Sobering article on how there will be a wave of disability & death from other chronic diseases after pandemic (happened in 1918 too). Will be tempting to keep testing asymptomatic after vax, but must turn attention to other health conditions after mass vax
medscape.com/viewarticle/94…
White House reports 88,000 overdose deaths during this pandemic (San Francisco has had 3 times as many overdose deaths than those from COVID-19 during pandemic). Another sobering reality of this painful time.
healio.com/news/primary-c…
And great article about @DrLeanaWen about the epidemic of obesity in US & its increase in the pandemic: "concerning study in which 42% of people self-reported gaining weight since the pandemic began; average addition was 29 lb; 10% reported gaining >50lb"
washingtonpost.com/opinions/2021/…
By the way, not new. Same thing happened after the 1918 influenza pandemic. See this article about rates of heart disease that followed 1918. This was partially related to stress. Any state with low #covid hospitalizations now - turn to other diseases too
ncbi.nlm.nih.gov/pmc/articles/P…
So, which states have hospitalizations that are low from COVID and can turn to other diseases too? 39 have rates lower than that of flu (<20 hospitalizations per 100K) and 14 have rates lower than 10 hospitalizations per 100K from #covid19 (including CA).

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More from @MonicaGandhi9

13 Apr
Rare side effect after J&J vaccine. 6 cases of blood clot called cerebral venous sinus thrombosis (CVST) among women between the ages of 18-48, with symptoms between 6-13 days after vaccination. Out of 6.8 million doses given (0.00009%). U.S. pausing statnews.com/2021/04/13/u-s…
222 cases of CVST out of 34 million people with AztraZeneca vaccine reported as well (0.00006%), most cases in women under 55 years. Of note, both J&J vaccine and AZ vaccine are adenovirus vaccines with DNA coding for spike protein inside them.
sciencemag.org/news/2021/04/h…
Both extremely rare (0.0000006-0.000009) so please first keep that in mind. Postulated mechanism here - syndrome called vaccination immune thrombotic thrombocytopenia (VITT). All patients with low platelets (thrombocytopenia) & unusual clots (thrombosis).
nejm.org/doi/full/10.10…
Read 9 tweets
11 Apr
Good news. Vaccines defanging virus. Public data showing reductions in hospitalizations among those who got vax first (older) very prominent. U.S. Total, Last 7 Days Hospital Admissions, 4/9/21, 37,519 vs. 45,003 2/24/21, -17% (7.5k reduction)
healthdata.gov/Health/COVID-1…
Hospitalizations per case (H/c) ratios:
70+ 4/9/21 9,741 vs. 2/24/21, 17,019: -43% (7.4k reduction)
60-69 4/9/21 7,464 vs. 2/24/21, 9,310: -20% (1.8k reduction)
50-59 4/9/21 7,100 vs. 2/24/21 6,677 or +6% (0.4k increase)
40-49 4/9/21 4,587 vs. 2/24/21 3,975 or +15% (0.6k increase
30-39 4/9/21 3,396 vs. 2/24/21 2,885: +18% (0.5k increase)
18-29 4/9/21 2,363 vs. 2/24/21 2,139:+8% (0.2k increase)
Under 18 4/9/21 843 vs. 2/24/21 1,020: -17% (0.2 reduction)- phew
Unknown, 4/9/21 2,120 vs. 2/24/21 1,919:+10% (0.2 increase)
Read 7 tweets
11 Apr
Another study showing re-infection rare after natural infection. "Establishing whether reinfection is typically symptomatic or asymptomatic, whether reinfected individuals are infectious, and expected duration" of immunity from infection vs vax paramount
thelancet.com/journals/lance…
From awesome SIREN study, which is prospective cohort study in staff working in NHS hospitals across UK (giving us great info about vaccine effectiveness too). Lancet asked for "prior evidence" before this study & re-infection up to Nov 15, 2020 rare - 24 documented infections.
25,661 participants with linked data on antibody and PCR included. If had prior infection (documented by antibodies, T cells not measured), re-infection rare. 1859 new infections: 1704 in the negative cohort & 155 reinfections in the positive cohort. Symptoms among re-infections?
Read 6 tweets
9 Apr
We proposed metrics when restrictions could be safely lifted in states- which are1) high rates of vaccination & 2) getting down to 5 hospitalizations per 100,000. Wanted to list where each state is in hospitalization metric (surge vaccine to those highest) washingtonpost.com/outlook/2021/0…
4/3/21 HHS COVID-19 Patient Impact and Hospital Capacity by State Report and COVID Tracking Project (for pandemic peaks):
Total U.S. Total: 15 hospitalizations per 100k; peak of pandemic was 64 per 100k, as of 4/3/21 we are at 23% of the pandemic peak
MI: 34 per 100k; peak of pandemic was 54 per 100k so at 63% of pandemic peak
DC: 33 per 100k; peak was 84 per 100k so at 39% of pandemic peak
NY: 32 per 100k; peak was 123 per 100k so at 26% of pandemic peak
NJ: 31 per 100K; peak was 116 per 100k so at 27% of peak
MD: 27 per 100k
Read 13 tweets
7 Apr
Let's talk B117 and why I don't think this variant is going to deter our progress. What are 3 things you worry about with a variant? 1) Increased transmissibility; 2) Increased virulence; 3) Can escape immunity from your vaccine (or natural infection). Let's take them 1 at a time
1) Increased transmissibility: There is lab data showing higher viral loads with this variant in nose so could be more infectious. However please look at epidemiology on world stage and in U.S. to make your decisions. UK tamped down virus with vaccines with 90% of their strains
being B117 and never saw their dreaded surge once vaccine roll-out started; 2) Israel started rolling out vaccine with 80% of strains being B117, saw surge as we are seeing in some states here (will get to that in min.) but then tamped down with vaccine
pfizer.com/news/press-rel…
Read 22 tweets
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
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 14 tweets

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