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Monica Gandhi MD, MPH Profile picture
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4 May, 4 tweets, 2 min read
Pres. Biden gives metric today of when counties, states, US out of public health emergency which is 70% 1st dose for >18 year old (US at 56.3% 1st dose >18 per CDC data, 14% more to go! CA 63%; SF 72%). Good to link end of emergency to metrics (vax rate)
nytimes.com/2021/05/04/us/…
I'd like to be clear what President Biden means by 70% 1st dose vaccination rate >18 years old. We are not at 44.4% first dose for >18 years (that is % total population); we are at 56% >18 years. Use that metric
covid.cdc.gov/covid-data-tra…
And one more point- places with high natural immunity like CA who had terrible 3rd surge will come down and stay down with cases sooner - places like MI need higher rates of vax (CA seroprevalence study done while vax not yet rolling in general population)
sfchronicle.com/health/article…
So getting to "herd immunity" will depend on natural infection rates + vaccination rate. Look at UK (hard hit with infections). At 51% 1st dose, their cases are 1649/66.5 million people; Israel needed higher 60% 1st dose since not as much natural immunity; US states will vary

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More from @MonicaGandhi9

Monica Gandhi MD, MPH Profile picture
6 May
Ok, was trying to stay off Twitter until Saturday but this question of children masking outdoors (in camps, etc.) keeps coming up. Let's discuss #outdoortransmission. Viral particles disperse quickly in the outside air
medrxiv.org/content/10.110…
A study in Wuhan, China, which involved careful contact tracing, discovered that just one of 7,324 infection events investigated was linked to outdoor transmission (none of the outbreaks identified from outside transmission). onlinelibrary.wiley.com/doi/10.1111/in…
In a recent analysis of over 232,000 infections in Ireland, only one case of COVID-19 in every thousand was traced to outdoor transmission. irishtimes.com/news/ireland/i…
Read 5 tweets
Monica Gandhi MD, MPH Profile picture
5 May
My understanding is trade commissioner under President Biden (Katherine Tai) deliberating & decision may be made to temporarily waive COVID-19 patents tomorrow. Please see this article I wrote in TIME comparison to HIV (let's not fail moral test)
time.com/6046096/india-…
I go over history of the HIV treatment world and how we debated and debated patents on this planet while millions died in sub-Saharan Africa from AIDS in the meantime; it took the international community and activism to change this; we don't have years, we have days with COVID
India and South Africa asked WTO for this temporary waiver of patents in October 2020 and it didn't happen; would India be in different position now? Open letter from Big Pharma to Biden on 3/5/21 said this proposal by India was 'unfortunate'. We can do now (ok, off Twitter 2 d)
Read 4 tweets
Monica Gandhi MD, MPH Profile picture
4 May
Think we are getting tripped up on definition of #herdimmunity: form of indirect protection from an infection that occurs when a significant % of population has become immune to an infection (through vax or previous infection). 74 cases/9.05 million Israel
ourworldindata.org/coronavirus/co…
(with openings and mingling) with a 63% 1st dose vaccination rate >16 years old (Pfizer only approved down to 16) means those unvaccinated (not yet or children) have INDIRECT protection from infection because virus not circulating much
ourworldindata.org/covid-vaccinat…
This is why children back in school without masks/ distancing: they are not protected by vax but by levels of virus circulating to be so low it is close to 2019. Do you see what I mean by definitions? Call it containment but protects others for more & more adults to be immune
Read 5 tweets
Monica Gandhi MD, MPH Profile picture
27 Apr
Someone asked me yesterday why schools aren't mainly open in San Francisco (despite 30 cases in city of 896K yesterday (& they test), <10 hospitalizations) or California (hundreds of thousand of tests done, 1400 cases in state of 40 million, lowest case rate in nation).
But do think clear why. We took a very partisan approach which - in this case- meant we used a fear-based, exaggerated approach to pandemic management without principles of #harmreduction (harm reduction reduces risk to a pathogen by sensible messages)
nytimes.com/2021/03/18/bri…
And, understandably, if we scared people more and took a fear-based approach, we could hopefully reduce infections by getting people to stay away from each other (a common tactic: people used to use scare tactics with HIV as well) instead of #harmreduction
nytimes.com/2020/12/07/opi…
Read 17 tweets
Monica Gandhi MD, MPH Profile picture
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
Monica Gandhi MD, MPH Profile picture
24 Apr
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%
Read 4 tweets

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