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Monica Gandhi MD, MPH Profile picture
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17 Apr, 7 tweets, 2 min read
Researchers have put together paper from publicly-available databases in US (waiting to hear back from journal) confirming what these two Lancet-based articles showed us last week, that B117 not more virulent in US. CDC today
thelancet.com/journals/lanin…
& thelancet.com/journals/lanpu…
added denominators to estimation of variants to come up with a %. Not making case that the variants are more virulent based on hospitalization data (from 4 week sampling period ending 3/27/21). See data below: 1st number for each state: COVID cases per 100k as of yesterday's
Okay, here is data. 1st number hospitalizations/100K now; 2nd number hospitalizations/100K at peak; 3rd number % B117 in state now that CDC has added denominators. See how % B117 not corresponding to virulence now that we know percentages? (and some states surging; some not)
State current hosp/100K Peak hosp/100K %B117
TN 14 64 60.5%
MI 46 54 59.6%
MN 15 40 55.6%
FL 18 71 52.2%
GA 12 71 45.6%
TX 14 73 42.7%
MD 25 40 /39.0%
LA 7 56 34.4%
NJ 27 116 32.8%
VA 12 44 30.7%
IL 17 68 30.1%
Do you see the no rhyme or reason aspect about % B117 &
hospitalizations? Likely surges at present have to do with low natural immunity + low rate of vax at first. Would definitely surge vaccine to high case states as those not yet vaccinated are those in hospital. Need this life-saving intervention & solution
bridgemi.com/michigan-healt…

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More from @MonicaGandhi9

Monica Gandhi MD, MPH Profile picture
19 Apr
Breakthrough infections by CDC. If we take out 29% of the 5814 who were asymptomatic, the rate of breakthrough infection is actually 0.00005 (or 0.005%). That is amazing! I took out asymptomatic infection because those actually show vax works: IgA in nose
cdc.gov/vaccines/covid…
limits replication & keeps viral load low so can't transmit (multiple articles below). For instance careful contact tracing of 39 breakthrough infections in Sonoma County last week showed no transmission!
nature.com/articles/s4159…
medrxiv.org/content/10.110…
academic.oup.com/cid/advance-ar…
And please remember that is vaccine effectiveness (how do they work in real world?) under "stress conditions": we still have high cases in some areas, variable mask wearing, people have to work, etc. So should see very little breakthrough (with symptoms) in places with low cases
Read 4 tweets
Monica Gandhi MD, MPH Profile picture
18 Apr
How is US doing? 44 states doing well. In HHS/CDC/ASPR Report, 6 States have almost 50% of Confirmed COVID-19 Admissions in the last 7 days; these states represent 26% of the U.S. Population (MI, NY, FL, PA, NJ, IL). Reason such a mix of caution/optimism on the news.
Most of this still in Michigan although they have now reached peak hospitalizations and are coming down. Less natural immunity, B117 (but not all explained by that, see thread yesterday), seasonality?, vax rate slow in some counties esp at first
clickondetroit.com/news/local/202…
NY, NJ, PA: didn't vaccinate seniors (in SNFs) as fast as other states. So remaining 44 states + DC + the territories (74% of pop), have hospitalization rate of 8.5 per 100K overall (much less than 20-40K of flu) and approaching 5/100K in article washingtonpost.com/outlook/2021/0…
Read 5 tweets
Monica Gandhi MD, MPH Profile picture
18 Apr
I really admire especially my local paper's dogged determination to help open schools given the impacts of school closures on child mental & physical health. However, would argue with @drlucymcbride that we need a @factsnotfear approach to our reporting
sfchronicle.com/opinion/editor…
if we really want parents/teachers/students to feel safe about school openings. Examples of #factsnotfear reports are 1) explain to public what the vax effectiveness data is showing us in real-world: vax incredibly effective under stress of surges, differential mask wearing etc. Image
Very difficult to get or give #covid19 after vaccine. So, also explain to public all the accumulating data that vaccines massively reduce transmission. Cover the multiple papers which show this & discuss how IgA (mucosal antibody) generated by vax protect from nasal infection Image
Read 11 tweets
Monica Gandhi MD, MPH Profile picture
16 Apr
Okay, you know what is interesting? I wrote this piece at the end of January (published early Feb) and it still is going on despite even more data out there on effectiveness & variants; we are not messaging vaccine optimism to decrease vaccine hesitancy
leaps.org/want-to-motiva…
1) On 1st point, variants, I hope we have convinced people that our vaccines will still work against variants. I have written threads since January but I hope the simple fact that the man that wrote the textbook on Virology is not worried is enough:
threadreaderapp.com/thread/1373506…
1) And the 2nd point, message the end of masks, distancing. Ease more restrictions as vaccines take hold and decouple cases from severe illness. If we want a good metric, please see WaPo- ease mandates based on # of hospitalizations/100K + vax rate
washingtonpost.com/outlook/2021/0…
Read 4 tweets
Monica Gandhi MD, MPH Profile picture
16 Apr
Pfizer CEO said boosters may be needed. Unlikely
1) T cell immunity from vax (and Abs) work against variants; 2) T cells last long time- 34 y & counting after measles vax; 3) 1st SARS recovered have T cells 17 yr later; 4) Covid Vax generate memory B cells (lymph node biopsy)
So, to back up each claim (I have longer thread on this)
1) T cell immunity from vax works against variants: I hope you have been persuaded
2) T cells last 34 years and counting after measles vaccine:
ncbi.nlm.nih.gov/pmc/articles/P…
3) First SARS pandemic was coronavirus like this one (called SARS-CoV) and it also called severe disease. Lasted 9 months late 2002-2003. Survivors of similar virus SARS have strong T cell immunity 17 years later and counting
nature.com/articles/s4158…
Read 7 tweets
Monica Gandhi MD, MPH Profile picture
15 Apr
A profoundly important article in my opinion from @davidzweig in my opinion from @NYMag about why children should not be remote learning in the fall. Key points: 1) NJ Governor saying it will not be option unless "world goes sideways"; 2) Remote learning nymag.com/intelligencer/…
harms well documented; 3) "Study after study has shown that schools tend to have lower case rates than the surrounding community"; 4) Dr. "Vincent Racaniello, a professor of microbiology and immunology at Columbia University and author of Principles of Virology, the leading
textbook on the subject, recently concluded, after addressing the mechanisms at work, “I am not worried at all that this virus is going to out-evolve vaccines.'"; 5) Are children at risk? "To put the mortality risk in perspective, the CDC estimates that around 600 children
Read 5 tweets

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