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Monica Gandhi MD, MPH Profile picture
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19 Jun, 5 tweets, 2 min read
Although hasten to say mask not necessary after vax or when low cases in a community protects unvaccinated, we had proposed early in pandemic that masks reduced viral inoculum lowering severity of disease. This paper links mask wearing to lower viral load
nature.com/articles/s4159…
"Increased masking would lower effective reproduction number (Re), lower percentage of infected people who transmit virus, decrease total number of super-spreader events, and lower the exposure viral loads among infected people, possibly leading to less severe infections overall"
We had several papers trying to describe this phenomenon - first one here observing masked settings had more asymptomatic infections
doi.org/10.1007/s11606…
Second was here which noted how asymptomatic and mild infection associated with development of T cells and so masks (if they led to asymptomatic disease) could help immunity while awaiting a vaccine.
nejm.org/doi/full/10.10…
Third was attempt to review literature on other infections to see if inoculum was associated with development of infection and severity of disease (associations with other pathogens)
thelancet.com/journals/lanin…

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More from @MonicaGandhi9

Monica Gandhi MD, MPH Profile picture
20 Jun
UCSF's Monica Gandhi says there are five ways the U.S. can help end the global COVID nightmare for good sfchronicle.com/opinion/openfo… via @sfchronicle
5 ways here in my opinion:
1) Donate surplus doses & buy doses for other countries, we need 11 billion (thank you to President Biden for 500 million, so sorry need more G7!)
2) Decide on best STRATEGY on how to allocate doses worldwide: We can delay vax of those with previous
infection in global settings, since immunity from natural infection associated with low rates of re-infection. Once supplies increase, single dose of a 2-dose regimen can be given to those with previous infection to boost responses.
Other strategy includes "ring vaccination"
Read 8 tweets
Monica Gandhi MD, MPH Profile picture
16 Jun
DELTA variant. To discuss this, let's actually start with discussing the spike protein of the virus. Remember, the spike protein of the virus is how the virus binds to our host cell. The spike protein is the protein that is encoded by the mRNA & adenovirus-DNA vaccines (J&J)
The vaccine gives you genetic material that enables YOU to make that spike protein and then you raise an immune response against it (of course natural infection makes you raise an immune response against virus). Genetic material goes away & you have immune response. J&J just one
step "upstream" from mRNA vaccines so gives you DNA which you MAKE into mRNA and then you make spike protein. mRNA vax allows you to make protein directly. Not that different though J&J vax takes longer to give full immunity (phase II trial, up to 60 days)
nejm.org/doi/full/10.10…
Read 15 tweets
Monica Gandhi MD, MPH Profile picture
14 Jun
Another paper describing durable immunity to natural infection. "Immunological memory ..distinct aspect of immune system...where B & T cells specific for a virus maintained in state of dormancy.. poised to spring into action if they encounter virus again"
nature.com/articles/d4158…
The reason I think this is so important is that it 1) gives credence to those who are questioning why WHO discusses natural immunity but we aren't; 2) saves vaccines for non-immune with global distribution for now; 3) allows sense of normalcy without fear
washingtonpost.com/outlook/2021/0…
And simple primer on immune system here as well although Nature paper very well written and explains the long-term nature of immunity to natural infection extremely elegantly.
leaps.org/booster-shot/
Read 4 tweets
Monica Gandhi MD, MPH Profile picture
14 Jun
NOVAVAX trial from this morning: First want to remind you that we have 9 vaccine candidates out there, 6 of which involve the spike protein in some way (Novavax actually gives the spike protein + an adjuvant) and 3 of which are whole inactivated virions. Table below
Here is our clinical trial data for the 6 spike protein vaccines (will summarize Novavax in moment as the phase 3 trial called PREVENT-19 came out today) and the next tweet shows the phase 3 data for the 3 whole inactivated vaccines (Covaxin, Sinopharm, Sinovac)
And here is phase 3 clinical trial data for the 3 whole inactivated vaccines. Okay, then, going back to Novavax, it is the spike protein put together with an effective adjuvant and we had a phase 2b study in S. Africa & UK study before, but PREVENT-19 was largest, results 6/14
Read 7 tweets
Monica Gandhi MD, MPH Profile picture
14 Jun
Wonderful paper by @ID_ethics. The reason ID people keep on turning to past pandemics is that we have used a lot of models in the current pandemic that don't end up being accurate. No time in history do we test this much or sequence asymptomatic infections in nose.
"While some degree of epistemic humility .prudent, apparent bias in favour of modelling techniques over analyses of historical data should be discarded.". those who only look at vax% when discussing delta variant, discuss natural immunity/testing after vax
Some thought leaders in US tweeting have interactions with companies making vax. Instead, we want to look deeply and cleanly at data- all the immunological research being done on natural immunity and vaccine immunity. % vax of a community is not only form of immunity.
Read 9 tweets
Monica Gandhi MD, MPH Profile picture
11 Jun
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)
Read 11 tweets

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