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Céline Gounder, MD, ScM, FIDSA Profile picture
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13 Apr, 4 tweets, 2 min read
1/ Agree with @CDCDirector @RWalensky and former CDC Director @DrTomFrieden. You can't vaccinate yourself out of a COVID surge. Vaccination works well to PREVENT a surge.
nytimes.com/2021/04/12/us/…
2/ Can we predict where the next surge will be? It may be too late for Minnesota, Illinois, too. Should we send more vaxx to the NE, where transmission is also up? If there's a seasonality or geography to this, will the southern states be next (like last summer)?
3/ Unless we can predict and get ahead of a surge, it doesn't make sense to reallocate vaccine supply.
4/ One could argue for allocating vaccine supply on the basis of disease burden... not disease burden now, but # of COVID cases in a zip code over the past year. That would be more equitable and reflect risk of transmission (vs allocating just based on population/head count).

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More from @celinegounder

Céline Gounder, MD, ScM, FIDSA Profile picture
15 Apr
1/ Apologies for not posting this sooner. I've been tied up juggling multiple jobs (Bellevue + media + congressional testimony + other), but I think it's important to get this out there now. I could have last night, but...
2/ The Food and Drug Administration and Centers for Disease Control and Prevention called for a pause on use of the J&J vaccine in this country. Six cases of blood clots have been reported among a million women between the ages of 18 and 48 who have received the vaccine.
3/ To put this in context, women who are not taking birth control pills have a 1 to 5 in 10,000 per year risk of getting a blood clot. This risk increases by more than 4x during and immediately after pregnancy.
Read 35 tweets
Céline Gounder, MD, ScM, FIDSA Profile picture
14 Apr
1/ I have counseled patients on:
- why they need to keep taking their tuberculosis antibiotics for months
- why they need to get tested for HIV or sexually transmitted infections
- why they should take pre-exposure prophylaxis for HIV or antiretroviral therapy
2/ I have worked throughout sub-Saharan Africa and spoken with religious leaders, teachers, community health workers, youth, journalists, activists, and politicians.

e.g. why didn't Guineans & other West Africans think Ebola wasn't real? Because they didn't trust the government.
3/ Analytic methods only take you so far. The math we use in epidemiology and economics, for example, is essentially the same. What's different is an understanding of the context, and that comes with experience on the ground, working with people.
Read 4 tweets
Céline Gounder, MD, ScM, FIDSA Profile picture
13 Apr
1/ It's really important that the FDA & CDC informed healthcare providers about the VERY RARE risk of blood clots after vaccination with J&J vaccine.
theatlantic.com/science/archiv…
We normally treat blood clots with heparin, but heparin can make things worse and even be deadly here. Image
2/ I'm not too worried about the latest news about the J&J vaccine will mean for the U.S. We'll have plenty of Pfizer and Moderna vaccine to vaccinate all Americans. I'm worried about what this could mean for the rest of the world. Image
3/ It's essential that the CDC and FDA prove themselves trustworthy. Worries about vaccine safety and efficacy and a lack of trust in the health system and government drive low confidence in vaccines. Image
Read 4 tweets
Céline Gounder, MD, ScM, FIDSA Profile picture
11 Apr
1/ Michigan is facing a surge in COVID cases due to
- the more infectious & virulent B.1.1.7 variant
- less masking, more indoor gatherings
- travel
Young adults hospitalized for severe COVID.
nytimes.com/2021/04/10/us/…
2/ But I'm not sure that surging vaccine supply to Michigan will help now.

People are misapplying the concept of ring vaccination, an important tool in smallpox eradication, to COVID.
3/ There's value in giving smallpox vaccination even AFTER exposure.

But the median incubation period for smallpox is 10-14 days.

The median incubation period for COVID is 4-5 days.
Read 4 tweets
Céline Gounder, MD, ScM, FIDSA Profile picture
8 Apr
1/ To delay 2nd doses of the Pfizer and Moderna COVID vaccines (like the UK, Germany, & Canada)?
usatoday.com/story/opinion/…
Or not to delay?
thinkglobalhealth.org/article/dont-b…
That is the question.
2/ Where there is this much disagreement among experts (BTW, some arguing for delaying 2nd doses are some of my favorite people!) and the stakes are this high, not only for individuals but also for populations, the only way to resolve the question is through empirical study.
3/ Agreed, though I think deaths will be blunted by our having vaccinated many of the highest risk (i.e. residents of long-term care facilities and people 65 and older).
Read 50 tweets
Céline Gounder, MD, ScM, FIDSA Profile picture
2 Apr
1/ And... I'm back off the fence.
One dose of Pfizer vaccine useless against B.1.351 and significantly less effective against B.1.1.7.
Two doses of Pfizer vs B.1.351 better.
pubmed.ncbi.nlm.nih.gov/33772244/
2/ I think I am more worried about B.1.351, P.1, and vaccine-evading variants.
3/ I think we have enough vaccine supply in the U.S. right now. 205M doses delivered and almost 158M doses administered. Delaying for 2nd doses is solving for the wrong problem if you're trying to speed up vaccination and get more of the population covered.
Read 4 tweets

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