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Monica Gandhi MD, MPH Profile picture
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4 Apr, 4 tweets, 2 min read
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
bloomberg.com/news/articles/…
2) Being outside is safe
sfgate.com/giants/article…
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
academic.oup.com/jid/advance-ar…
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
nature.com/articles/s4159…
And another paper showing lowering of viral loads if exposure after vaccination (when nursing home resident kept on getting swabbed after vaccination)
academic.oup.com/cid/advance-ar…

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More from @MonicaGandhi9

Monica Gandhi MD, MPH Profile picture
6 Apr
Why should we not worry about VARIANTS "escaping" immunity from vaccines or natural infection; why are we not likely to need vaccine BOOSTERS? Remember immunity is both antibody and cell-mediated (CD4 and CD8 cells). Long-term immunity mediated by memory B & T cells (both get Image
stimulated if they see the virus again). We now feel secure that T-cell immunity will be preserved against variants after these 2 papers reassured us. Sette's great paper showing T-cell immunity after natural infection or mRNA vaccination preserved against biorxiv.org/content/10.110…
B.1.1.7 (UK), B.1.351 (South Africa), P.1 (Brazil), and CAL.20C (California). Means T cells generated by vaccines can readily fight these variants. 2nd paper is by Dr. Redd one showing that CD8 responses preserved despite spike protein mutations
academic.oup.com/ofid/advance-a…
Read 9 tweets
Monica Gandhi MD, MPH Profile picture
5 Apr
Let's look at CDC data on "inflection point". Is there a pattern emerging whereby those who are getting close to 40% 1st dose vax rate are seeing turn-around in cases (read below on inflection point). We've already seen hospitalizations per case decrease
threadreaderapp.com/thread/1378411…
due to vaccinations, which is why we know B117 is not creating more virulence (not more hospitalizations per case) although certainly seems more transmissible which is why you want to vax FAST with your restrictions. Data sources: beta.healthdata.gov/browse & covidtracking.com/data/state/tex…
&, Let's look at
*7 day average of cases, comparing to an earlier 7 day average, to get test/positivity rate comparison from different times during the pandemic.
*Number of days in a downward trajectory.
*Positivity rate by week for the last 6 weeks
nytimes.com/interactive/20…
Read 12 tweets
Monica Gandhi MD, MPH Profile picture
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
nih.gov/news-events/ni…
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
threadreaderapp.com/thread/1368679…
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
Monica Gandhi MD, MPH Profile picture
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)
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…
Read 19 tweets
Monica Gandhi MD, MPH Profile picture
3 Apr
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
nytimes.com/interactive/20…
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
washingtonpost.com/graphics/2020/…
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)
academic.oup.com/cid/advance-ar…
Read 7 tweets
Monica Gandhi MD, MPH Profile picture
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)
sfchronicle.com/health/article…
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
latimes.com/projects/calif…
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.
sfchronicle.com/local/article/…
Read 4 tweets

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