc.gov/flu/pandemic-r…
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And then what is the other tipping point- the percentage of the population that needs to be vaccinated to get to "herd immunity". Remember what herd immunity is - enough of us immune that the virus can't find enough of us to infect (too many pink sheep) & dies down to whimper Image
I don't know what that exact threshold is for herd immunity but at 58% first dose, Israel getting close. 323 cases in a country of over 9 million yesterday. At 51% first dose, UK had 3402 cases yesterday out of a country of 66.5 million. Please don't look at measles, models, etc
But look to our junior/seniors in high school (UK/Israel 58% 1st dose; 51% 1st dose) compared to us 31.4% 1st dose to see how herd immunity with play out. Israel open etc, low cases. Is it 60% herd immunity? 65% for good measure even. Don't need young kids vax to get there.
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What I mean is that number of children <=11 in US in 2020 is 23.1 (0-5) + 24.8 (6-11) million per childstats. Population of U.S. is 328.2 million so 85% of those in U.S. are >11. If herd immunity achieved at around 60-65% per above, will get there sooner.
childstats.gov/americaschildr…

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More from @MonicaGandhi9

Aug 30, 2023
HOW LONG DOES IMMUNITY LAST? To COVID vaccines or infection? We do not really know but there have been some really nice papers lately that give us more information. Please remember immunity divided into antibodies (which can come down & not work as well against variants)
IgA is one in the nose & mouth ("mucosa") that is raised by shots (vaccines) to certain extent but rise higher after natural infection; IgG is the one that is "humoral" or in the bloodstream. Many threads on here about cellular-mediated immunity: B & T cells cover all variants
This recent preprint is really important and summarized by @florian_krammer below in depth. Main take-aways: Breakthrough infections induce IgA (we knew) but protection from vaccine long-lasting even against former variants to severe disease/mortality
Read 8 tweets
May 3, 2023
RSV VACCINE FOR OLDER ADULTS: Respiratory syncytial virus (RSV) respiratory virus (most common after flu pre-COVID). 2 subtypes, A&B (1 dominates/season). Droplet; Recurrent infections. Most severe in neonates & adults >65; FDA approves 1st RSV vax today
msn.com/en-us/news/us/…
RSV vaccine 3 trials of new RSV vaccine, all published in the @NEJM recently so just to keep them straight- here is the vaccine which just got approved May 3 by the FDA for older adults. Remember our T/B cells so protection against severe disease higher!
nejm.org/doi/full/10.10…
A single dose of the RSVPreF3 OA vaccine had an acceptable safety profile and prevented RSV-related severe respiratory illness by 94% in adults>=60 years (71% against RSV infection, likely to fall with time as antibodies fall but severe disease protection will remain)
Read 4 tweets
Mar 21, 2023
NASAL VACCINES: To explain nasal vaccines, we have to explain the immune system first.
IgA is an antibody that helps attack the pathogen and exists in mucosal surfaces (like nose/mouth)
IgG is an antibody that is in the bloodstream
bbc.com/news/world-asi…
Cellular immunity is fantastic, redundant (so even if one cell line down in immunocompromised, have other), generated by either vaccine or infection; Comprised of
T cells- so in breadth from vax - works even across spike protein with its mutations
And the 2nd type of cell produced by vaccines or infection -B cell- amazing thing about B cells is that - if see omicron or one of its subvariants in future- they make antibodies adapted to that variant or subvariant (aided by T cells); adaptive immunity
Read 15 tweets
Mar 15, 2023
PUBLIC HEALTH POLICY: Seem to be at reckoning phase of COVID response- what worked, what didn't. Which interventions will be used in future pandemic responses? Interventions asked of public need good medical evidence for them (e.g. RCTs preferably, systematic reviews) to impose
In our field, Cochrane reviews represent best way to sum up the medical evidence to date by performing meta-analyses or systemic reviews of currently-available data; here is Cochrane on masks & other interventions for respiratory viruses including COVID
cochranelibrary.com/cdsr/doi/10.10…
Many asked past 3 years how CDC developed policies on masks (& age to mask), distancing (feet), ventilation, schools-> all non-pharmaceutical interventions. Originally theory-based. Now 3 years in, have data (RCTs highest level) to form policies from both US and other countries
Read 4 tweets
Mar 6, 2023
VACCINE DISCRIMINATION: We need to stop vaccine requirements for US entry like almost every other country. Am finishing COVID chapter for our ID "bible" & vaccines prevented transmission early on with alpha, but not enough now with current variants to justify such discrimination
Moreover, shame, stigma, blame (remember COVIDiots?), coercion, discrimination not good public health tools. When used for HIV, public health & ID physicians decried them but tactics used a lot in COVID. This book tries to explore & correct that for future
barnesandnoble.com/w/endemic-moni…
Concept of #harmreduction in pandemic responses means watching carefully if vulnerable people (like students, older people, low-income populations, migrants, sex workers, prisoners, those with disabilities, refugees, minorities) harmed more by response
nature.com/articles/s4146…
Read 4 tweets
Feb 8, 2023
FEAR: Some media & public health officials concerned Americans aren't fearful of COVID now. But the vaccines & therapeutics DO WORK. If we can't celebrate biomedical advances & imbibe their effectiveness (we have better tools for COVID than flu), what is point of developing?
In HIV medicine, when therapies came out, we didn't say to people- stay fearful; make this the controlling principle of your life. The book #Endemic I wrote (coming out July 11, 2023) hails these biomedical advances & the age we are in to fight pandemics to reassure the world
This is a rather brilliant summary of the issue from @benryanwriter
Read 4 tweets

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