@DLeonhardt article today NYT illustrates what @drlucymcbride, I & so many others discussing: a fear of normal or even following simple March 8 CDC guidelines that vaccinated people can get together without masks/distancing due to irrational fear.
nytimes.com/2021/04/19/bri…
"Fortunately, [fear] also curable. The vaccines have nearly eliminated death, hospitalization and other serious Covid illness among people who [got] shots. .vaccines have also radically reduced chances that people contract even a mild version of Covid or can pass it on to others"
Even acclaimed experts like @ashishjha realized how "awesome" it was to meet friend for drink unmasked 2 months (!) after his last shot. My advice for society on this as MD who talks to patients about irrational fear all time?
1) Leaders like President Biden? Model behavior like
sitting together unmasked/undistanced when work if all vaccinated as you are photographed a lot
2) Hospital infection control @VivekJainMD: Update guidance so fully vaccinated doctors, nurses, trainees can sit together unmasked/undistanced as we used to for morning report, etc
3) Those not in public eye, try it! Just try getting together with your friend or two for a dinner or drink without masks/distancing. I tell this to patients all the time about keeping security blanket around so keep your mask around but try it! Get your feet wet.
4) Above all,
Keep these numbers in your head (or on piece of paper as you venture out:
Out of 77 million Americans fully vaccinated against COVID: 5,800 infections (0.008%)- 0.005% with symptoms; 0.0005% hospitalizations; 0.0001% deaths (latter handful reported with other health problems)
If public health data-driven, #factsnotfear in our approach, trust will increase! I urged former administration to model mask wearing publicly as quoted; I urge current administration to model non-mask wearing in fully vaccinated groups per CDC guidelines; confidence in vax!.

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More from @MonicaGandhi9

20 Apr
Will we be able to achieve herd immunity and at what level vaccination? I believe we will but I don't know at what % vaccination though I suspect it could be 65-70%. Why?
1) Achieving herd immunity with a vaccine is dependent on its effectiveness; the mRNA vaccines are more Image
effective than we dared hope with 100% efficacy at 6 months per Pfizer data and amazing CDC breakthrough data showing (with ongoing cases), of 77 million fully vaccinated against COVID-19, ~5,800 infections (0.008%) – 0.005% symptomatic (29% asymptomatic)
pfizer.com/news/press-rel…
2) Study from Israel shows children do not need to be vaccinated to massively reduce transmission in this group. Just vaccinating adults >16 years brings down infections among children substantially (every 20 point increase adults; halves in children)
medrxiv.org/content/10.110…
Read 5 tweets
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
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
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.
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
Read 12 tweets
17 Apr
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)
Read 7 tweets
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

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