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Monica Gandhi MD, MPH Profile picture
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8 Jun, 8 tweets, 3 min read
Thanks to @NYT for publishing this guest essay by @TracyBethHoeg, @DrDanielJohnson (Pediatric ID) by me saying we must fully reopen schools this fall and here's how. Main points: 1) Full in-person learning need not be tied to child vaccination status
nytimes.com/2021/06/08/opi…
given falling cases & hospitalizations in children with adult vax (61% & 40%, respectively in just last 6 weeks; 80% since January)
2) Hand-washing great for rotavirus, noravirus, rhinovirus; excessive hand sanitation, cleaning not needed for COVID;
3) No plexiglass barriers
4) No mass asymptomatic testing unless community transmission high (won't be anywhere by September - 200/100K)
5) Test symptomatic individuals
6) Don't close class for a child testing positive; unvaccinated teachers follow CDC I&Q protocols
7) No masks outside for recess per CDC school camp
8) Stop masking children indoors when community hospitalization rate is <5 per 100,000 and adult vax at 67%
9) Oh, and did we say- please please open schools?
washingtonpost.com/outlook/2021/0…
Just did the calculation - 47 of 50 states are at or just near the metrics we proposed for no masking indoors by children in the fall; all will be there by the fall school openings. All places across US meet metric of no mass asymptomatic testing. Thanks
My 12th article on school openings- NYT, 3 WaPo (1 on normal life; 1 on asymptomatic testing schools; 1 on metrics), SF Chronicle, 2 Atlantic (1 on overcaution; 1 on waiting on vax in US kids for global), Stat News, The Hill, USA Today, Mission Local, WSJ. I am trying, my friends
California is below the metric we put in the @NYT article for unmasking children indoors (CA is at 4/100,000 COVID hospitalizations) but California mask guidance just came out an hour ago & specified will follow CDC guidance & children must mask indoors at childcare/schools.
However, one aspect of CDC guidance- camp guidance in May said considering masking indoors when community transmission high & CA has lowest rates of community transmission in nation; so CDC school guidance for fall will likely align with camp guidance
cdc.gov/coronavirus/20…

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More from @MonicaGandhi9

Monica Gandhi MD, MPH Profile picture
10 Jun
My last school opening article (a plea, really). Returning to school buildings full time next year will improve the mental health of young people, write @MonicaGandhi9 and @JeanneNoble18 wsj.com/articles/the-p… via @WSJopinion
-CDC said last week adolescent hospitalizations due to COVID were on the rise, media picked up the message Not true: child cases and hospitalizations down 84% and 69% since Jan
-CDC failed to highlight that 20% of hospitalizations in their study Jan-March 2021 were psychiatric
-Mental health (MH) effects hard to study since healthcare utilization down & MH services for children already has gap
-Only way is to look at ED visits & suicides. Data from Children's Hospital Oakland: 66% increase in 10-17 screening yes for active or recent suicidal ideation
Read 6 tweets
Monica Gandhi MD, MPH Profile picture
5 Jun
MYOCARDITIS after 2nd dose of COVID vaccine after 2nd dose mainly among 12-17 year olds in US. Data from Vaccine Adverse Events Reporting System (VAERS). Remember, vaccines can cause myocarditis. The rate of myocarditis from smallpox vaccine was 1/12,000: jamanetwork.com/journals/jama/…
Mechanism unclear (handwaving paper says "antibodies & T cells"). Now remember, only Pfizer is approved for 12-17 year olds and the dose of the vaccine (30 micrograms) is the same dose used for adults (the trials among kids 6 months-11 years uses lower dose, 10). Publicly
available data from VAERS up to 5/28/21 shows myocarditis rate post vax for16-17 yo is 0.0016% (so comparable to smallpox). In fact, hospitalization for myocarditis post-vax among 12-17 year olds is currently 12x greater than hospitalization for COVID with low cases among
Read 13 tweets
Monica Gandhi MD, MPH Profile picture
4 Jun
Good to see that 45.7% of adolescents in this study did not have primary reason for admission be related to COVID-19 which is consistent with careful work done by our Stanford & Northern California colleagues that 40% admissions in children not for COVID
cdc.gov/mmwr/volumes/7…
That work is summarized here in a commentary I wrote with @DrAmyBeck - careful chart review find reasons for 40% hospitalizations in children during pandemic linked to other reasons (consistent with 45.7% in this study) hosppeds.aappublications.org/content/early/…
Those carefully done studies with chart review are here so you can look at them for yourself
hosppeds.aappublications.org/content/early/…
Read 8 tweets
Monica Gandhi MD, MPH Profile picture
1 Jun
These days in U.S., asked what end of epidemic would look like & I wanted to explain why COVID - once controlled- will be more like measles (where public doesn't think about every day) than influenza (where public does think about in winter). COVID has highly effective vaccine
like measles does - the effectiveness of the measles vaccine is high like the effectiveness of the COVID-19 vaccine - one dose 93% effective and two doses 97% effective per original studies. We give measles vax
fda.gov/consumers/cons…).
two doses in childhood & then high exposure populations like healthcare workers/international travelers often given booster - schedule is here. We have already discussed that T cells from measles vaccination last a long time -remember paper
cdc.gov/vaccines/vpd/m….
Read 13 tweets
Monica Gandhi MD, MPH Profile picture
31 May
With 0 deaths across England from COVID today, I am reminded that on April 22, 2021, England downgraded its epidemic to "endemic" status when an infection no longer is causing morbidity/mortality to justify extreme measures adopted earlier without vax
news.yahoo.com/covid-pandemic…
Now the UK is at 58% 1st dose and we are at about 50% 1st dose because they adopted a 1st dose first strategy so going faster than we - please see World Vaccine tracker here. And UK does a lot of testing & has seen B.1.617 but has not changed 0 death mark
ourworldindata.org/covid-vaccinat…
You can see and track cases/hospitalizations/deaths here at Worldometer across regions & this is what UK rate looks like. When hospitalizations/deaths become DECOUPLED from cases with vax, not prudent to track cases as metric of re-opening (or variants)
worldometers.info/coronavirus/co…
Read 5 tweets
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 9 tweets

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