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Monica Gandhi MD, MPH Profile picture
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19 May, 7 tweets, 4 min read
2 important studies in Hospital Pediatrics this am with a commentary by @DrAmyBeck (pediatrician at UCSF) and myself. Since universal screening for COVID done on every inpatient (for infection control), careful chart review shows pediatric admissions
hosppeds.aappublications.org/content/early/…
in 40% of cases were not for COVID at all, but the PCR test was just incidentally found to be positive (and the child was admitted for a completely different reason). Here are the two well-done chart review studies- one by Webb et al
hosppeds.aappublications.org/content/early/…
The other by Kushner et al - e.g. hospitalized "for" COVID or "with" COVID. This has been practice in our hospital systems since early in the pandemic; for safety of our health care workers, we swab the noses of every admitted patient for COVID
hosppeds.aappublications.org/content/early/…
Why is this important? It confirms @JenniferNuzzo recent work and @j_g_allen discussions and multiple other epidemiologic studies that show children are - thankfully- mostly spared from severe disease with COVID and allows us to risk calculate for our kids
capitalgazette.com/opinion/letter…
Also consistent with work done by @elbeezuchdt and @citizen_oregon and myself that hospitalizations were not increasing among children in MI/MN during the recent surge. Speaks to careful adjudication of reasons for hospitalization by academicians
statnews.com/2021/04/23/use…
when decisions are made regarding school openings or closures. Know we will look back at this period & see how many assumptions were incorrect: careful analysis, dispassionate data gathering, academic work as our colleagues did in these two papers can inform policy for kids.
Piece on these important Hospital Pediatrics papers released today by @davidzweig in @NYMag today. Please read our commentary: @DrAmyBeck did careful work on detailing ill effects of school closures for children over the past year. Should inform policy
nymag.com/intelligencer/…

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More from @MonicaGandhi9

Monica Gandhi MD, MPH Profile picture
21 May
WHY DID THE CDC RECOMMEND NOT TO TEST ASYMPTOMATIC PEOPLE AFTER VACCINATION (nor to quarantine after exposure if no symptoms) A thread. I start with this piece by my colleague @AmeshAA at Johns Hopkins: how testing algorithms change after vaccination
thehill.com/opinion/health…
Okay, why did we test asymptomatic people at all with COVID-19? Because there is asymptomatic transmission with this virus (see @NEJM paper we wrote early in pandemic below) unlike so many viruses where "syndromic surveillance" (testing if have symptoms)
nejm.org/doi/full/10.10…
works to curb spread. In fact, this is true of the original SARS in 2002-03: because you were infectious when you had symptoms, people could be isolated if they felt unwell & pandemic was quickly curtailed after 8098 cases total (although it caused severe disease like this one) Image
Read 16 tweets
Monica Gandhi MD, MPH Profile picture
19 May
Looks like Oregon following CDC guidance now - like NY, MA, so many other places. Of note, CDC is super cautious but guidance was based in sound science. Oregon officials release new rules for masks, approve five counties for lowered restrictions opb.org/article/2021/0…
CA can be on its own time schedule as many Californians needed more time to absorb but I do cite the effectiveness/transmission studies here. Whatever CA does, I hope the state DPH & @SF_DPH consider in-person learning as their #1 priority for fall.
washingtonpost.com/outlook/2021/0…
When I saw report on hunger in SF (low income) this am in @sfchronicle; predictable headline that 'no, we didn't have a 4th surge' (not predicted by those who know data/immunology); see @DrAmyBeck laying out of impact of school closures in our piece today
hosppeds.aappublications.org/content/early/…
Read 4 tweets
Monica Gandhi MD, MPH Profile picture
18 May
So sorry don't have time to tweet for few days on this but see talk by experts on @MSNBC you can transmit when asymptomatic after vax. Dr. Fauci/CDC knows the studies that led to their rec. Multiple studies show reduced viral load in nose after vax
nature.com/articles/s4159…
Here are 3 more - sorry can't go through them all with you- did on previous tweets
medrxiv.org/content/10.110…
medrxiv.org/content/10.110… (England large study)
academic.oup.com/cid/advance-ar…
Here is biological context why vaccines reduce transmission - IgG, IgA (yes, produced by COVID-19 vaccines), and T cells all line your nasal mucosa- so they are produced by vaccine, go and swoop down on virus if you get exposed & limit replication
Read 4 tweets
Monica Gandhi MD, MPH Profile picture
17 May
I wanted to go back to this question of the redundancy of the immune system when we assume that those who don't have antibodies aren't protected after vaccination (e.g. immunocompromised patients). Please remember how redundant & complex the immune system is
We have paper from our group last week that shows people with HIV may have lower antibodies after natural infection but follow-up analyses shows T cells (CD4 and CD8) preserved. If one line of immune system down, other line can help.
thelancet.com/journals/lanhi…
Know this thread is super long & sorry but it really discusses why antibodies are just "tip of iceberg" in terms of immunity (or feeling 1 part of elephant!). My patient on cancer treatment had low antibodies, but T cells just fine in research lab.
Read 5 tweets
Monica Gandhi MD, MPH Profile picture
15 May
As @sfchronicle aptly put it, new data-based CDC guidance is psychological shock; will settle; everyone can decide for themselves on masking. In meantime, India still with raging epidemic with 10% 1st dose vax rate; really shows us how mitigation strategies are tools vax solution Image
And when country opens up without vaccine, and is as crowded as India, and had a likely more transmissible variant, the epidemiology without the protection of vaccines is devastating Image
And the tragedy cannot be overstated (as Americans debate whether they trust each other on masks or whether they think the vaccine is as effective as study after study says) in a place without vaccine. Vaccine is solution; masks,distancing, ventilation are tools until solution Image
Read 6 tweets
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

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