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Monica Gandhi MD, MPH Profile picture
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20 Jun, 5 tweets, 3 min read
Important article today Bloomberg saying that we are likely to monitor hospitalizations not cases now as our cases dip towards 10K mark (that Dr. Fauci lists as control). As cases become "decoupled" from hospitalizations with vax, most important metric
bloomberg.com/news/articles/…
@ashishkjha, @syramadad & I wrote this in @washingtonpost early April but case/hospitalization decoupling even more prominent now as hospitalizations remain mainly among unvaccinated & most states have reached <5 hospitalization/100K and adult vax metric
washingtonpost.com/outlook/2021/0…
Important for scientists who are school opening advocates because 1) means, despite variants, metrics for normal school by fall being reached with adult vax; 2) ok to increase public trust/transparency by adjudicating cases of myocarditis in young from vax
nytimes.com/2021/06/08/opi…
I saw tweet today saying I have "agenda" for discussing school openings. Don't. My children in private school which are open in SF (public schools closed). Any scientist interested in equity should think about disparities in COVID in US both from pandemic & restrictions
On other hand, I have seen SF's response (not San Mateo) to my articles; I do understand my #harmreduction approach different for SF; will cease tweeting on anything but immunology/variants now (email if you need help with schools); then off twitter once global vax equity higher

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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
19 Jun
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…
Read 5 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

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