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Monica Gandhi MD, MPH Profile picture
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13 May, 4 tweets, 2 min read
This JID study was the one quoted by CDC as saying risk of outdoor transmission was 10%. However, corresponding author clarifies risk much much less than that based on review of the literature. Moreover,
there have been two additional examinations of the question not included in this review which is this report from Ireland examining >232,000 infections & finding 1/1000 linked to outside. irishtimes.com/news/ireland/i…
And this scoping review from University of Canterbury concluding that outdoor transmission very rare, citing opportunity costs of not encouraging public to congregate outdoors
canterbury.ac.uk/science-engine…
The World Health Organization guidelines from December 2020 state masking not required outside if not crowded circumstances (and also no children <5 need mask). Outdoor mask mandates for children in summer camp likely to be updated.
who.int/emergencies/di…

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More from @MonicaGandhi9

Monica Gandhi MD, MPH Profile picture
14 May
Wanted to explain my thoughts on Yankees cases (8 total; 7 out of 8 asymptomatic) two weeks after J&J vaccine. Currently messaging you are safe 2 weeks after 2nd dose of mRNA vaccine or 2 weeks after 1st dose of J&J; think latter should change to 4 weeks
sports.yahoo.com/how-surprising…
Based on this @NEJM study of phase I/II trial of J&J vaccine. Please see how immunogenicity (immune response) increased over time from 2 to 4 to even 59 days out. Indeed, in phase 3 trial, efficacy better at 15-28 days vs 0-14 days for this reason.
nejm.org/doi/full/10.10…
So, I am telling my patients (and FDA may want to consider) that they can freely mingle 4 weeks after their 1st dose J&J, not 2 weeks. The symptomatic player likely had high enough viral load in nose to transmit to others but the 7 asymptomatic players
thelancet.com/journals/lanin…
Read 4 tweets
Monica Gandhi MD, MPH Profile picture
13 May
No need to mask/distance after vaccination. We have threads here on real-world effectiveness of vaccines (incredibly high) & how vaccinations block transmission. So, this rec by CDC based in science. Remember, incentives motivate those on fence to get vax
nytimes.com/2021/05/04/ups…
Here is thread on real-world effectiveness of vaccines (even against variants) to remind you how high the effectiveness is in the real world
And here is thread on transmission and how vaccines block transmission to reassure you that you are protecting others by getting vaccinated (protection that means masks can come off):
Read 7 tweets
Monica Gandhi MD, MPH Profile picture
12 May
TRANSMISSION routes - a PROPOSAL. Have seen all the discussion on aerosol spread of a pathogen (defined as small particles that can linger in air & ventilation most important) vs droplet spread (larger particles with gobs of spit, distance important) and I propose new definition
Which is to define a pathogen (e.g. SARS-CoV-2, TB, etc.) by the best way to keep people safe, best strategies for mitigation instead. We proposed a complementary 3-way non-pharmaceutical (NPI) triangle in this @TheLancetInfDis article.
thelancet.com/journals/lanin…
Masks, distancing, ventilation being most important NPI strategies but relative importance of each being defined by (traditionally) aerosol vs droplet. Why not instead of define each pathogen by relative importance of mitigation strategies? For instance, ventilation important
Read 11 tweets
Monica Gandhi MD, MPH Profile picture
11 May
An Open Letter to the Biden Administration and Congress from multiple public health/global health academic leaders in US on "Ensuring Global Health Security via Vaccine Donation" regarding humanitarian crisis in India
hividgm.ucsf.edu/ensuring-globa…
"Second year of the COVID-19 pandemic showcasing the stark inequity in global health security. The most advanced economies are entering a period of containment while the rest of the world is unable to respond or recover from the pandemic with relevant medical or economic tools"
"U.S. is on track to a summer of pre-pandemic levels of normalcy while South Asia and India in particular is reporting an estimated 1–2 million cases/day and 15,000-25,000 deaths/day. The pandemic will end when it ends for all.". Even with US vaccinating 12-15 yo, 70 million
Read 9 tweets
Monica Gandhi MD, MPH Profile picture
11 May
I see a lot of concern on Twitter today about #B.1.617 variant evading immune response. I think it is likely more transmissible and hospitalizations and deaths increase if cases increase which is happening in India and is tragic.
However, t think B.1.617 will evade immunity from the two vaccines in India - Covaxin & AZ (nor the vaccines you have in UK - Pfizer, AZ, Moderna): This study on the #Covaxin vaccine (Bharat pharm) shows strong neutralizing Ab titers against B.1.617
biorxiv.org/content/10.110…
Moreover, and this is a KEY point, if T cells decrease our severity of disease to an infection (references here- will break them all down when have more time), what is our T cell response against the spike protein with AZ vaccine- COMPLEX and in breadth. How do we know that? Image
Read 7 tweets
Monica Gandhi MD, MPH Profile picture
8 May
7 reasons why think immunity to COVID from vaccination or infection will be long-lived (and why I continue to marvel that CEOs of companies who stand to make profit from boosters get to message that boosters needed; instead, please donate vax to India).
1. Memory B cells: Image
We discussed this at more length before; remember this amazing memory B cell paper that showed us that 32 people ages 91-101 who survived 1918 flu pandemic STILL had memory B cells that could produce neutralizing antibodies to that strain 9 decades later
nature.com/articles/natur…
Memory B cells last long time & hang out in germinal centers (like lymph node) until they are needed again and then come out to produce neutralizing antibodies against the pathogen. Do we know COVID-19 vaccines produce memory B cells? Yes from this paper
researchsquare.com/article/rs-310…
Read 17 tweets

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