I am interested in increasing trust in public health. 4 things we can address now to increase that trust:
1) Natural immunity: Real, don't know duration of immunity from either route; 1 dose only? Acknowledge natural immunity, our knowledge limits
2) Vax in kids: Acknowledge that adult vax massively reducing community transmission in US, kids less at risk of getting sick. Acknowledge risks vs benefits of vax in kids under study. 1 dose, lower dose to reduce risk of myocarditis? If low rates, can kids have normal life?
3) PCR test: Acknowledge limits of PCR especially after vax. PCR picks up "dead virus" or low virus in nose because very sensitive (can tell if must cycle the machine a lot; CT >30 is low viral load). Don't isolate someone with high CT (use Ag; no asymptomatic testing after vax)
4) Acknowledge collateral damage: Poor have lost jobs; kids have been out of school & had mental health effects; loneliness & isolation of pandemic Will not hurt efforts to control virus to acknowledge this pain & work to address, normalize as many settings as possible when safe
Here is thread explaining why not to test asymptomatic individuals after vaccination:
& here is NYT article explaining reasoning why normal school need not be linked to child vax status while trials in young kids ongoing & while we try to figure out how to maximize safety of vax for 12-15 year olds (1 dose? reduced dose? increase spacing?)
And here is article with @LeslieBienen & @JeanneNoble18 explaining why it is okay to acknowledge risks vs benefits of our lockdown procedures &, with adult vax & lower rates, ok to turn our thoughts to minimizing collateral damage
And here is article relevant to first point regarding immunity - what we know about natural vs vaccine-induced from immunologic research.
And here is thread explaining why variants unlikely to be able to evade T cell immunity. With 52 (lowest) to 87 to 100s of T cells lining up across spike protein, hard to evade T cell immunity even with 13 mutations of delta variant
So, 4 points to help increase trust in public health: 1) Discuss natural immunity; 2) Discuss risks vs benefits of vax in kids; we want to vax children but keep safety paramount with lower risk; 3) PCR, testing limitations before & after vax; 4) Collateral damage to vulnerable
This is my final tweet of this thread. I have been wondering if Infectious Diseases doctors who see patients should have larger role to play in response as this is an infection & we study 2) virology; 2) immunology; 3) impacts on patients because we see them; 4) #harmreduction

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More from @MonicaGandhi9

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 7 tweets
8 Jun
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
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
Read 8 tweets
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
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
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
Read 8 tweets
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
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
Read 13 tweets
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
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
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)
Read 5 tweets

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