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Monica Gandhi MD, MPH Profile picture
@MonicaGandhi9
Apr 18, 2021 • 12 tweets • 6 min read • Read on X
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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.
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
3) Cover variants with data we have in hand: 1 (B117) may be more transmissible but masks/distancing/ventilation work; not more virulent; use publicly available CDC data & show hospitalizations not increasing per %B117 in states
thelancet.com/journals/lanpu…
&
thelancet.com/journals/lanin…
4) Explain complexity of immune system even if takes time. CD8 T cells respond to 52 epitopes or small pieces across spike protein/ CD4 to 23 epitopes; will be difficult for variants to break through our immune system. Expert who wrote textbook on Virology
thestreet.com/latest-news/th…
5) Explain clearly why mass asymptomatic testing of vaccinated individuals is not indicated because small amount of virus in nose of person without symptoms that can't be transmitted actually shows vaccine is working (you are cutting it off at the pass)
salon.com/2021/04/17/bre…
6) Do not be fearful of messaging when mask mandates will end as that will not make public less careful & will be motivating for parents/teachers/students towards new normal. Mask ending show us the end of a public health emergency
slate.com/technology/202…
7) Ask public health officials for clear metrics when public health emergency orders will end - is it 5 hospitalizations/100K + 40% vaccination rate or another metric? Put clear metrics into place given our fast vaccine roll-out & incredible effectiveness
washingtonpost.com/outlook/2021/0…
8) Report with @factsnotfear per @drlucymcbride as we enter this summer determine fall school openings. Discuss impact of school closures on child mental health, discuss successes of UK/Israel fast roll-out, report on "what can you do after vax" confidently etc. Thank you!
7.5) Report deeply on how long immunity expected to last after vaccination given T cell/memory B cell data emerging from important studies & how unlikely to need boosters if so (& how coronavirus has strong proofreading mechanism)
wsj.com/articles/how-l…
Oh the papers on the 51 epitopes CD8 cover across the spike protein and the 23 epitopes of CD4 papers are in this thread
I should have ended this 9-point thread on how experts & reporters interested in school openings can use facts in their reporting to ease fear in parents/teachers/students with this important article from @davidzweig for @NYMag (where he did just that):
nymag.com/intelligencer/…

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More from @MonicaGandhi9

Monica Gandhi MD, MPH Profile picture
May 12
HANTAVIRUS: Let's start with obvious. Global pandemics in 1918 (influenza) and 2020 (coronavirus) are from viruses easily spread by respiratory contact which is why flu/coronaviruses most of concern for pandemic potential. Hantavirus is an RNA virus in bunyavirus family, can be
called "robovirus" from rodent-borne virus. Two types of Haantan viruse- one with hemorrhagic fever with renal syndrome: Cause of severe hemorrhagic fever with renal syndrome in Korea, China, eastern Russia, Eurasia. Spread by aerosols from rat urine usually.
Fever, thrombocytopenia, acute renal insufficiency from acute interstitial nephritis. Incubation period about 2 weeks. Go through oliguric and polyuric clinical stages and may take weeks or months to recover. In the toxic phase, get headache, abdominal pain, back pain
Read 10 tweets
Monica Gandhi MD, MPH Profile picture
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
Monica Gandhi MD, MPH Profile picture
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
Monica Gandhi MD, MPH Profile picture
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
Monica Gandhi MD, MPH Profile picture
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
Monica Gandhi MD, MPH Profile picture
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

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