Appreciate Healio covering this message with @AmeshAA that our vaccine roll-out messaging should emphasize that vaccines will change your life to decrease vaccine hesitancy (and also appreciate them using the term vaccines are "defanging" the virus):
healio.com/news/infectiou…
Let me show you what is happening in the US which is that ER visits are decreasing for COVID which is sign of defanging but, now, cases are decreasing too (inflection point). 7-day ave
Cases: 4/23/21: 59.9k vs. 70.1k (4/16/21) or -14.6%
4/22/21: 61.8k vs. 70.5k (4/15/21), -12.4%
4/21/21: 63.0k vs. 71.5k (4/14/21) or -11.9%
4/20/21: 64.8k vs. 71.1k (4/13/21) or -8.9%
4/19/21: 67.2k vs. 68.9k (4/12/21) or -2.4%
4/18/21: 67.5k vs. 68.0k (4/11/21) or -0.7%
4/17/21: 68.4k vs. 68.0k (4/10/21) or +0.6%
4/16/21: 70.1k vs. 67.9k (4/9/21) or +3.2%
@EricTopol MI, NJ, NY shows cases below. And defanging? ER visits for COVID-19 decreasing (also specifically decreasing in MI & hotspots), marker of less severe disease. ER visits:
4/20/21: 2.0% (Day) & 2.4% (7 Day Average) compared to 2.5% (Day) & 2.7% (7 day ave) on 4/13/21. Image

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More from @MonicaGandhi9

24 Apr
of passing the virus to others if you are undetectable on antiretroviral therapy because I marveled CDC (a traditionally conservative public health agency, understandably; they are messaging for nation) would put out such a bold statement even though it was true. For breakthrough
infections after vaccination, I hope I, others have convinced you that these are RARE (0.008%) and even more rare for symptomatic infections. 77 million Americans fully vax against COVID, ~5800 symptomatic & asymptomatic but only 4100 symptomatic so 0.005%
cdc.gov/vaccines/covid…
See that nursing homes are still performing asymptomatic testing after vax of staff & residents even though symptomatic swabbing would reveal what we need to know but think this recent MMWR paper important
cdc.gov/mmwr/volumes/7…
Read 10 tweets
24 Apr
Wanted to send you 2 articles today that indicate when an epidemic can be downgraded to endemic for an infectious disease. What is an epidemic? An epidemic is when a disease affects a large number of people within a community, population, or region. That is what was happening in
the UK prior to their mass vaccination program. This study in UK looked at 373,402 participants aged ≥16 years who had mass swabbing (even when asymptomatic after vax) Dec 1, 2020-April 3, 2021. In fact, 1,610,562 PCR swabs as vax rolling out.
medrxiv.org/content/10.110…
Whether AztraZeneca (which is like J&J in being an adenovirus/DNA vaccine) or Pfizer (mRNA vaccine), symptomatic infection massively reduced after even 1 dose and importantly so was asymptomatic infection with CT<30 on PCR (at which point extremely hard to transmit).
Read 8 tweets
23 Apr
Two amazing papers recently that show the power of the vaccination to "uncouple" cases from hospitalizations and also massively prevent severe disease. Fully vaccinated Houston, 96% effective at preventing hospitalization; 98.7% at preventing death
medrxiv.org/content/10.110…
Paper, NEJM shows that 2 symptomatic infections (both mild, variants) out of 417 after vaccination (with mass screening program of asymptomatic)-rate of 0.005% consistent with CDC data last week showing 0.005% symptomatic breakthroughs out of 77 million
nejm.org/doi/full/10.10…
The fact that the 2 participants in NEJM study had mild infection with variants is consistent with fact that T cell immunity is preserved across the variants with mRNA vaccination
biorxiv.org/content/10.110…
Read 9 tweets
22 Apr
Thanks Dr. McBride. I think laying out the evidence on why ceasing outdoor masking (except when at rallies or packed crowds) based on biology will help ease us back to normal, shows trust of the public & is nuanced/tiered messaging.
My key points are as follows: 1) People know when they are outside (!); 2) A study in Wuhan China with careful contact tracing shows 1 of 7324 infections seem to be connected with outside transmission (& no outbreaks);
onlinelibrary.wiley.com/doi/10.1111/in…; 2) A meta-analysis from UCSF shows
risk inside >20x more than outside; 3) Scoping review from University of Canterbury shows outdoor transmission rare, citing the opportunity costs of " impact on physical and mental health and wellbeing" not gathering outside.”canterbury.ac.uk/science-engine…
Read 4 tweets
21 Apr
Want to talk about INFLECTION POINT and how it looks like we have reached this in our country with hospitalizations at this vaccination rate & also turning the corner in Michigan. We discussed this first with Israel & I think "inflection point" with both hospitalizations & cases
will be different by country/state/region depending on degree of natural immunity there. This article in Nature from early on in the Israel roll-out: "You need to vaccinate much >1/3 of the population to really see a reduction in transmission", how much
nature.com/articles/d4158…
more probably depends on 1) natural immunity (surges before (CA has 38% of its population exposed); 2) degree of lockdown as you are vaccinating (UK more; Israel less; places in US variable); 3) maybe even what vaccine (?India). Paper from Israel (Fig)
nature.com/articles/s4157…
Read 15 tweets
20 Apr
This is true but I am VERY worried about India right now. My understanding is that vaccine capacity is not maximal because more raw materials are needed. India has called on the Biden Administration (ASlavitt) for help. Masks/distancing as much as possible in crowded conditions.
India has Covishield (AZ vaccine) + Covaxin (Bharat Pharm). I see from phase I/II trial of the Covaxin vaccine that cell-mediated responses were generated (although used IFN-gamma assay that Sputnik V used in their paper instead of direct measurement).
medrxiv.org/content/10.110…
However, reason worried about Covaxin is that we have not seen phase 3 clinical trial results yet except in press release; would love to see peer reviewed publication (does anyone know status?). Covaxin is a whole inactivated viral vaccine like Sinovac
economist.com/graphic-detail…
Read 7 tweets

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