Article in @washingtonpost by myself, @TracyBethHoeg, @KrugAlli and @drlucymcbride on returning children's lives to normal now with clear metrics on how children can return to school unmasked in fall based on high adult vax rate + ~3 hospitalizations/100K
washingtonpost.com/opinions/2021/…
What are main premises of this piece?
-We can discuss risk vs benefits of all restrictions now in presence of vaccine for adults
-50% decrease in last 4 weeks of covid among children with adult vax in US (like seen in other countries)
-we go through calculation of how low a risk
a child is in this country of getting covid with our current rates
-We go through why masks outside at camp not needed; inside in fall in school (if hospitalization rates 3/100K by then) not needed & can impact learning
-Vax for younger children not yet EUA but luckily falling
rates in country with adult vax making children low risk while we await trials of covid-19 vax in young kids (probably late fall?)
-CDC is group that thinks about risks vs benefits just like UK did for kids when unmasked in school May 17 - thanks @CDCgov for reading this!

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More from @MonicaGandhi9

27 May
If you put together our WaPo piece from today with the data from Yahoo News , you can see that children now are very low risk in the US (without masking) because of the power of vax in adults; we have to update our recs with time due to vax
news.yahoo.com/youngest-child… via @YahooNews
As an Infectious Diseases doctor, am very sensitive to the idea of people being called vectors -can lead to stigma. Children less likely to transmit infection than adults (school studies show it is usually adults to children if anything) so they are not vectors. Adult vax
Here are some papers on this (that children not efficient transmitters): Seropositivity among children was more closely linked to exposure at home than at the daycare
thelancet.com/journals/lanch…
Read 9 tweets
26 May
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…
Read 5 tweets
24 May
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,
Read 4 tweets
24 May
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…)
Read 4 tweets
24 May
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.
Read 8 tweets
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)
Read 18 tweets

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