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Monica Gandhi MD, MPH Profile picture
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28 May, 4 tweets, 3 min read
There is much upset today: Please listen to this segment if you can. 1) CDC & AAP will only consider a metric (of cases or hospitalizations in community) for lifting masks on kids, we propose 3-5 hospitalizations/100K; 2) @KrugAlli has detailed comparisons on flu vs COVID in kids
@TracyBethHoeg, @drlucymcbride, @KrugAlli & I put together studies on how children less likely to transmit than adults here which refutes the unfortunate claim that children become vectors for adults so must continue restrictions to protect adults
This is not science-based; this is emotional. And there are so many inconsistencies from a pediatric-based organization (AAP) who is not fighting for children to be in school, not discussing mental health effects, & discuss masking children outside:
So, this is my advice from someone who is actually highly-credentialed, "usually" respected in my field, and an ID doctor but can't move needle on this. @DrAmyBeck @doctortara. Only pediatricians can change this & advocate with CDC. Peds & Peds ID who see children as whole people

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More from @MonicaGandhi9

Monica Gandhi MD, MPH Profile picture
29 May
Wanted to talk to you about our #inoculum hypothesis and may have particular relevance in the vaccine era. Our idea was -after seeing that mitigation procedures like masks didn't always block transmission especially if just cloth or plain surgical, but seemed associated with less
severe disease and more asymptomatic infection - was that if you are exposed to less viral inoculum or dose, more likely to get mild disease. We first explored this hypothesis here and then, given that even asymptomatic or mild infection triggered T cells,
link.springer.com/article/10.100…
we hypothesized that anything that would drive the infection towards asymptomatic or mild (if unlucky enough to be exposed) while awaiting a vaccine was helpful -e.g. nonpharmaceutical interventions (NPIs) like masks nejm.org/doi/full/10.10…
Read 7 tweets
Monica Gandhi MD, MPH Profile picture
28 May
The @CDC guidance on outside masking has changed!
I am so relieved. Let's take this victory for now towards a science-based approach to outside masking for children in camps this summer & keep working towards rest once I take a little break from this my friends.
news.yahoo.com/cdc-relaxes-gu…
By the way, this guidance means no unvax person has to make outside as per the science. This is good to be aligned with WHO who has been so right on so many things (natural immunity, children <5 don't need to mask, no outside masking unless crowded)
wsj.com/articles/take-…
Read 4 tweets
Monica Gandhi MD, MPH Profile picture
28 May
Due to need to go back to my "real work" in academia, I will be taking short break from Twitter. However, if interested, I tried to summarize my thoughts on why we won't need boosters anytime soon in this article technical-leaps.org/booster-shot/ and less washingtonpost.com/outlook/2021/0…
In terms of COVID origins, effectiveness of the vaccines & why CDC messaged what they did (of course you still can mask if more comfortable as individual choice) & global vaccine equity please watch this segment from @democracynow
democracynow.org/2021/5/27/covi…
Much confusion about children should not be masked outdoors this summer & return to normal life (with masks removed in school like UK once hospitalization or cases low in area)- Explain in voice on @NPR & print in WaPo
washingtonpost.com/opinions/2021/…
npr.org/podcasts/47885…
Read 4 tweets
Monica Gandhi MD, MPH Profile picture
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
Monica Gandhi MD, MPH Profile picture
26 May
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
Read 4 tweets
Monica Gandhi MD, MPH Profile picture
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

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