Agree with Dr. Fauci @greg_folkers that "Somewhere between control and elimination is where we’re going to wind up. Namely a very, very low level that isn’t a public health hazard that doesn’t disrupt society.” washingtonpost.com/health/coronav…
Definitions:
*Control: Active measures to reduce infections in area like vax
*Elimination: No more cases in specific area
*Eradication: Worldwide elimination - has only been achieved with smallpox (we live with many other pathogens without eradication) pedaids.org/2015/02/18/hiv…
I wanted to explain what it feels like to be an ID doctor in the US with measles. Once we get to control of COVID (which we are or already have) which is similar to the concept of herd immunity, COVID is no longer the public's problem but an ID doctor's problem. For instance,
I have seen measles in my career, but it has been rare and has occurred due to someone unvaccinated here traveling back from a place with more vaccine hesitancy in Europe or place with more measles circulating or a community declining vax here. RARE, no longer public's problem.
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What would I do with this new information (more to come) about cases of myocarditis in young people who got the vaccine? Mostly young (adolescents), 4 days after 2nd dose, not after 1st. This is what I think. The duration of 3 weeks between Pfizer doses nbcnews.com/health/health-…
was chosen PURELY for expediency - wanted to get the clinical trials done quickly (understandably); needed to get the vaccine out fast. As one of my ID heroes wrote long ago now (Dr. Stanley Plotkin), lots of good reasons to extend interval between doses academic.oup.com/cid/advance-ar…
And we now have good data that extending duration between doses of the Pfizer vaccine (to 11-12 weeks) actually BOOSTS immune response to vaccine in older patients. Now, if myocarditis/pericarditis is result of more vigorous immune response in kids at 2nd nature.com/articles/d4158…
Wanted to address a circulating myth that the COVID-19 vaccines that help you produce spike protein in your body generates fragment of virus (they do, spike protein) that can infect another (they can't, just a piece of protein, not live virus) health.com/condition/infe…
Remember, 6 of the vaccines we have (including those in EUA in US - 3) involve you getting a piece of genetic code (mRNA or DNA) in the vaccine that YOU use to make in your body the spike protein of the virus (shown below).
There are also 3 vaccines that are whole inactivated virion (all seen in this table below) - of those 3, Covaxin from Bharat Pharm has the best efficacy data 100% against severe disease; 78% symptomatic COVID. (globenewswire.com/en/news-releas…)
In this Medical Grand Rounds segment with @Bob_Wachter, @PCH_SF and Dr. Rutherford from last week, Dr. Wachter asked me about risk of mild or asymptomatic infection (& long COVID) after vax since risk of severe disease blocked almost 100%
Your risk of standing next to someone at grocery store unmasked if you are unmasked after vaccination who can give you COVID is related to hospitalization or case rates in your community (CDC and UK says 2-3 cases or hospitalizations/100K out of danger, yellow). U are protected
almost 100% from severe disease (severe breakthroughs in this country very rare 1/1 million even when case rates much higher); protected against asymptomatic 86-94% by studies even at higher case rates in community. But in India, with very high case rate, more likely.
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)
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/…
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/…