Wrote to CDC:
1) For males 18-30, J&J preferred as myocarditis not seen (clot risk mainly in females). If mRNA, #2
2) For males 12-18, give 1 dose Pfizer. Give 2nd dose (at 3 weeks or 8-12 weeks) based on community transmission. If low (<5 hosp/100K), latter to increase safety
<10K cases across country now. Does NOT increase vax hesitancy to acknowledge a side effect. It decreases vaccine hesitancy and increases trust to tell people that public health cares about both safety and protection from COVID.
Since US & Israel seeing more cases of myocarditis in young with 2nd dose & use 3 weeks spacing - whereas UK uses 8-12 weeks & not seeing the number of cases of myocarditis- increasing that spacing between doses could help. Prior tweets - 1 dose Pfizer 94% effective against delta
This way, children get 2 doses, maximizes efficacy and safety in settings with low transmission. J&J not going as much to young women; more to young men. As @CarlosdelRio7 said very smartly to me, we can call this "precision public health"!
Finally, please remember 3 weeks between Pfizer doses not based on any specific science; this was minimal interval designed to hasten clinical trial results given urgency of getting a vax. Dr. Plotkin explains why longer interval has benefits
academic.oup.com/cid/advance-ar…

• • •

Missing some Tweet in this thread? You can try to force a refresh
 

Keep Current with Monica Gandhi MD, MPH

Monica Gandhi MD, MPH Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

PDF

Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @MonicaGandhi9

25 Jun
CDC weighs in that boosters don't seem to be needed or no evidence at this time. Agree and I summarize some of the T cells/B cell studies in the paper below in next tweet but want to add a few more!
nbcnews.com/health/health-… via @nbcnews
Here is the paper where I tried to put some of this together but 3 more EXCELLENT studies that came out since wrote this that add to the idea we won't need boosters (at least anytime soon!)
leaps.org/booster-shot/
One paper that didn't get into the summary above shows that memory B cells formed from even mild COVID (other papers have shown this) but then they were tested to see if they produce antibodies specific to a variant if they see a variant & they do
medrxiv.org/content/10.110…
Read 5 tweets
23 Jun
Slides from ACIP meeting in progress on increased risk of myocarditis/pericarditis in 2nd dose mainly in young males, now seen down to 12 years: can't tell what recommendation they will make on pause/warning, 1 dose, etc. but slides here
cdc.gov/vaccines/acip/…
Higher than expected after 2nd dose in 12-29 year olds
Symptoms (484 cases): Chest pain, shortness of breath, EKG changes, elevated troponins (marker of myocardial damage), abnormal echocardiograms (ultrasound of heart) - proportions below (number over 484 to get %)
Read 7 tweets
22 Jun
Great article by colleague @AmeshAA, Johns Hopkins. "COVID became public health emergency because, unlike 4 other coronaviruses that cause 25% cases of common cold, able to cause severe disease on scale and speed that threatened hospital capacity in US"
thehill.com/opinion/health…
"Walking through a hospital this month is so different than it was in January 2021 for one reason: the vaccines..looking at vaccination rates one may be struck by the fact that a proportion of Americans are not vaccinated. However, I would argue that is not the best metric .."
"to gauge where we are in the pandemic. Not only does that number omit significant natural immunity from prior infection, but it also undersells the initial goal of the vaccination campaign. Over 3/4 of those above 65 — the high-risk hospitalization group — are fully vaccinated"
Read 5 tweets
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
20 Jun
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…
Read 5 tweets
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

Did Thread Reader help you today?

Support us! We are indie developers!


This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Too expensive? Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal Become our Patreon

Thank you for your support!

Follow Us on Twitter!

:(